Newsletter – July 2022

Welcome from the President

I am sick of the phrase Urgent and Emergency Care! I believe that it is unhelpful and makes people focus on the wrong stuff. We need an Emergency and Urgent care system. The risk of U&EC is that the conversation drifts inexorably to demand management. Demand is not the issue paralysing ambulance services and Emergency departments or worrying the public! As we all know the fundamental problem is that patients are not moving on from the Emergency department to their next phase of care on a ward. I know there is great work to be done in SDEC and hot clinics and no doubt same day primary care and community response but trying to find imaginative ways to make these alternative access points function with no additional funding or staff is distracting from the critical business of getting patients who are ill enough to need admission attended to by a prehospital crew, seen in the ED, treated and admitted to a ward bed in a timely way that does not detract from the care of the next patient needing help.

The heart of the Emergency and Urgent care system needs to be a great 999 call handler system, communicating with highly trained paramedics and prehospital clinicians who get to a patient, identify their needs, and get them to hospital for further care. At the hospital there need to be highly skilled frontline clinicians (mostly Emergency medicine clinicians but also stroke teams, cardiologist etc) who are great at identifying serious illness and injury and do all the evidenced based and peer agreed interventions that make a difference in saving a life, or limb, or ovary, or testicle or eye sight or heart muscle or brain tissue, or kidneys or whatever needs to be done ‘as an emergency’ to fulfil the NHS constitutional aim for the NHS of ‘supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health.’ 61% of the public asked by Ipsos MORI were not confident of getting an ambulance when they needed one.

This is shocking and wrong. In England Category 1 call response time is now a mean of 9 minutes with a 90% percentile of 16 (standards 7 and 14). With these patients’ minutes matter. Meantime Category 2 patients should be reached in 18 minutes but the actual response time for C2 incidents have exceeded the 18-minute national standard since August 2020, and in June 2022 increased to 51 minutes. Against a national standard of 40 minutes, the 95th centile measure neared 2 hours.

Data from our FOI request of trusts reveals information on numbers of patients waiting six and eight hours from their time of arrival. We found that across the sample of trusts, in 2021 18.5% of patients waited six hours or more from their time of arrival. 11% of patients in our sample waited eight hours or more from time of arrival. In our sample of trusts, 381,991 patients (4.3%) experienced a 12-hour delay from TOA in 2021. This means on average 1,047 patients were delayed by 12 hours or more from their time of arrival every day across these trusts.

Our SNAP SURVEY in June showed that 80 percent of departments surveyed were having to hold ambulances, 83% had to care for patients in corridors and one third that their longest patient stay in the emergency department in the last week was over two days.

These findings are unacceptable and should be the primary focus of concern in any developed health system – timely access to emergency care and timely access to a bed when admission required. Everything else should come after making sure we can deliver that. Hence my belief it is now time to focus on Emergency care above urgent.

Similarly in Scotland, as RCEM Scotland Vice Chair says, the deterioration in performance seen in the service which (like in England) is not to do with numbers through the door but is driving out medical and nursing staff. Downstream staffed beds are what will make the difference to operational pressures at the frontline. We risk haemorrhaging staff from Emergency departments at a time when the workforce is depleted in all areas of healthcare.

And so NHSE is developing an Urgent and Emergency care strategy – we had a first meeting last week. We worry this is a rush job and that too much time is being spent on Demand Management. As with the Fuller Stocktake Report in Primary care, they are consulting using ‘crowdsourcing’. Given that this launched on 27^th July – the day of the first meeting we were invited to I am happy that we can share this far and wide! This is what they say:

Our approach

In developing the strategy, we are reviewing the evidence around UEC.
We will work with patient groups, services and systems to better understand the challenges and opportunities, and test thinking.
This will include launching a crowdsourcing tool to get views and ideas from as wide a range of people as possible, including patients, frontline professionals, those supporting UEC services or working within the health and care system.

