The National Health Service (NHS) is grappling with a severe consultant crisis, compelling managers to allocate more than £674 million annually to fill up to one in three vacant posts with locum staff. This significant financial drain, highlighted in a recent report, also exacerbates pressures on efforts to reduce extensive waiting lists, as securing suitable candidates often takes over 12 months.

Analysis conducted by BMJ Careers reveals the alarming scale of the problem. Between 2022 and 2025, nearly 33,000 consultant jobs were advertised on the NHS Jobs website across England and Wales—a figure substantial enough to staff more than 66 large hospitals. Geographically, over a third of these vacancies were concentrated in Greater London and the South East. By specialty, psychiatry accounted for a quarter of all openings, with surgery, paediatrics, and radiology also identified as areas with high demand for consultants.

Data obtained through Freedom of Information requests by the medical journal underscores the severity, showing that some NHS trusts and health boards face vacancy rates of up to one in three consultant positions. The reported £674 million spend on consultant locums represents only a portion of the true cost, as this figure is based on responses from a limited number of organizations, suggesting the overall expenditure is likely much higher.

The impact of this crisis is deeply felt across the service. A resident doctor at a north London trust described the situation as “a complete nightmare,” noting that remaining doctors are forced to work at “150 per cent,” leading to exhaustion and longer patient waiting times. Dr. Shanu Datta and Dr. Helen Neary, co-chairs of the British Medical Association’s consultants committee, articulated the fundamental issue: “Simply put - we do not have enough consultants to meet the needs of patients or run services to the standard they should be.”

Phil Johnson, director of BMJ Careers, emphasized the gravity of the situation, stating that while the word “crisis” can be overused, the current confluence of increasing activity and government pledges to eliminate agency spending and slash international recruitment indicates that “a tipping point has been reached.”

A related survey of 107 consultants revealed that a mere 4 percent are actively seeking new employment. However, a substantial 47 percent expressed openness to changing jobs, even if not actively looking. Among those contemplating a move, a significant proportion cited growing disillusionment with NHS working conditions and an interest in relocating outside the UK.

Recruiting managers also face considerable challenges. A survey of 116 managers showed that half anticipate an increased need for consultants in the coming year. A large majority (61 percent) reported that consultant vacancies significantly negatively impact waiting times, and 54 percent stated they affect the quality of care. Furthermore, over a quarter (27 percent) regularly or always need to source candidates from overseas to fill particularly difficult consultant positions.

In response, an NHS England spokesperson stated, “While agency spend is at a record low with trusts on track to save £1 billion over two years, we want to go further still.” The spokesperson added that NHS England is collaborating with the government on a 10-Year Health Workforce Plan, which will detail future staffing requirements.