Delivery of paediatric rheumatology care in the UK--the projected shortfall

Adult rheumatologists in the UK have historically provided a significant contribution to clinical care for children with rheumatic disease. However, changes in postgraduate training have resulted in adult rheumatology trainees no longer being trained in paediatric rheumatology (PRh), and accordingly, they will be ill-equipped to manage children when incumbent adult rheumatology specialists retire. The objectives of this work were to ascertain the number of UK adult rheumatologists currently involved in PRh care and to inform future workforce planning. As part of the British Society for Rheumatology annual consultant workforce survey, additional questions relating to PRh were included. A questionnaire was sent to 584 adult rheumatologists, of whom 403 (69%) responded to questions about PRh; of these, 75 of 403 (19%) reported seeing children and many will retire in the next 5 and 10 years (13/75 (18%) and 35/75 (48%), respectively). The majority (58/75, 78%) reported having separate clinics for children, often alongside other health care professionals (mostly consultant paediatrician, paediatric rheumatologist, or allied health professional). Notably, 4 of 75 (5%) adult rheumatologists had clinical sessions seeing children without any paediatric input. The median (IQR) number of paediatric consultations by adult rheumatologists per month was 10 (6, 15), equating to a total 931 paediatric consultations per average month. Many UK adult rheumatologists are involved in managing paediatric rheumatic disease and many will retire over the next 10 years. This will result in a shortfall in clinical provision as their replacements in adult rheumatology will not have had appropriate PRh training. This projected shortfall needs to be addressed in future workforce planning.