The #SolvingTogether “crowdsourcing” platform is an initiative which is regionally led and centrally supported to capture, assess, test and share ideas. This platform is being used by NHS England’s urgent and emergency care (UEC) strategy team to create a two-way dialogue to: encourage people to share ideas, challenge assumptions and provide solutions, with a ‘no wrong answers’ approach on ways we can improve urgent care services.

You have until Friday 19 August 2022 to share your ideas.

So PLEASE CLICK and provide some frank, informed ‘two-way dialogue’ to help then better understand ‘the challenges and opportunities’!

UEC Welcome (crowdicity.com)

We need strategy to be based on the service we should deliver for the public and addresses the blockages to this being possible. We all know what should happen, but it looks like we will all have to make the case all over again.

August means trainee rotations, lots of staff move around while lots more stay put ready to welcome the new intake of trainees or locally employed doctors. Induction is important and do make use of the RCEM eLearning induction material which is freely available.

I recently went to a training/ workforce event where eloquent testimony from trainees emphasised the importance of getting the basics right. We have often woeful HR processes that duplicate work despite us all working in the NHS. Accurate pay, timely rotas, hot food at night, having a locker, knowing how to get scrubs, meeting your educational supervisor and the name of the Specialty tutor are all basic requirements to make someone feel they are valued starting the job. Let’s do all we can to get this right.

The GMC survey makes tough reading, but we must face up to it and be determined to make things better. One in three EM trainees are at a high-risk of burnout, two thirds of trainers in EM felt their work frustrated them to a high or very high degree, both trainers and trainees in EM gave the most negative responses to questions in the survey. Nearly 80% of trainees rated the intensity of their work as ‘heavy’ or ‘very heavy’. Staff are reaching the end of their tether, for many senior staff it is the worst it has ever been, for trainees it is increasingly unsustainable. Resilience, adrenaline, and goodwill will only take you so far.

We know the practice of Emergency Medicine still brings immense job satisfaction, but the operational pressures are relentless and there feels like no light at the end of the tunnel. We have every reason to think that the months ahead are going to be very tough. So, what can we do? The College as a charity cannot push on pay but we can make the case for safe staffing ratios and retention to maintain and improve patient safety. Losing experienced staff because of operational pressures makes no sense. We continue to highlight the risks of moral injury and burnout. The pension problems and trainee debt are both practical issues which could be solved. Having fulfilling, sustainable careers for all clinicians is the best use of workforce investment.

Learning and education are the bright spot in our specialty – nine out of 10 trainees rate their clinical supervision as good or very good, and to see nine out of 10 trainers reporting they enjoy their training role. Having educational shifts helps trainees, trainers, and patients. We have an evidence base from the Clinical Educators in Emergency Departments (CEED) project to support us focusing on this.

Clinical educators as provided within the pilot realise the following benefits:

Quality of patient care improved.
Clinical decision-making by staff improved.
Staff morale improved.
ED staff recruitment and retention improved.
Patient safety improved.
Wellbeing at work improved
Competence and confidence of clinical staff improved.

The project recommendations are therefore

NHS Emergency Departments should appoint Clinical Educators to support the development and training of their multidisciplinary ED clinical staff.
Clinical educators should be given sufficient ring-fenced time to fulfil their role. This will need local consideration but a minimum of eight hours per week is likely to be needed to realise the benefits identified during the CEED project. Within the study, sites typically appointed clinical educators to one or two PAs per week. PAs are 4- hour sessions.

So, in a world where there is lots we cannot control, let’s push to have time dedicated to education- fight to have trainers in the educator role – ring fenced educational shop floor teaching as part of SPA or if you can, team job plans with this included. This is a rationale retention strategy for senior staff.

Dr Katherine Henderson
President, Royal College of Emergency Medicine
@RCEMpresident

College News

New Vice Presidents appointed
The College is delighted to announce the appointments of Dr Ian Higginson, Dr Jason Long, Dr Salwa Malik, and Dr Maya Naravi to roles of Vice President.

