A recent report from the GMC highlights the growing pressures on workloads in emergency departments and raises concerns about the supervision of junior doctors training in emergency medicine. Niall Dickson, GMC’s chief executive, talks about why we need to invest in today’s doctors to ensure tomorrow’s workforce.
The rising demand on emergency departments has been well documented and the reasons behind it are well understood. The reality of what it means in practice is outlined in our latest report which sets out findings from a review of training in seven departments around the country. What it shows is the difficulty of training doctors in areas where all staff are struggling to cope with growing numbers of patients, staff shortages and resultant heavy workloads. Perhaps inevitably training is not always the first concern of those having to deliver such services, but the consequences of ignoring shortcomings in this area will be severe. This is not just about immediate patient safety – we will not attract the doctors to work in this specialty unless those in training now are given the supervision and support they need, and deserve, to develop.
Our, admittedly limited, review which covered six emergency medicine departments in England and one in Jersey over a two-month period suggests that high workloads and inconsistent supervision are putting doctors off from training in emergency medicine.
An emergency for doctors in training
Those in training point to lack of supervision at night, too much reliance on locum doctors who lack experience in the specialty and in the hospital, and supervisors who are too busy and preoccupied with managing high-risk patients to provide them with adequate support.
Strikingly, the report highlights the high intensity of workload, understaffing and rigid rotas that leave doctors in training unable to attend teaching sessions or take study leave as both they and the consultants must focus overwhelmingly on providing care rather than education.
The report also draws attention to unfilled training posts – 177 doctors in training in England and Wales applied to train in emergency medicine in 2012, of those 115 were offered a place but only 61 accepted. And in a worrying sign of what may be to come, the review found that many doctors in core training for emergency medicine were planning to take a break to reassess their career choice before applying for higher specialty training.
Support for the front line
It is crucial that we value the doctors in training who choose to pursue a career in emergency medicine. If we do not get this right we will not attract the doctors we need to work in this specialty.
With this in mind, our review team has made a number of recommendations to improve the quality of education and training in emergency medicine, such as making the recruitment of doctors into the specialty a priority and reducing the burdens and pressures to make it a more attractive career choice. Where there are alternative services, patients and health professionals referring patients could be encouraged to reduce pressures on emergency medicine departments. In some cases, trusts could explore whether combining departments would alleviate pressures on staffing and lack of time for training.
Where there are examples of good practice, and there are, our report may raise awareness of these among other trusts showing how improvements could be made. For example, at Leeds General Infirmary, GPs can admit patients directly onto the relevant specialty ward without having to go through the emergency department, and there is a helpline for GPs who are considering a referral to the emergency department. This has helped reduce admissions.
The GMC will continue to work with NHS trusts, senior doctors and others at a local level to ensure that high standards are met. We have set a number of requirements for each NHS trust that took part and if necessary we will carry out further checks to ensure that standards are being met.