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Consultant shortage worsening A&E crisis

Poor data and financial incentives stymie efforts to cut A&E admissions say MPs

Louise Prime

Tuesday, 04 March 2014

Lack of a clear strategy to address the chronic shortage of specialist accident and emergency consultants is costing the NHS money and reducing the quality of service, MPs warned this morning. The Public Accounts Committee called in its report on emergency admissions for a clear, consistent system of financial incentives to reduce emergency admissions and for NHS England to ensure that commissioners can access good quality local data on urgent and emergency care services.

Committee chair Margaret Hodge reported that in 2012 nearly a fifth of consultant posts in A&E were vacant, or filled by locums, and that only 18.5% of first year of higher training posts were filled. She said: “Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants.”

She went on: “What we found amazing is that neither the Department nor NHS England has a clear strategy to tackle the shortage ... With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.”

The Committee suggested that to help address the shortage, greater use could be made in A&E of consultants from other departments; that spending time in A&E could be made mandatory for all trainee consultants; and that terms and conditions could be improved to make working in A&E more attractive. Chair of the BMA’s Consultants Committee, Dr Paul Flynn, responded: “The government needs to urgently address issues such as workload pressures, resourcing and work-life balance if the NHS is to attract doctors in training and the consultant numbers that are needed, not least because spending large amounts on locum doctors is not financially sustainable in the long run.”

MPs found that attempts to limit emergency admissions are failing because poor alignment of financial incentives undermines coordination of care across the system. They said: “Hospitals, GPs and community health services all have a role to play in reducing emergency admissions – but financial incentives to make this happen are not in place. Attempts to ensure patients are treated without coming to A&E are not working.”

They recommend that the Department of Health, NHS England and Monitor should review the overall system for funding urgent and emergency care to ensure that incentives for all organisations are coherent and aligned.

The Committee also pointed out that commissioners and urgent care working groups lack the good quality data on demand, activity and capacity that they need to more effectively manage performance of the emergency care system. They called for NHS England to ensure that reliable information are available across the urgent and emergency care system and for local information to be published collectively in one place.

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