All four will take up the role from 4 October, with the RCEM AGM on the same day being their first official College event.

You can read what it means to each candidate to be appointed here.

Join us in Belfast for the Annual Scientific Conference
The programme for the Annual Scientific Conference is now available! Take a look at some of the topics being discussed at our flagship event in ICC Belfast on 3 – 6 October. Pre-conference workshops from APEM and ultrasound will take place in-person on 3 October. For the full experience including access to all three tracks, oral abstracts and the poster exhibition, we recommend you book an in-person ticket. If you can’t make it in person, virtual tickets are available enabling you to watch all keynotes and track 1 of the conference. Click here for more information and to book your place.

Guest blogs
This month we had guest blogs from Dr Adrian Boyle, President-elect, summarising our recent beds report, and a briefing from our Policy Team on the efficacy of NHS England’s UEC 10 Point Action Plan.

New ACP Chair
We’re delighted to welcome Ashleigh Lowther to the role of Chair of our ACP Forum. You can find out more about Ashleigh here.

The College would like to thank Olivia Wilson for all her work in the role over the past few years.

Research Grants
Applications are invited from all College members and fellows for the Autumn 2022 RCEM Research Grants.

Grant application forms can be downloaded from here and a guidance document found here. For advice on writing a grant application see www.mrc.ac.uk and the following headings should be used:

Introduction – what is already known in this area
Research Question – usually as a 3 or 4 part question
Methods – including sample size calculation if relevant, how the statistical analysis of results will be performed and a timeline for the project
Project Budget Sheet – details of exact costs of proposed project
Project timeline – a detailed plan
Reasons for support requested – include importance of the question to Emergency Medicine, and future potential of the work for attracting further research funding.

Applications will be rated according to the quality of science, the relevance to Emergency Medicine, the potential for academic development of the lead applicant, deliverability and the likelihood that the work will lead to future research funding.

Successful applicants will be expected to produce a short report in the approved format on the progress of the project every 12 months and may also be invited to present their work at the RCEM Annual Scientific Conference.

Applications are particularly welcome from trainees, specialty doctors, consultants within 5 years of CCT and consultants without an established research background who wish to develop an academic portfolio.

The lead applicant must a member or fellow of the College. A team-based approach with strong EM leadership is encouraged. Appropriate commercial and non-commercial partnerships are welcome.

These grants are potentially eligible for inclusion on the UKCRN Portfolio and for support from your local clinical research network. Preference will be given to applicants who submit projects likely to lead to UKCRN Portfolio adoption.

Applications are particularly welcome around the theme of wellbeing and mental health. These applications will be considered for RCEM Foundation grant funding alongside being considered for funding through the main research grants call.

Please send your application along with a copy of your CV to the College office or via email to Theo.Chiles@rcem.ac.uk

Deadline: 5pm Friday 23 September 2022

For further information regarding the application process please contact:
Theo Chiles, RCEM research committee administration email: Theo.Chiles@rcem.ac.uk
Matt Reed, RCEM Professor, email: matthew.reed@nhslothian.scot.nhs.uk

EMJ’s latest issue is now online
EMJ’s latest issue is now online. The highlights are summarised by the journal’s editor, Ellen Weber, here.

In addition, why not check out the latest “Monthly top five”. This month’s update comes from a team at the Department of Emergency Medicine, Stanford Medicine. Using a multimodal search strategy, and drawing on free open-access medical education resources and literature searches, they reviewed all papers published between 15 March 2022 and 15 April 2022. They then placed the five most interesting and relevant papers into one of three categories:

Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice

Finally, make sure to follow us on Twitter – for all the latest news on pre-hospital and hospital emergency medicine, and critical care @EmergencyMedBMJ.

Workforce: the persistent victim of the covid-19 pandemic
President-elect Dr Adrian Boyle, has written an opinion piece for the BMJ about rising covid rates, NHS pressures and how the workforce continues to suffer. Read the blog here.

