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A&E service is ‘unsustainable’ say doctors

62% of A&E consultants warn current system cannot survive

Adrian O'Dowd

Tuesday, 08 October 2013

Around two thirds of doctors working in emergency medicine say the A&E service cannot survive in its current form due to work pressures.

A survey detailed in a report published today by the College of Emergency Medicine, reveals the level of concern amongst the medical profession about the strain on A&E services.

The report Stretched to the Limit is based on a survey of emergency medicine consultants in the UK, which had a 70% response rate (1,077 respondents).

It shows that overall, 62% of doctors regarded the job they were doing in running the emergency medicine service as unsustainable in its current form.

The vast majority (94%) said they regularly worked in excess of their normal planned hours to help deliver the service, which had potentially serious repercussions for safe working by doctors.

The college said this situation was also reducing the attractiveness of the specialty to new trainees and causing difficulties in retaining doctors and consultants who were leaving the UK in greater numbers.

One of the report’s recommendations is for immediate action by executive boards of trusts and commissioners to ensure there is good job planning for consultants and other medical senior decision makers in emergency medicine.

An urgent review by the BMA and NHS Employers to consider ways in which safe and sustainable working practices for consultants and other medical senior decision makers in emergency medicine can be appropriately recognised, is also recommended, especially for out-of-hours and night time work.

The college said it was pleased to be active participants in Sir Bruce Keogh's ongoing review due to report soon, on urgent and emergency care re-design in England.

Dr Taj Hassan, vice president of the College and one of the authors of the report said: “This report has major implications for health policy makers, regulators, commissioners and executive board of trusts in the UK.

“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 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 Paul Flynn, chair of the BMA’s consultants committee said: “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.”

Dean Royles, chief executive of NHS Employers, said: “The NHS and its patients need to see urgent changes to the working patterns of doctors, both in emergency departments and elsewhere.

“NHS Employers plans to enter formal negotiations with the BMA this year, seeking contractual changes that can address many of the issues in emergency care. We welcome a debate by all those providing leadership in the medical profession on this issue.”

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