March 2014 Urgent and Emergency Care: A workforce Fit for the Future Patrick Mitchell Director of National Programmes Joanne Marvell Specialty Recruitment Manager
The Emergency Medicine Taskforce Poor recruitment at ST4 in Emergency Medicine (EM) raised concerns within the specialty and the medical profession. Since 2011 there has been a lower than 50% fill rate into higher training. DH officials and members of the College of Emergency Medicine (CEM) established the Emergency Medicine Taskforce in September 2011 to address workforce issues in Emergency Medicine. The Taskforce developed an Interim Report, which contains a number of recommendations exploring many aspects of medical education and training, which may be contributing to the problems that the specialty is currently facing.
Emergency Medicine The interim report was presented to the last Medical Education England (MEE) Board on 19 September 2012. The recommendations in the report were strongly supported and MEE passed the report to Health Education England (HEE) for action. HEE has responded to this by setting up the Emergency Medicine Workforce Implementation Group. HEE hosted a Workshop sharing good practice in EM on 10 May 2013 for LETB Directors of Quality and Education with a similar event hosted jointly between CEM and HEE in February 2014 for Heads of Schools of Emergency Medicine. Most LETBs have established their own local EM taskforce and identified project resource to deliver local solutions.
The key recommendations Work with the CfWI to explore workforce modelling in EM. EM trainee numbers should be carefully calibrated to support continued Consultant expansion. Early exposure to the EM component within ACCS core training to improve early experience and improve MCEM pass rates. Develop alternative routes into EM training for trainees currently in other specialty programmes.
The recommendations Explore the recognition of transferable competences of trainees currently in other specialities to increase the pool of trainees eligible to apply for EM training at a level higher than CT1. Support Associate Specialist and Staff Grade Doctors (Specialty Doctors) in their roles to ensure retention and increase work satisfaction. GPs could be invited to consider the following options: Improving access 24 hours, evenings and weekends Primary care expertise in a facility co-located to the ED GPs working with ED team to facilitate discharge GPs to develop Emergency care skills as a special interest
Urgent and Emergency Care Review Keogh review of U&EC led by Sir Keith Willett main themes More extensive services outside hospital GP and primary care, paramedics and ambulance services in mobile treatment units, community pharmacists, NHS 111. Patients with more serious or life threatening conditions receiving treatment in centres with the best clinical teams, expertise and equipment.
Progress to date Flexible training medical workforce GMC have approved a pilot project to allow trainees to be exposed to Emergency Medicine longer and earlier in their training. There is now a run-through programme so that trainees will not have to apply at ST4 for Higher EM training but will be able to continue right through to CCT. Trainees who have started life in other specialties, eg surgical, can have their existing competences recognised and transfer to an EM training scheme taking such competences into account meaning they will be able to apply at a level higher than CT1.
Progress to date Non-training grades HEE are seeking examples of good practice in supporting SAS doctors (Specialty Doctors) in their roles to ensure retention and increase work satisfaction. Examples: Health Education Thames Valley runs a study group for doctors in non-training grades to be able to achieve CESR (CCT equivalent) University Hospital of North Staffordshire NHS Trust provides fixed rotas and study support to enable doctors in non-training grades to achieve CESR Wessex LETB funded and provided a night safe course for all EM SAS over a series of weekends
Progress to date GPs and primary care Again there are examples of good practice. Health Education West Midlands have recruited Emergency Medicine Fellows, GPs who will gain Emergency Medicine skills HEE is currently liaising with a subgroup of COGPED to explore developing Out Of Hours competences for GP trainees.
Progress to date Multiprofessional workforce Clinicians in the multiprofessional workforce can operate as mid-level decision makers but are not in training rotations and therefore can form a core stable workforce. They include: Advanced clinical practitioners (ACPs) Paramedics Physician Associates (PAs) Pharmacists
Advanced clinical practitioners Advanced clinical practitioners - development group have defined a core minimum set of competences for ACPs based on the Membership examination for the College of Emergency Medicine - first time there is a national minimum standard for ACPs. Next steps are to Describe and agree educational preparation Define the assessment framework Develop a national growth plan by geography Disseminate the work
Physician Associates Although there are currently about 200 physician associates working across England, the biggest barrier to their employment is lack of ability to prescribe medication and ionising radiation. HEE are working with the Royal College of Physicians to create a Faculty for PAs. Faculty will manage voluntary register, re-accreditation examinations and CPD HEE and RCP Faculty will lobby for statutory registration This will lead to work to enable prescribing for PAs.
Paramedics National work on paramedics is taking place The Paramedic Education and Training Steering Group will make recommendations to the HEE Executive with respect to the conclusions from the Paramedic Evidence-Based Education Project (PEEP) The Urgent and Emergency Care Review recommends using paramedics and ambulance services as mobile treatment centres The group will also consider the use of paramedics within Emergency Departments, for instance triage posts
Pharmacists The role of community pharmacists is emphasised within the Urgent and Emergency Care review How pharmacists can fit in with Emergency Department staffing is being considered, with a sub-group about to be convened. One suggestion is to bridge the gap between attainment of prescribing for PAs is a buddying scheme between pharmacists and PAs - there is a pilot in Health Education Kent Surrey and Sussex where pharmacists and PAs have been partnered in Trauma and Orthopaedics.
Next steps There are working groups and identified individuals to take forward the work but some of the recommendations will not impact for two or three years. Meanwhile, HEE are working with NHS England to Ensure the working/implementation groups in NHS England and HEE have robust communication lines and governance in place Ensure work is complementary not duplicated Review the workforce that the review of Urgent and Emergency Care requires Ensure that the workforce is in place by developing training pipelines
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