The pathology workforce

Pathologists are facing great pressures through the rising workload, the increasing complexity of their work and vacancies of 10–12% and rising. The amount of histopathology requests to laboratories has increased by around 4.5% on average year on year since 2007.

Pathology workforce challenges

There is a growing demand for pathology services, both in the number and complexity of tests performed, caused by developments in testing such as the introduction of the faecal immunochemical test (FIT), which has increased clinical biochemistry and histopathology workload, and new targeted therapies needing genetic or molecular tests on samples. 

Cancer Research UK's report, Estimating the cost of growing the NHS cancer workforce in England by 2029  indicates that a 45% staff increase is needed across 7 cancer-related professions to meet Health Education England’s (HEE) aim to provide world-class services for cancer patients by 2029. 

Retirement intentions

For pathology, our workforce census data showed that the average age of retirement is 63, which is three years below the current state pension age. Across all specialities, we are going to see a large portion of the consultant workforce retiring in the next 5 years. For example:

Histopathology	19%
Neuropathology	29%
Paediatric & perinatal	21%
Immunology	33%

The above states the predicted retirements within the next 5 years for our consultant (medical & scientific) UK fellows, who responded to our workforce census (data from 2021-2024).

An ageing workforce

Our consultant workforce is ageing, and a large proportion of our workforce is over the age of 55. This does vary by specialty, however some of our specialities are at risk of losing a large number of the consultant workforce in the next 5-10 years, which will leave a significant gap and impact patients and services.

Consultant workforce over the age of 55 by specialty:

• Paediatric and Perinatal pathology: 31%
• Neuropathology: 45%
• Histopathology: 29%
• Immunology: 34%

Data sourced from RCPath Workforce Census (2021-2024) for consultants (medical and scientific) aged over 55.

Surveys from the BMA found that consultants are choosing to retire earlier than planned with 6 out of 10 stating they intend to retire before the age of 60. Workforce shortages and increasing workload are putting extreme pressure on our workforce, and we could see those over the age of 55 leaving the workforce well before the expected retirement age for pathology, which is 63.

Working conditions and morale must be addressed to improve retention and wellbeing

Results from the Workforce Member Survey 2023 told us just how stretched and stressed our workforce is feeling. Wellbeing and resilience to stay within a post, or the profession entirely, will be impacted by the working environment.

• 38% of consultants say the quality of facilities provided for them to perform their role are inadequate.
• 37% of staff disagree that their employer provides sufficient space for breaks, lunch or rest.
• 47% feel they do not have the right resources to deliver the administrative elements of their role.

Contracted time for professional development and CPD activities is dwindling, and these are important factors that contribute quality improvement, research, training and service development, all of which positively impact patient pathways when pathologists have the time to engage in these activities.

• 57% of consultants feel they are not given the time to complete professional development activities in a given work week.
• 51% of consultants feel they are not given the time to participate in the development of their profession.

A growing number of our workforce are facing low levels of satisfaction and morale.

• 35% of consultants do not feel valued.
• 40% of consultants do not feel heard.
• 33% of consultants do not feel supported.
• 44% of consultants do not feel empowered.

The future of the pathology workforce

Across all pathology specialties, staffing levels have not risen in line with demand and there are not enough trainee doctors in post to fill the current vacancies, nor the incoming shortfall in consultants’ posts from predicted retirements. 60% of our consultants feel that their department is not adequately resourced to meet service demand.

Investment is critical to sustain the current workforce, but also to build and reform so we can see a more sustainable pathology workforce in the future, that has the tools and resources to tackle increasing workload and backlog.

The NHS’s intention to build the cancer workforce needs to address the requirements for pathology, including histopathology, but also in haematology and other areas. This must be a key investment priority for the government. Without this, there will be no capacity for pathology to deal with any increase in workload associated with efforts to overcome cancer backlog and waiting lists.

The pathology workforce is also crucial to disease prevention, infection control and good antibiotic stewardship. Our workforce is facing chronic shortages in these areas too, and it is vital that investment is targeted at pathology services to alleviate these pressures and meet increased demand

As well as more investment to recruit and retain more pathology staff, we also would like to see more training places, better IT for day-to-day work and capital investment to implement digital pathology more widely, so staff can work more efficiently and flexibly. 

Digital pathology (whole slide imaging) is a technology that allows glass histopathology slides to be reviewed digitally on a computer screen, rather than with a microscope. As a result, it is a technology that can transform pathology services in the NHS and beyond. The technology is relatively new and rolled out in a relative minority of labs and but increasing numbers are now using it for substantial amounts of diagnostic work. Digital pathology also facilitates remote working in several ways which will help with staffing issues - home reporting, avoiding the need to be physically in the same space as a colleague giving a second opinion, and facilitating trainee pathologists in learning. Any investment should also build on the initial investment of the NHS to develop centres of excellence in digital pathology nationally. These centres can help with any further expansion of the technology across the NHS, by sharing knowledge and standards. It is the view of the College that digital pathology should be centrally funded and rolled out nationally in a similar way to digital radiology.

Our work in this area

Workforce Strategy and Workforce Planning

It is the top priority of the College in 2024 to refine and improve our approach to data collection that sees us gain accurate and insightful workforce data. In addition, we are also building a new workforce strategy that seeks to provide timely and potent contributions to efforts aimed at ameliorating the workforce crisis that is facing pathology services as described above.

Robust data and intelligence for both workforce and workload are fundamental for evidence-based workforce planning. It has become apparent that workforce planning for pathology does not happen and has never happened. It is therefore more important than ever for the College to have the best possible insight it can on workforce and why future engagement with College surveys is so crucial.

Through this work we aim to influence a better resourced and sustainable workforce, fit to deal with the workload challenges of the future.

If you have any questions for RCPath around workforce, please email [email protected] 

Also on the agenda