RCEM AGM – 17:10, Tuesday 4 October 2022

This year’s Annual General Meeting will be held on Tuesday 4 October at our Annual Scientific Conference in Belfast. Members that have an onsite ticket that includes day 1 of the conference can attend the AGM onsite, in-person.

Members that have an onsite ticket that does not include day 1, or have a virtual ticket (any combination of days) can attend the AGM virtually on the conference platform.

Members not purchasing any ticket for the conference should complete this form. They will then be able to attend the AGM virtually via the conference platform (please note this means no onsite access to the conference for the AGM).

NHS Pension Scheme webinar – changes to member contributions from October 2022
Watch the recording of the NHS Employers webinar to hear the changes that will be made to the member contribution structure for the NHS Pension Scheme from 1 October 2022 .

NICE Guidance development – Adrenal Insufficiency
NICE is developing a guideline ‘Adrenal Insufficiency: acute and long term management’ and the Guideline committee is looking for a either a full member or co-opted member from Emergency Medicine to support development of the aspects of the guideline around emergency care. If you would like further information, or an application form, feel free to contact Dr Helen Simpson, Topic Advisor, (helen.simpson22@nhs.net) or Tarama Diaz, Project Manager, (tamara.diaz@ nice.org.uk).

Get involved!
We have a number of opportunities for members to get involved with the workings of the College and help set the direction of our boards and committees.

Right now we’re looking for a new West Midlands Regional Chair! Are you interested in representing fellow members and advocating for patients in your region? If so, then please check out the job description and contact us at daisy.harmer@rcem.ac.uk. Finally, please share this call out with your networks.

Role profiles and person specifications for all roles can be found at rcem.ac.uk/volunteering-opportunities/

#CountMeIn – help us improve representation by filling in your College profile
Emergency Medicine is one of the most diverse professional clinical communities. Unfortunately, we are currently unable to fully evidence the diverse intersectionality of who we are, as the demographic data we have of our members is patchy.

Thing Spring we’re running #CountMeIn to truly capture and celebrate the diverse intersectionality of who we are.

Having a sense of our members’ representation will help us to better understand how best to represent you.

Help us to help you by filling in your College profile today.

Join us in starting a dialogue about the importance of representation in emergency medicine by sharing the campaign and your views on social media.

RespectED – our anti-bullying campaign to challenge toxic behaviour in EDs
The Royal College of Emergency Medicine is launching RespectED, an anti-bullying campaign that aims to raise awareness and tackle the rise in toxic behaviours such as bullying, harassment and incivility between staff in Emergency Departments (EDs). These negative behaviours have a huge impact in EDs; they can create a toxic working environment, affect morale and the delivery of safe patient care.

The RespectED campaign is being launched to acknowledge that bullying, harassment and incivility occur in Emergency Departments. It encourages staff to address their own behaviours, to speak up and challenge these behaviours if they witness or are targeted by them and to positively change Emergency Departments and their cultures.

As pressures once again mount on the NHS it is vital that negative and toxic behaviours are challenged, and staff are supported by their colleagues and peers.

Jayne Hidderley, Chair of the Royal College of Emergency Medicine Lay Group, said: “We know when incivility and bullying take place in our Emergency Departments, it not only has a detrimental effect on all staff but is a serious risk to patient safety. Our RespectED campaign, in collaboration with Civility Saves Lives, is a call to action to raise awareness amongst our staff and start the conversation. We want all staff in our Emergency Departments to be equipped to speak up, challenge these behaviours and change the culture together.”

You can find out more about the campaign, along with other useful resources, here.

Parents! Apply now for The Leaders Plus Fellowship Programme
Are you expecting a baby, currently on maternity or shared parental leave, have recently returned to work or have children who are in primary school? If yes, then apply now for the award-winning Leaders Plus Fellowship Programme.

