ERCP workforce, workload, and experience: early results from the BSG national survey of ERCP practitioners

Introduction

In 2014, the BSG standards framework set out key performance indicators for endoscopic retrograde cholangiopancreatography (ERCP). Recent JAG Census from ERCP units and Getting It Right First Time reports have identified significant variation. As part of the BSG Endoscopy Quality Improvement Programme, BSG have launched a national survey of ERCP practice with individual and organisational components. Here we report the initial findings from the individual survey.

Methods

Independent ERCP practitioners in the UK were identified via BSG regional leads, NHSE endoscopy leads and the gastroenterology trainee network. An anonymised survey link was emailed to practitioners. Multiple reminders, and individual contacts, were used to maximise the response rate. Clinical questions were aligned with published guidelines and covered a range of ERCP scenarios.

Results

491 ERCP practitioners were identified, of whom 386 (78%) responded to the survey. Responses were received from all four nations and all regions in England. The majority of those performing ERCPs are physicians (84%), followed by surgeons (14%) and radiologists (1%). Only 4% of respondents were female. 37% of respondents were over 55 years, and 29% were under 44 years. Of responders, 25% have been practising ERCP for up to 5 years, 21% for 6–10 years, 13 for 11–15 years, 12% for 16 to 20 years and 30% for more than 20 years. 21% reported they were very likely to stop doing ERCP in the next 5 years. One-third report performing between 101 and 150 ERCPs a year (table 1). 59% had attended online CPD within the last year, and 36% had face-to-face CPD within the last year. 49% felt the CPD they received for ERCP was not adequate, and 66% felt the time allocated to ERCP governance was inadequate. 95% of respondents enjoy their ERCP lists most of the time, and 97% felt confident performing ERCP most of the time. 88% felt supported by their clinical colleagues in the hospital and broader network. 87% felt adequately supported by specialist GI radiologists. 86% felt there was a learning culture in their team or department.

Conclusion

In the UK, a fifth of ERCP practitioners are likely to stop performing ERCP within the next 5 years, which is a clear concern for workforce planning. More than 10% of ERCPists perform fewer than 75 procedures per year. Women are significantly underrepresented in the ERCP workforce. ERCP practitioners report enjoyment with their job, but there is a need for more time dedicated to ERCP CPD and governance.