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A&Es facing 'intolerable pressures', warn doctors


Urgent action must be taken to ensure that emergency departments remain safe and sustainable, doctors have warned.

The College of Emergency Medicine said that A&Es were facing “intolerable pressures” after a poll found that 62% of emergency doctors reported their job is not sustainable in its current form.

The survey of 1,077 emergency medicine consultants also found that 94% regularly worked more than their contracted hours to help maintain levels of service.

The college said that this has “potentially serious repercussions” for safe working by senior medics.

It also warned that the pressure was reducing the attractiveness of the specialty to young doctors and causing difficulty in retaining doctors - some of whom are leaving the UK to work elsewhere.

The report shows that in 2009 just two emergency consultants emigrated from the UK but in 2013 the figure had already risen to 21 by August 8.

The report said: “The results show a worrying trend.

“Increasing numbers of consultants who have been trained by the NHS are choosing to use their skills abroad.”

The report was published after figures showed that the number of A&E units failing to meet the government four-hour target has almost trebled in a year.

Some 39 departments failed to meet the target of seeing 95% of patients within four hours during the period July to September, compared with 14 units during the same period in 2012, according to NHS England data released last week.

Dr Taj Hassan, vice president of the college and one of the authors of the report, said: “The college is working with its members and fellows to help them do all they can in this challenging situation but we need prompt action by relevant stakeholders on the three key recommendations in this report.

“Senior medical decision makers in emergency medicine provide one of the most vital strands in maintaining safety for emergency care systems in the UK.

“A failure to address these issues will compromise this ability and also further worsen the present workforce crisis affecting emergency departments.”

Dr Andrew Goddard, of the Royal College of Physicians, said: “This survey reflects what most consultant physicians observe in their hospital’s A&E departments with an unmanageable workload and difficult working conditions that make emergency medicine unattractive to trainees.

“Finding ways to make consultant working in hospital medicine more attractive where such conditions exist is one of the key challenges facing the NHS at the moment and needs to be addressed as a matter of priority.”

A Department of Health spokesman said: “We know we need to do more to support emergency departments to do their important work through winter and beyond. That is why we are investing £500 million in A&E over the next two years and we tasked Health Education England with developing plans to encourage more medical students to become A&E doctors in the future.

“We have asked Professor Sir Bruce Keogh to carry out a review to look at the demands on services and how the NHS should respond. Sir Bruce is due to report and share his recommendations very shortly.

“We are also investing in other parts of the health service, to help keep people healthier and out of A&E departments in the first place.”

Dr Paul Flynn, chairman of the British Medical Association’s consultants committee, added: “Consultants working in emergency medicine face some of the most challenging, high-pressured and stressful work environments in the NHS, often with limited resources and gruelling workloads.

“Unsurprisingly, the result has been fewer doctors choosing to go into emergency medicine and others leaving to work abroad, meaning existing consultants are working flat out to meet rising demand.

“We urgently need to look at how we can make working practices in emergency medicine safe and sustainable to address this recruitment and retention crisis.”

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Readers' comments (5)

  • Managers need to get their act together and support dr's and nursed by not ramming pt's in the AE department leaving them unsafe because their is not enough staff to monitor them. Where i work we can have up to 10 trolley's lined up in the middle of the department, they will have vital signs down and then thats it unless you have a good nurse who can spot the one who is acutely unwell, sadly the rest are put at risk until a cubicle is found for them and a nurse appointed to them to ensure their safety. This practice must stop. Trusts need to say enough is enough especially when their are no beds and patient flow stops from the AE department.

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  • Anonymous | 8-Oct-2013 12:58 pm

    if everybody wrote a succinct post such as yours and sent it where it matters and had to be taken heed of something would happen. There needs to be a way of making them very visible and unavoidable such as a huge pile on Hunt's desk with invisible dye in different colours on them as they use to catch thieves with so that all can witness when he has read them and becomes covered with by now indelible ink! Maybe there should then be insistence that he reports to his local A&E for its removal!

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  • Francis, thats all, but they are ignoring all the same. A health service with it's department managers tunnel visioned on targets - financial ones

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  • The government are trying to do something about the crisis in our A&E Departments: they're sorting out the GP's.

    People will continue to flock to A&E until they've got somewhere else to go. The last time I tried to get an appointment at my GP,(I rang on Monday the earliest I could be seen was that Thursday) I knew I had a chest infection so I went to the local Walk-in Centre and was seen within 30 minutes by a NP.

    GP's do do a good job, but they need to be doing far much more in making their services accessible. Being able to access your GP 7 days a week from 0800 - 2000 (as announced by the Government) will make a big difference in the numbers attending A&E.

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  • Anonymous | 9-Oct-2013 1:53 pm

    what happens to the elderly who don't have a walk in clinic nearby and can't access it? some might be too ill to wait so long for a GP appointment. this is not 'health care'!

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