Patterns of less-than-full-time working by NHS consultants

The 2020 NHS People Plan committed to providing flexible working opportunities to all NHS staff. An important component of flexible working is less-than-full-time (LTFT) working, enabling staff to balance paid work with other commitments. However, there is currently only limited empirical evidence on the extent to which different staff groups work LTFT across the NHS.

This report uses the Electronic Staff Record (ESR), the monthly payroll of all staff directly employed by NHS hospitals in England, to examine the patterns of LTFT working by consultants in NHS acute trusts. We first consider how the prevalence of LTFT working among consultants has changed over time, how it varies by age and gender, and the extent to which changes to the demographic composition of the consultant workforce explain changes over time to LTFT working rates. We then examine how patterns of LTFT working vary across NHS trusts, regions and clinical specialties.

One particular area of interest for policymakers is how LTFT work interacts with, precedes and potentially delays consultants leaving the NHS. This is especially true for older, more experienced consultants, who may reduce their working hours prior to full retirement. We therefore also document how LTFT working interacts with leaving the NHS acute sector by examining how working patterns change in the four years leading up to consultants leaving the NHS acute sector, and how these patterns differ between older and younger consultants.

Key findings

1. Less-than-full-time working has become more common for NHS consultants over the last decade. The share of consultants working less than full-time in the NHS acute sector rose from 15.6% in April 2012 to 21.6% in August 2021. Over the same period, nurses and midwives were much more likely to work less than full-time than consultants, but this increased at a much slower rate, from 40.7% to 41.7%.

2. Female consultants are much more likely to work less than full-time than male consultants, but these differences narrow at older ages. Around one in three female consultants under 60 work less than full-time, compared with fewer than one in ten male consultants. After age 60, rates of less-than-full-time working increase for both men and women: among those aged 60–64, 34% of male consultants and 45% of female consultants work less than full-time.

3. About half of the increase in less-than-full-time working by consultants between 2012 and 2021 can be explained by changes to the demographic composition of the consultant workforce. In addition to these demographic changes, rates of less-than-full-time working increased at all ages and among men and women between April 2012 and August 2021. The largest percentage increase was for male consultants aged under 50, with the share in this group working less than full-time rising by 75%, from 4.7% to 8.2%. 

4. The share of consultants working less than full-time varies by clinical specialty, even after adjusting for differences in the age and gender of consultants and the trusts in which they work. Consultants working in obstetrics and gynaecology are 9.6 percentage points less likely to work less than full-time than a consultant of the same age and gender working in the same trust but in a different specialty. Consultants working in ophthalmology are 5.4 percentage points more likely to work less than full-time.

5. There is considerable variation in the share of consultants working less than full-time across different NHS acute trusts in England, even when comparing consultants of the same age and gender working in the same specialty. For consultants of the same age and gender working in the same specialty, less-than-full-time working rates ranged from 20.1 percentage points above the national average to 8.8 percentage points below across different trusts. The majority of variation is within region rather than across regions.

6. Consultants, and particularly older ones, often shift towards less-than-full-time working before they exit the NHS acute sector. Four years before leaving the sector in their 60s, 24% of all consultants work less than full-time. This increases to 39% two years before leaving and 51% one year before leaving. For consultants who leave the NHS acute sector at younger ages, the movement away from full-time working prior to leaving the sector is much less pronounced, with 73% still working full-time one year before leaving.