Author: Dr Satya Francis, RCoA Council Member

The UK needs more anaesthetists. This is the key message of RCoA’s 2025 Census, which was a huge project involving three large surveys of clinical leaders, College tutors, and the wider anaesthetic workforce.

These surveys generated an enormous amount of data, much of which is still being processed. However, given the development of major government plans, such as the NHS 10-year workforce plan in England, we thought it useful to get some of the census results out early. Hence, we published our ‘Anaesthetic Workforce Census 2025: Key Interim Findings’ report last October.

The report gained a fair amount of media coverage, such as this story in The Independent newspaper. It also led to questions being tabled in Parliament, such as this one by Adrian Ramsey, as well as forming the basis of RCoA’s consultation response to the aforementioned workforce plan.

Demand vs shortfall

The report showed that while the number of consultant and SAS anaesthetists has increased by 17% since 2020 – from 10,124 to 11,874 – demand has increased by more than supply. The shortfall in anaesthetic staff has gone up by 45% from 1,483 to 2,147.

The census doesn’t show why demand has risen so much. Likely reasons are the UK’s growing and aging population, the increasing list of conditions amenable to surgery, and the expansion of the anaesthetist’s role into areas such as perioperative care.

Whatever the drivers, the consequences for the NHS and the patients it serves are stark. Around nine out of ten (89%) clinical leaders indicated that elective surgery was being delayed due to a lack of anaesthetists. Furthermore, 43% said that this was occurring on a daily or weekly basis.

On the flip side, boosting anaesthetist numbers was the single most common factor cited by clinical leaders that could increase the rate of elective surgery. This was above other staff groups, such as ODPs, and physical factors such as ward space, operating theatres, or ICU capacity.

It seems clear, therefore, that anaesthetist shortages are severely constraining the NHS’s capacity to perform surgery.

Fortunately, there is space in the system to train more anaesthetists. The census also revealed that hospitals have a capacity to take on an extra 178 CT1s and 206 ST4s per year. The only thing lacking is the government funding to do it.

Government plans

In the NHS 10-Year Health Plan for England, published last summer, the government pledged an extra 1,000 medical specialty training posts, albeit spread over three years. This dilutes the increase to an average additional intake of around 333 per year, divided between all medical specialties. While this is a step in the right direction, it’s not nearly enough considering that doctor shortages also exist among GPs, radiologists, pathologists, psychiatrists, and probably many more specialties. It also misses an opportunity to address the enormous and growing bottleneck in the medical training system between foundation years and specialty training.

We will continue to push for further expansion of training place numbers, and advocate for as many of these as possible going to anaesthesia. We’ve already made multiple representations to support this, including letters, formal submissions to consultations, and meetings with key stakeholders such as politicians and civil servants across all four UK nations.

Wellbeing and (dis)satisfaction

Another issue identified by the census was low levels of wellbeing, particularly among Locally Employed Doctors (LEDs). The number of anaesthetist LEDs stands at 2,150, which constitutes a large chunk of the anaesthetic workforce. LEDs are a diverse group, but many are those who applied for specialty training but were unable to secure it, perhaps due to the severity of past and present training bottlenecks.

The census also showed that more general drivers of dissatisfaction among the workforce include poor IT systems, parking charges, lack of rest and refreshment facilities, and pension taxation. On the latter, many anaesthetists, particularly consultants, are still reducing their hours due to pension taxation rules. It appears, therefore, that these rules may be another factor constraining anaesthetic workforce capacity.

Next steps

The full census results will be published in a series of reports over the next few months, along with a new iteration of the State of the Nation report. These will go into depth about topics such as the wellbeing of anaesthetists, the value they bring to the NHS, factors hindering productivity, more detail on anaesthetic workforce numbers, and the actions that we intend to take.