A review of clinical infection specialist staffing in Scotland following the COVID-19 pandemic

• There has been a 10% fall in consultant infection specialists in Scotland since 2019. • Five boards have lost over 25% of pre-pandemic microbiology consultant staffing. • The main factors implicated were poorer staff wellbeing and increased workload. • Fragmentation of roles means the overall impact of the shortage is under-recognised. • Workforce planning needs to account for a diversity of roles and training paths. We aimed to assess the post-pandemic senior clinical microbiology and virology workforce in Scotland. A structured survey compared the clinical microbiology/virology workforce across Scotland in 2019 with 2022, explored factors felt to contribute to understaffing, and described out-of-hours activity. The expectations of combined infection trainees on completion of training, and current infectious diseases consultant staffing were also surveyed. Consultant infection specialist staffing fell by around 10% (headcount and full-time equivalency) between December 2019 and May 2022. The shortage was primarily within medical microbiology. Seven of eleven (64%) territorial boards saw a fall in microbiologist staffing, with five (45%) losing over a quarter of their staffing. Wellbeing and workload were perceived to be significant detrimental factors. Based on anticipated retirals, expected dates of completion of training and a rise in less-than-full-time working, the shortfall is expected to deepen before it improves. Most trainees wish to hold less-than-full-time posts spanning clinical and laboratory roles. There has been significant, unrecognised infection specialist attrition in Scotland that is likely to worsen. Urgent action to understand and address the causes is needed. Workforce planning and infection service delivery must account for all infection specialist roles, changes to medical infection specialist training, clinical scientist training, and the rise in less-than-full-time working.