Severe medical staff shortages have left some NHS services 'entirely dependent' on doctors working beyond their basic hours, according to a dossier compiled by the Academy of Medical Royal Colleges (AoMRC) that paints a bleak picture of health service capacity ahead of the coming winter.
These services are now 'at risk' as damaging taxes on pensions that can leave doctors paying more than they earn for taking on extra hours have forced many to refuse additional work, the report says.
GPonline reported last week that GPs could face a devastating knock-on impact as a poll found nearly seven in 10 surgeons had reduced their working hours to avoid tax penalties.
The AoMRC dossier, sent to health and social care secretary Matt Hancock and chancellor Sajid Javid, brings together evidence showing how doctors across medical specialties have been forced to refuse shifts and cut back on working hours.
Significant reductions in hospital capacity could add to GP workload as patients seek reassurance and additional support while hospital treatment is delayed. BMA GP committee chair Dr Richard Vautrey warned last month that 'longer waits mean GPs will struggle further to help their patients get the timely care they need, and this is likely to impact practice workload'.
In one case highlighted in the report, Guy’s and St Thomas’s hospital in London 'closed an ICU for 18 weeks over the summer', while at Mid Essex Hospital Services Trust staff have warned it may be impossible to keep the high dependency unit open over weekends.
The AoMRC report warns that three quarters of consultant anaesthetists had reduced their workload, while among doctors in emergency medicine a similar proportion were considering this.
Three quarters of emergency medicine doctors said patient flow was being adversely affected 'as a result of the taxation issue’s impact on the availability of appropriate medical workforce'.
Among members of the Royal College of Physicians, nearly half planned to retire early - with 86% citing concerns over the pension tax crisis. A drop in workforce among radiologists, paediatricians and doctors in obstetrics and gynaecology was also reported.
In a letter to Mr Hancock and Mr Javid, AoMRC chair Professor Caroline MacEwen says: 'Itis evident from the findings that, due to severe medical staff shortages, the NHS has become entirely dependent on consultants delivering service provision over and above their existing contracts; this service is being put at risk because of the current pension taxation position.
'Furthermore, our findings indicate that pensions taxation is undermining staff morale, which is detrimental to the recruitment and retention of the medical workforce. Staff shortages in the NHS are a significant concern and we must ensure these pressures do not intensify further as a result of the pension arrangements.'
The letter warns that government proposals for additional pension 'flexibility' around contributions to NHS pensions 'are insufficient to tackle the long-term problems'.
GPonline reported last week on a warning from the Association of Independent Specialist Medical Accountants (Aisma) that the government's proposals were no more than 'uninformed tinkering'.
Government tax advisers have suggested that the annual allowance cap on NHS pensions could be removed. Mr Hancock has said that if the Treasury was to take this step the DHSC may scrap plans for pension flexibilities.