UK readers will be fully aware of the staffing difficulties currently faced by UK emergency medicine. Arguably the difficulties are so severe that our international readers will also be aware, since many of them trained in the UK before moving abroad to achieve a better work/life balance.
This is not the time or place to review why UK Emergency medicine finds itself in trouble, but in my opinion demand has simply outstripped the resource that the UK emergency physician provides with a cycle of underfilled posts leading to a progressively more dissatisfied workforce. Many departments are held together with a mixture of locums, non-specialists and overtime. This is not a sustainable solution to the pressures of emergency care and progress must be made. This will not be easy as EM faces the twin difficulties of both recruitment (most notably at middle grade level) and retention for all grades of staff.
This week we may have seen the first part of the jigsaw appear. Health Education England has published its first workforce plan for Emergency Medicine. You can download the full report here. This joint report addresses the issues around recruitment and workforce expansion.
There is a clear recognition that the speciality needs to expand with an initial increase of 125 new training posts in 2014 (75 at ACCS and 50 at ST4*). More trainees and medical students will be exposed to EM during their training and alternative routes into EM are to be developed with the possibility of dual accreditation and/or credentialing in EM by other professional groups.
The HEE report goes some way to outline how the issues of workforce expansion and recruitment will be addressed in the next 3 years. It is less explicit in its consideration of workforce retention. Increasing pay is ruled out as an option and other options such as the alteration to working practices for older consultants are unclear and arguably aspirational. This may be because such changes to working consultant working practice are not within the remit of HEE. However, unless retention is addressed with as much energy and resources as recruitment I fear the crisis will remain.
Associate Editor EMJ