Chapter 3: Vacancies & workload

Overtime

Survey respondents indicated that 78% worked overtime. Of this cohort working overtime, 83% were providing between 10% and 20% over and above their contracted hours. More than 50% of this overtime worked was spent on catching up with patient related administration.

Only 5% received payment for their work, 32% were unpaid, 34% received time off in lieu (TOIL) and 29% had a combination of TOIL and unpaid overtime. A common theme is that it is very difficult/impossible to take TOIL owing to heavy workloads. Of those who received payment, this may be dependent on whether there is any funding left in the departmental budget at the end of the financial year.

Of the 5% who received payment for overtime worked above their contracted hours, if these payments are via a bank or agency agreement, then under NHS AfC terms and conditions this is not considered as overtime. This may affect some of the responses from the 5% of respondents who indicated that they received payment for additional hours worked, see appendix 10.1 and 10.2 for more details.

Vacancies

Questions including vacancies was included in the survey to get an overview of the national situation and consider what impact this has on the dietetic workforce. Many organisations are reporting recruitment issues across a range of bandings.

A snapshot of NHS vacancies advertised in September 2023 revealed a range of titles and requirements for the band 6 and band 7 roles advertised (the largest proportion of survey respondents).[1]

Band 6 roles were generally described as ‘specialist’, ‘senior’ or ‘experienced’ dietetic roles. Band 7 roles titles varied widely from ‘Band 7 Dietitian’, ‘Specialist Eating Disorders/Gastro/Diabetes etc Dietitian’, ‘Senior Specialist Dietitian’, ‘Senior Specialist/Team or Operational Lead Dietitian’, or ‘Advanced Dietitian’.

Band 8a roles were deputy director or clinical lead dietetic positions. Band 8b roles were deputy head of therapies or consultant level positions.

The requirements for knowledge and experience varied hugely for the band 7 roles. Some, correctly, stipulated essential evidence of Level 7 (Masters) or equivalent post graduate training via courses/certificate/diploma, some listed this as desirable whilst others had no such requirement stipulated.

Experience requirements varied from no requirement specified, experience being desirable rather than essential, an unspecified length of experience in a particular specialty to a year of experience in the speciality.

Regarding the 6 ‘Advanced Dietitian’ band 7 roles advertised, 4 correctly specified masters level or equivalent training but 2 had no requirement stipulated

The 8a and 8b roles advertised all correctly had Masters level or equivalent qualifications or currently being undertaken. Those reporting vacant positions reported anything from zero to 20 positions becoming vacant within the year. The majority was between 1 and 4 posts, the median figure being 3.

Respondents reported that as a percentage of the team/department, these vacancies represented up to 60% of their workforce. For most services, this equated to between 10% and 30% of their establishment being unfilled at any time of the year, see appendix 11.1 and 11.2 for more details. 

Clearly these vacancies have an impact on service delivery; managers would be required to look at recruiting temporary staff depending on their organisation’s financial situation, reductions in service delivery if vacancies were multiple or prolonged, and staff would be under considerable pressure to attempt to cover additional workloads. Workplace stress therefore increases - which in turn could lead to ill health and ‘burn out’ amongst some of the workforce.

A question was also asked to see if recruiting managers were making alterations to the vacant positions in order to improve recruitment possibilitie. Nearly a quarter of respondents did not know. 25% did not alter the roles, 21% readvertised at a lower band with preceptorship, 13% changed to a lower band with skill mix alterations within the team, 11% readvertised at a higher band with increased responsibilities and 7% readvertised at a higher band without altering the job specification at all, see appendix 11.3 for more details.

Work place concerns

There were 429 responses to the question: “If you have any concerns regarding your workload, what are your main concerns? Please select up to 6 concerns from the list below”

The top 6 concerns were:

• lack of opportunity to develop self (CPD) in work time
• patients not seen in a timely manner
• lack of opportunity for service development
• reduced opportunity for MDT working
• too much clinical work to manage properly
• high vacancy rate and lack of backfill

See appendix 12.1 for full details.

All of these were chosen by at least 30% of respondents as were low staff morale and poor patient experience/satisfaction.

Other comments were highlighted: 3 respondents wanted to choose all items. Only 3% of respondents added a new concern that was not already listed. These were as follows:

• difficulty recruiting staff
• working extra hours to get everything done
• non-dietetic members of MDT provide nutrition advice instead of Dietitian
• delays in getting things done
• inadequate delegation to support workers

None of these workload concerns were surprising given the responses provided earlier in this document regarding current workload.

Workload and work-related stress

A total of 490 respondents provided data on their workloads and whether they were perceived to be excessive. 77% of the respondents stated their workloads were excessive.

There were a small number of responses from public health, more from primary care and mental health and the highest number from community and acute hospital settings.

Large numbers of dietitians reported excessive workloads, which would correlate with the overtime worked by such a large percentage of respondents. Acute hospitals reported 80% with excessive workloads, community 79%, mental health Services 58%, primary care 54% and public health 33%

The greatest number of staff feeling their workloads were excessive were from the acute sector. Please note that: freelance in this context relates to those working in the NHS and therefore are most likely to be working as a locum, this may explain the high percentage stating that their workload is excessive. 

A positive comment was that 83% of respondents felt that they had the freedom to speak out if they felt that things were going wrong – and thus be proactive in improving the work situation. See appendix 13.1 for more details.

The figures for those who reported a stressful workplace, the responses for episodic and chronic stress in the workplace were not dissimilar (32% of all respondents stated their work-related stress was episodic and 29% stated it was chronic, while 29% did not have work-related stress). This indicates just under a third of the workforce feel that they are continually working under stressful conditions.

There were 429 respondents to the question relating to workload stress and feeling unwell due to work related stress in the last 12 months. The responses demonstrate a clear link between excessive workloads and being unwell due to work related stress. Of those with an excessive workload, 62% felt unwell due to work related stress, which still left 38% who did not feel unwell in the last 12 months. In contrast, those who stated their workload was not excessive, only 35% felt unwell due to work related stress while 65% did not.

Clearly, there are many in the dietetic workforce who, despite working with excessive workloads, are resilient and have coping strategies so that they do not suffer from work stress-related illness. See appendix 13.2 and 13.3 for more details.