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Securing the Future of the Emergency Department Workforce

Health Education England working with partners NHS Improvement, NHS England, and the Royal College of Emergency Medicine have published a plan that addresses staff shortages in emergency departments in England and makes recommendations for future planning.

Emergency departments are at the heart of our National Health Service, recording 23 million patients visits in 2016. It is evident that there is a need to recruit and retain more clinical staff and senior decision-makers to help address the reported pressures in A&E services. Improving staff numbers remains a priority.

We have established the Emergency Medicine Workforce Implementation Group to take forward the recommendations made by the former Emergency Medicine Taskforce, published in 2012, and to look at how best to encourage more people into emergency medicine as a career. Emergency Medicine Workforce Implementation Group is jointly chaired by HEE and the College of Emergency Medicine and consists of experts in emergency care and medical education and training. We published a report setting out a wide ranging programme around the new and existing workforce, including ensuring the availability of more doctors in emergency medicine, both in terms of appropriately qualified middle grade doctors and additional trainees for the future.

This work includes expanding the emergency medicine branch of the Acute Care Common Stem programme, establishing a run through pilot for specialty training and developing a mechanism whereby doctors working in other clinical areas can transfer into emergency medicine with their skills recognised and progress quickly through the early years of emergency medicine training. These actions are having a positive impact on the system and we are currently achieving a 98% fill rate in speciality training meaning fewer vacancies and more doctors.

We have been working to support the development of other roles to support patient care in emergency departments, such as by committing to increasing the numbers of physician associates in emergency medicine, general practice and other areas. As the NHS will continue to recruit more doctors, the role of physician associates will be to supplement this expansion, supporting doctors so they can concentrate their time on patients who really need them. We will work with higher education institutions towards the expansion of physician associates programmes across England and with the Royal College of Physicians (RCP) towards the establishment of the Faculty of Physician Associates to support the profession in the future.

Our local offices have been encouraged to generate and support local strategies to address demand. For example, in the West Midlands we have initiated a number of pilots to increase the skills of pharmacists and the support they provide within the emergency department. 

We are working with partners to deliver on the Government’s commitment to provide the same quality of care in hospitals for urgent and emergency services, seven days a week by focussing on the recruitment, retention and development of the urgent and emergency care workforce. Read our plan, 'Securing the future workforce for emergency departments in England' to address clinical staff shortages and ensure we have sustainable staffing in our emergency departments.

Key points for Health Education England include:

- Recruiting an additional 100 doctors per year for four years into other training programs that develop skills in emergency medicine to help develop the mix of junior and middle grade expertise in emergency departments

- Investment in the growth of the advanced clinical practitioner (ACP) workforce, with funding for 42 ACPs across 14 trusts in 2017, rising to 84 ACPs in 2018

- A significant increase in the number of qualified Physician Associates through the training pipeline to 3,200 by 2019 with approximately 30% working in emergency departments

- HEE have been piloting less than full time training for all ST4 and above trainees in emergency medicine

- Raising awareness about the Certificate of Eligibility Specialist Registration Programme to support alternative routes to becoming an emergency departments consultant, through development events and best practice toolkit

- Investment in a leadership/personal development programme for every emergency departments trainee in England

- Following a successful pilot, the GMC has approved the incorporation of run-through training into the curriculum. 

The Royal College of Emergency Medicine (RCEM) and HEE have co-produced the Emergency Care Advanced Clinical Practitioner Curriculum, endorsed by the Royal College of Nursing (RCN).

Higher Education Institutions provide high quality Masters level courses in advanced practice however these do not include specialty specific competences or nationally defined curricula. There is variation in the range of competences acquired, and no standardisation of the level of competence of the practitioner. The Advanced Clinical Practitioner curriculum provides an opportunity for standardisation and consistency.

Further details including the curriculum, application form and frequently asked questions can be found on The Royal College of Emergency Medicine website.

Specialty Associate Specialist doctors are an important group of the urgent care workforce. HEE launched a number of initiatives to address some of the staffing challenges faced by Urgent and Emergency Care staff. One in particular was a pilot launched in the Midlands, to implement what became known as the Specialty Associate Specialist doctor’s development and retention toolkit - developed by the Derby NHS Foundation Trust - available at the bottom of the page.

The implementation of this toolkit at the Trust resulted in better recruitment and retention, a positive impact on the 4 hour performance target and lower spend on agency and wider financial savings. It provides tried and tested information regarding best practice including practical support for development towards successful entry on to the Certificate of Eligibility for Specialist Registration and is now available nationally for trusts to discuss, adapt and use to implement locally.

Elements of the toolkit can be edited for local use, using the 'edit text and edit' Adobe feature, or similar provider. To obtain a copy of the documents in an alternative format, email our urgent and emergency care team.

We are running a pilot that will look at whether we can provide higher specialty trainees in emergency medicine with greater flexibility in their working lives, by extending opportunities to train Less Than Full Time.