The Leaders Plus Fellowship is a nine-month Programme enabling parents with babies and young children to accelerate their careers whilst still enjoying their families. You’ll get access to inspirational role models, a Senior Leader Mentor, a cross-sector network of peers, as well as support to progress your career whilst looking after young children.

The RCEM are delighted to part-fund 6 places on the Leaders Plus Fellowship for individuals working in emergency medicine. Find out more at http://www.leadersplus.org.uk/rcem

EUSEM Academy

We would like to share with you the opportunity to access the European Society of Emergency Medicine’s (EUSEM) learning platform as part of the College’s membership with EUSEM.

The platform contains a range of resources including webinars, videos and document libraries, the majority of resources are available via open access, find out more via: https://academy.eusem.org>

Follow our Officers on Twitter
Are you following our officers on Twitter? Keep up to date by using these handles:

Dr Katherine Henderson – @RCEMPresident
Dr Lisa Munro-Davies – @RCEMvp
Dr Ian Higginson – @RCEM_VP
Dr Carole Gavin – @RCEMmembersVP
Dr Adrian Boyle – @RCEMPolicyVP

You can also follow our current VPs for the devolved nations:

Dr Paul Kerr – @VP_NI_RCEM
Dr Suresh Pillai – @VP_Wales_RCEM
Dr John Thomson – @VP_Scot_RCEM

Events

The programme for the Annual Scientific Conference is now available! Take a look at some of the topics being discussed at our flagship event in ICC Belfast on 3 – 6 October. Pre-conference workshops from APEM and ultrasound will take place in-person on 3 October. For the full experience including access to all three tracks, oral abstracts and the poster exhibition, we recommend you book an in-person ticket. If you can’t make it in person, virtual tickets are available enabling you to watch all keynotes and track 1 of the conference.
Click here for more information and to book your place.

Eating disorders in the ED

Date: 6 September 2022

This event gives insight into the physical and mental impact of eating disorders on patients and their carers. It will introduce the new Medical Emergencies in Eating Disorders (MEED) guidelines which are essential for correctly managing these patients in the ED.

View the programme online and book now

Global Emergency Medicine Day – Innovation, Partnerships and Opportunity

Date: 8 September 2022

Global Emergency Medicine (GEM) is a rapidly developing field with broad scope. It incorporates disaster and humanitarian response, health system strengthening, advocacy and working in partnership to reduce inequality. The event will cover a range of related topics through talks and discussions with a diverse range of speakers from across the globe. We hope to encourage reflection on how we, as emergency care providers, can be involved in a sustainable manner to promote better emergency care for all.

View the programme online and book now

Pre-Hospital Emergency Medicine

Date: 15 September 2022

This event will help delegates understand what happens to patients in the prehospital setting before they arrive in the ED, including the limitations, innovations and how we can improve the PH-ED interface. It provides an insight into careers in PHEM: useful for clinicians considering working in PHEM or for Consultant Educational Supervisors supporting trainees with future career choices.

View the programme online and book now

Catch-up with past events

All our virtual study days are available for booking post-event for 6-months. This means if you’ve missed a study day you can register and watch the whole thing whenever suits you. Recent study days that have been added include:

Clinical toxicology
Violence and aggression in the ED
RETURN to EM

You can also book to catch-up with all 3-days of the recent Spring CPD Conference. This content is available to watch for 12-months.

View all past events and book now

Policy

Parliamentary Debate Summary

Following the publication of RCEM’s Tip of the Iceberg report which looked at FOI data on the number of 12-hour TOAs in 2021, the Policy team worked closely with Wera Hobhouse MP for Bath, to successfully table a debate in Parliament examining waiting times for emergency care.

In preparation for the debate, Regional and Lay Board members wrote to their MPs, expressing concerns about the current level of pressure experienced by the NHS and urgent and emergency care pathway, asking them to turn up to the debate, with the hope of creating political pressure and to hold the government to account.

