Emergency Department Workforce Benchmarking report finds only 16% of EDs meeting minimum consultant staffing levels

27 September 2019

A new benchmarking report on the Emergency Medicine workforce has found that only one in six Emergency Departments had the minimum recommended number of consultants in 2017/18.

The Emergency Department Workforce Benchmarking Research Report, published jointly by the Royal College of Emergency Medicine and the NHS Benchmarking Network, gives an overview of the Emergency Medicine workforce, and provides definitive benchmarking comparisons for Emergency Department provision and performance.

Despite an overall increase in staffing levels since 2012/13, the report found many EDs were not meeting the minimum number or consultants or senior decision makers per 100,000 attendances.

Other findings in the report include:

• EDs employ an average of 178 WTE staff per 100,000 ED attendances
• Between 2012 and 2017 the EM workforce grew at an average of 6.6% per year
• There is a correlation between a higher proportion of consultants on the workforce in the ED and lower patient length of stay in the ED, and senior support is also associated with better four-hour system performance
• Very large departments have the greatest challenge in recruiting EM Consultants with a third of posts vacant
• On average 23% of ED pay is spent on bank, agency and locum staff
• Sustainable working practices and recruitment and retention strategies are a key part of reducing the locum spend and increasing the workforce substantively
• The joint strategy in England ‘Securing the future ED workforce‘ that was agreed in 2017, must continue to be supported and executed well to address these challenges. Policymakers and the RCEM must also finalise and agree similar frameworks for the devolved nations.

Dr Taj Hassan, President of the Royal College of Emergency Medicine, said: “This report shows that the emergency care workforce remains under pressure, with increasing demand, rota gaps, high vacancy rates, trainee attrition and workforce burnout all contributing to the challenge of securing workforce stability.

“Despite an overall increase in our workforce, it is disappointing to see EDs are still struggling to have enough consultants; particularly when considering higher consultant levels are associated with better patient flow which also enhances safety.

“However, this report provides a helpful stocktake of current provision, providing evidence to support Trusts in their workforce planning.

“It should be used alongside RCEM recommendations which, if applied well, show that Trusts can create a better working environment, provide further incentives for staff to choose to work in emergency departments, and broaden the pool of staff used. Valuing and supporting clinical staff both medical and nursing in the most intense environment in acute healthcare is vital if we are to succeed.”

Stephen Watkins, Director of the NHSBN said: “We are delighted to share the findings of the workforce component of the Emergency Care benchmarking project.

“In 2018 almost all English and Welsh emergency departments participated in the project giving a unique insight into the operation of emergency departments.

“Benchmarking supports organisations by providing structured comparisons to help define and implement best practice. This work provides a unique evidence base to help improve patient care and develop new models of service delivery.”