UK Surgical Workforce Under Pressure: What the 2025 RCS Census Means for Capacity and Infrastructure Planning

While much of the public debate around surgical capacity focuses on staffing numbers alone, the census makes clear that environment, estate and operational constraints are equally significant factors limiting productivity, training and long-term workforce sustainability.

Productivity constrained by space, not just staff

One of the clearest messages from the census is that surgeons’ ability to deliver care is frequently restricted by limited access to operating theatres and appropriate clinical space. Respondents reported cancelled lists, delayed starts and underutilised theatre sessions caused by estate limitations, staffing gaps elsewhere in the system, or competing service pressures.

As a result, many consultants continue to work beyond their contracted hours in an attempt to maintain service delivery. This not only affects morale and wellbeing, but also undermines the system’s ability to reduce elective backlogs in a consistent and sustainable way.

The findings reinforce a critical point: having skilled clinical teams in place does not automatically translate into increased activity if the physical environment cannot support it.

Impact on training and future workforce supply

The census also raises serious concerns about surgical training capacity. Trainees reported reduced access to theatre time, fewer supervised procedures and missed learning opportunities as a consequence of service pressures and estate constraints.

Over time, this risks creating a damaging cycle. Limited training exposure affects confidence and competence, contributes to burnout, and increases the likelihood of trainees leaving programmes early. In turn, this exacerbates future consultant shortages — adding further pressure to an already stretched system.

The RCS findings underline that training environments must be protected, even during periods of high operational demand or estate redevelopment. Without reliable access to suitable clinical space, it becomes increasingly difficult to balance service delivery with the development of the next generation of surgeons.

Workforce sustainability and wellbeing

Alongside productivity and training challenges, the census highlights persistent issues around workforce sustainability, including high vacancy rates, uneven regional distribution of surgeons and a growing cohort approaching retirement.

Burnout remains a significant concern, driven by workload intensity, lack of control over schedules and the frustration of being unable to deliver care as efficiently as clinical teams would wish. Addressing these issues requires more than recruitment alone; it calls for system-level solutions that enable staff to work effectively within supportive environments.

The role of flexible infrastructure in supporting surgical services

The census findings align with a broader recognition across the NHS that infrastructure flexibility is becoming increasingly important. Traditional capital builds, while essential, can take years to deliver and may struggle to keep pace with changing demand, population needs or workforce pressures.

Flexible healthcare infrastructure — including modular theatres, mobile operating facilities and temporary surgical hubs — offers a complementary approach. When deployed strategically, these solutions can:

• Provide additional theatre capacity to reduce backlogs
• Maintain surgical services during refurbishment or rebuild programmes
• Protect training activity during periods of operational pressure
• Support targeted capacity increases where workforce is available but space is limited

Crucially, flexible facilities can be delivered at pace, allowing systems to respond more quickly to emerging pressures highlighted in workforce data such as the RCS census.

Data-led planning for the future

The 2025 Surgical Workforce Census reinforces the need for joined-up planning across workforce, estate and service delivery. Workforce strategies that do not account for physical capacity risk falling short, just as infrastructure investment without sufficient clinical input may fail to deliver intended benefits.

For healthcare leaders, the message is clear: improving surgical productivity and sustainability depends on creating the right clinical environments alongside supporting the workforce within them.

As the NHS continues to address elective recovery, training reform and long-term workforce resilience, insights from the RCS census provide an important evidence base for shaping decisions — not only about people, but about the spaces in which care is delivered.

Read the full Royal College of Surgeons of England 2025 UK Surgical Workforce Census here:
https://www.rcseng.ac.uk/-/media/Files/RCS/Standards-and-research/2025-UK-Surgical-Workforce-Census.pdf