Juniors need ED consultant support

THE majority of care in emergency departments should be delivered by consultants rather than “inexperienced” junior doctors.

The College of Emergency Medicine has called for a “paradigm shift” away from the traditional workforce model where the majority of clinical care in EDs is delivered by trainees.

All EDs should have a minimum of 10 emergency medicine (EM) consultants to provide up to 16 hours of on-site “shop floor” cover seven days a week, with bigger departments requiring higher numbers.

The recommendations are set out in a new guidance document from the College, Commissioning the delivery of high quality care in the Integrated Emergency Department, aimed at commissioners, clinicians and managers.

The guidance states: “Increasing the number of EM consultants demonstrably improves the quality of patient care, enhances patient safety and results in cost efficiencies”, adding: “Clinical care must be led by experienced middle grade doctors at those times when there is not an EM consultant present in the ED.”

It goes on to say that the greatest challenge to the ED medical workforce is the recruitment crisis of EM doctors at both middle grade and consultant levels.

“Increasing work intensity and anti-social work patterns for the same remuneration as other specialties have decreased the attractiveness of EM as a career option for junior doctors. This has significantly contributed to the national recruitment crisis.”

In addition, the College blames the European Working Time Directive and the specialty doctor contract for reducing the number of hours that middle grade and junior doctors are available for actual clinical work. It calls for improved supervision and training by EM consultants to make the specialty a more attractive career option.

The College is also working to ensure a more attractive work/life balance within the specialty.