Several MPs responded to us directly, meeting with President Katherine Henderson, President Elect Adrian Boyle, and members of the Policy team. MPs including Wera Hobhouse MP, Naz Shah MP, Duncan Baker MP, Helen Morgan MP, Jerome Mayhew MP, and Mark Pawsey MP, asked for briefings and data relevant to their local hospital trust, which they utilised to highlight challenges and the need for change. These MPs spoke passionately about a range of important issues impacting urgent and emergency care, from exit block and overcrowding to the metrics used to report on waiting times.

The debate itself took place on Wednesday 6^th July, chaired by Graham Stringer MP. Wera moved the motion, opening the debate by asking the House to discuss waiting times for ambulatory and emergency care and interconnecting issues from workforce shortages and increasing patient needs, to waiting times for assessment and treatment across the NHS.

Overarching themes amongst the speakers included prolonged waiting times, patient dignity, and safety, with many recounting stories of constituents suffering due to crowding, long waits, and handover issues. Transparency was also key amongst the speakers, highlighting the need for greater reporting on the extent of 12-hour TOA waits, as without such clarity policymakers cannot act to remedy the problem.

Wera called for a formal enquiry into this crisis. As the Conservative party confronts the political void left behind by the collapse of the previous Government, we are extremely concerned about the deepening crisis facing the Urgent and Emergency Care system. The NHS was a top priority for the Conservative Party during the 2019 General Election and the College will continue to lobby to ensure that the recovery of the NHS remains front and centre of the new administration.

If you would like further information or to get involved in our campaigns and lobbying efforts, get in contact with us at policy@rcem.ac.uk

You can catch up with the debate, here.

Press releases

Tip of the Iceberg: 12-Hour Stays in the Emergency Department

Our new report reveals that on average 1,047 patients waited 12-hours or more from their time of arrival every day in a major Emergency Department in 2021 in England, equalling a total of 381,991 patients experiencing these 12-hour waits in 2021.

A Freedom of Information request was submitted to 124 NHS trusts in England, and we received responses from 74. The data captured therefore represents only 60% of trusts in England, meaning the scale of the problem is actually far higher.

The report calls for action to tackle these long waits, starting with full and regular publication of 12 hour stays measured from time of arrival rather than when a decision to admit is made.

There was much media attention on the report, with coverage in all the main national newspapers and interviews with Good Morning Britain and ITV news.

RCEM CARES: The Next Phase
There is a severe mismatch between demand and capacity in the Urgent and Emergency Care (UEC) system. The unparalleled levels of demand placed on EDs has not been met with sufficient investment into the NHS. EDs now sustain other parts of the system and are the first port of call for many patients, despite not always being the most appropriate place to receive care. The pandemic has exacerbated many of these challenges and there is an urgent obligation to plan for the future healthcare needs of the UK. Eliminating overcrowding must be the number one priority.

Our RCEM CARES campaign provides solutions to address these pressing issues so that ED staff can deliver safe and timely care for patients. The campaign focuses on five key areas: Crowding, Access, Retention, Experience, and Safety.

In RCEM CARES: The Next Phase, we revisit our original policy asks in light of COVID-19 and begin to explore what happens next. Read it here.

Performance Figures
A summary of all the latest performance figures for England, Wales, Scotland and Northern Ireland can be found here.

Quality and Audit

Safety

Safety Flash – Monkeypox evolving situation

Get involved!
We have a number of vacancies across quality and service delivery committees.

RCEM Safer Care Committee (SCC) Chair
RCEM Safer Care Committee (SCC) Nurse Representative (Honorary post)
RCEM Safer Care Committee (SCC) SAS Representative (Honorary post)
RCEM Mental Health Sub-Committee Chair (Honorary post)
RCEM Major Trauma Sub-Committee Chair (Honorary post)
RCEM Quality Improvement Projects (QIPs) Topic Team Members – Care of Older People (Honorary post)
RCEM Quality Improvement Projects (QIPs) Topic Team Members – Infection Prevention and Control (Honorary post)

Details of all can be found at rcem.ac.uk/volunteering-opportunities

Recently updated RCEM guidance

Use of body cameras in the emergency department

TOXBASE antidote guidance updated – please see the most recent version on TOXBASE or in the toxicology guidance section of the RCEM website.

