Safe staffing levels set out by RCP

THE definition of safe staffing levels that are needed to provide care for hospital patients has been set out for the first time by the Royal College of Physicians.

The College’s new report, Guidance on safe medical staffing, provides a detailed assessment of the time needed to diagnose, treat and manage patients in a variety of hospital settings. It divides clinicians into three tiers based on levels of knowledge, experience and responsibility, and calculates how much time is needed from clinicians in each tier.

Tier 1 comprises "competent clinical decision makers" such as foundation year doctors and new specialty trainees. Tier 2 is "senior clinical decision makers" such as specialty registrars while tier 3 is "expert clinical decision makers" such as consultants and associate specialists.

The report then applies the tier model across four different hospital settings and makes specific recommendations for the amount of hours needed from each tier of clinician in each setting. It emphasises that hospitals need effective mechanisms in place to continuously monitor for surges in activity that compromise safe patient care.

Amongst the recommendations is a call for "as much patient care as possible" to be delivered during normal working hours to reduce pressures on out-of-hours teams. The daytime staffing of wards, the report says, should be such as to minimise "legacy" work. It warns that the out-of-hours workload of the medical registrar on-call is "inappropriately onerous" which could have implications for patient safety.

RCP president Professor Dame Jane Dacre said: "This report… provides a tool which can be used to calculate a safe level of medical staffing. We hope to work with NHS colleagues to refine the method in different hospitals, so that it can help ensure that patients are not put at risk by medical workforce shortages.”

RCP registrar and president-elect Dr Andrew Goddard added: “The variation in the numbers of doctors per bed in the UK is staggering. At last we have a way we can benchmark medical staffing levels to ensure that patients will know if the wards they are on have safe staffing levels."

Read the report on the RCP website