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The Real Emergency in A&E HCL counts the cost of the staffing crisis

The Real Emergency in A&E – HCL counts the cost of the staffing crisis

The largest commercial provider of healthcare professionals to the NHS, HCL Workforce Solutions, has today revealed the extent of the real crisis in England’s A&E departments, as the chronic shortage of emergency doctors begins to impact Trust’s ability to maintain the service. HCL’s investigation The Real Emergency in Emergency Departments ( points to the building of a perfect storm as NHS Medical Director Sir Bruce Keogh announces a national review of the service.

The specialist staffing solutions provider’s investigation, published today, echoes Shadow Health Secretary Andy Burnham’s recent comments that A&E departments are “overstretched and understaffed”, as the company explored the disproportionate requests for locum emergency medicine doctors in relation to its overall Doctors’ business.

Drawing on data from the HCL Doctors division, data obtained under a Freedom of Information (FOI) request made to 54 NHS Acute Trusts and interviews with A&E specialists, the paper paints a gloomy picture for the sustainability of the service:

Disproportionate staffing across what is a 24/7 service: Locum doctors made up almost a fifth of the medical staffing at weekends with around 13% supporting the service during the week.  HCL’s own data suggests that this is actually much higher. 

Some Trusts have been unable to get their staffing needs under control – particularly those who have not yet achieved Foundation Trust status where their average locum emergency medicine doctor spend is around &pound9.19 per patient compared with &pound3.16 per patient.  In some cases locums were being sourced outside the national framework agreements opening the system to unscrupulous agencies who were making headline profits at the NHS’ expense. 

The FOI revealed a fifth had vacancies for middle grade doctors with almost 40% consultant vacancies – flying in the face of the national policy for consultant-led care. 

In exploring the issues around the medical staffing crisis HCL found a number of major concerns which are converging to create a & lsquo;perfect storm’ in the service:

The creation of 26 Trauma Centres – where the best skills and equipment are pooled to create & lsquo;centres of excellence’ for urgent trauma care which intend to give patients a much greater chance of survival and rehabilitation – have created a pooling of talent at geographical centres. 

The choking off of further supply channels – the UK Borders Agency further increased restrictions on non-EU doctors coming to work in the UK in December 2012 while at the same time interest in medical students in becoming A&E specialists reached an all time low. 

Consultant-led care has been shown to lead to enhanced outcomes for patients but the existing consultant working model is still rooted in the 9-5 culture which means a continued reliance on locum consultants to deliver the service.  This is further undermined by the European Working Time Directive which restricts doctor’s working hours. 

Liz Bickley, Managing Director of HCL Doctors, said “For several years workforce planners, medical educators, professional bodies and the Government have identified the challenges of staffing NHS A&E services, but have not offered tangible solutions that resonate with those managing the shop floor.

“With over 21 million attendances recorded at A&E centres in England last year – and growing – we see no realistic reduction in demand in the short or even medium term, yet at the same time we are seeing a real crisis in medical staffing.  While we can provide them with high quality locum candidates via a Government Procurement Service framework to ensure continuity of their A&E service in the short term, a long term radical review of emergency medical staffing is needed.”


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