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A&E at Grantham and District Hospital may close at night

Shortage of emergency doctors is behind decision to consider shortening A&E’s opening hours

Ingrid Torjesen

Wednesday, 10 August 2016

United Lincolnshire Hospitals NHS Trust has announced that due to a severe shortage of doctors in its three A&Es it may have to reduce the opening hours of the A&E at Grantham and District Hospital by closing it at night.

ULHT emergency departments normally work based on having 15 consultants and 28 registrar or middle grade doctors. At present, there are 14 consultants, of whom 10 are locums, and just 12 middle grades. This means the trust has just 43% of the middle grades it needs.

The trust has been unable to recruit further locums, so consultants have been filling gaps in rotas by doing extra shifts, but this was “unsustainable”, the trust said.

The trust has ruled out reducing the opening hours at Lincoln County Hospital and Pilgrim Hospital, Boston, because they both take more seriously ill patients and have a higher number of patients attending A&E and being admitted than Grantham and District Hospital does.

Dr Suneil Kapadia, medical director at ULHT, said: “We haven’t made a final decision yet, and we hope to avoid this, but the reality is we will need to temporarily reduce the opening hours of A&E at Grantham.

“The quality and safety of patient care is the Trust’s number one priority and we haven’t rested on our laurels. We have tried to recruit in the UK and internationally, and we have offered premium rates to attract agency doctors whilst investing £4 million in urgent care services. Despite this, we have reached crisis point.”

Allan Kitt, Chief Officer, south West Lincolnshire CCG said: “Any temporary emergency closure is very concerning, whilst we are disappointed that we may be forced to take this action, we do believe that closing A&E at Grantham overnight is the best way to ensure that services for our patients remain as safe as possible.

“We will be working closely with ULHT, local GPs and our community services to develop a range of services to ensure that those people who have less serious illnesses but might currently use A&E can get a service locally during the temporary closure. We will be sharing these plans with the public in the next week.”

The Royal College of Emergency Medicine found the news that another emergency department is having to close at night due to staffing difficulties disappointing, but unsurprising.

Dr Clifford Mann, President of the Royal College of Emergency Medicine, said: “The great efforts made by doctors and nurses to help patients in under-resourced locations sometimes is not sustainable.

“As well as potentially putting patient safety at risk, placing an ever increasing workload on overstretched staff can create a vicious circle in retention and recruitment with many overworked trainees simply choosing to leave the country or indeed the specialty altogether.

“The wider picture is there is a real crisis in Emergency Medicine as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E Departments.”

Dr Mark Porter, BMA council chair, said : “Emergency medicine in particular is experiencing a recruitment and retention crisis. This is crippling at a time when we need more of these doctors to keep up with rising demand on services. It also creates a vicious circle, adding to pressures on existing doctors, further increasing the risk of burnout and making these areas of medicine less attractive to doctors in training.

“More broadly, in light of possible closures, we urgently need a long term strategy for the NHS that addresses the fundamental workload and funding challenges that are overwhelming our health service.”

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