QIPS

We are still taking registrations for the QIPs, all the details can be found here. Should you have any questions please email quality@rcem.ac.uk

The Consultant Sign Off QIP data collection began on 25 April. EDs that have registered to participate can now enter data by logging in to the portal.

The QIP 2020 – 2021 Infection Prevention and Control report has recently been published and can be viewed here.

The QIP 2020 – 2021 Pain in Children report has recently been published and can be viewed here.

The National Data Opt Out Policy started on 31 March 2022. RCEM statement about QIP participation and the National Data Opt Out Policy can be found here.

Membership

Update your details/subscription

July and August are a time of change/rotation for our members so please do ensure that all the data on your RCEM account (especially contact details) is correct and you’ve informed us of any changes to your circumstances. It’s important that the information we hold for you is accurate, not least because as we head towards 2023 we want to ensure you’re paying the correct membership subscription.

RCEM provides reductions on subscriptions to those who are: –

Resident in Low and Lower Middle Income Countries (as defined by the World Bank)
Taking maternity leave or equivalent parental/adoption leave
UK-based members who are working LTFT and are earning less than £35k per annum

Reduced subscriptions are also provided in recognition of the following: –

Members working outside of Emergency Medicine
Members working overseas
Retired members (for the purposes of subscriptions the College considers retired members to be ‘members who are retired from NHS work and do not have a licence to practice’)

Fellows and Members who pay UK taxes are also able to claim tax relief on membership subscriptions at the highest marginal rate of tax – details can be found on the UK Government website.

Further information on the criteria for membership discounts is available on our website and if you have any queries about your membership subscription then please contact us via membership@rcem.ac.uk, by phone on 0207 404 1999 or via LiveChat via our website. As a reminder, for members with a UK bank account Direct debit is the easiest way to pay for your membership and we offer monthly as well as annual payment options, sign up via: https://www.rcem.ac.uk/subscriptions2022.

RCEM Diaries

We know from your feedback that many members value their College diaries and look forward to receiving them. Once again for 2023 we’re providing free RCEM-branded diaries to all members who request them so if you would like to receive a 2023 RCEM diary then simply email membership@rcem.ac.uk to let us know and we’ll send it to you later this year.

New 24/7 confidential helpline for RCEM Members

We are now offering free, 24/7 confidential helpline support for all our members via a Health Assured Employee Assistance Programme. Your call will be handled by an experienced therapist or advisor who will offer support in a friendly, non-judgemental manner. You can contact them by phone at any time for help with: –

Stress and anxiety
Bereavement
Relationship advice
Tenancy and housing concerns
Counselling
Financial wellbeing
Legal information
Alcohol and drug issues
Family issues
Childcare support
Medical information
Consumer issues

Simply call the free 24-hour confidential helpline on 0800 028 0199 and use the code MHA 229 700 to access support.

Further information can be found HERE

Member Engagement Group – Get involved and have your say!

RCEM’s Member Engagement Group (MEG) involves members in what the College does and how it does it. The MEG’s valuable insights will allow us to deliver an even better service and will also mean that we can more effectively support you, your fellow members and all Emergency Medicine staff.

Being part of this group is an opportunity for you to contribute to the College, engage directly with its staff (recent meetings were attended by the Exams/Training teams and Chief Executive and an upcoming meeting will be attended by our Head of Membership) and inform what we do and how we do it. We want to add to the diverse group of members already in the MEG to provide insight into our work as well as feeding back on how we are doing and what we could do better. The time commitment isn’t onerous (approximately three online surveys and four meetings per year and attendance isn’t compulsory) and you can join at any time.

Further information can be found on our website (https://rcem.ac.uk/member-engagement-group/) and if you would like to find out more about/join the MEG then please contact Jen (jennifer.barley@rcem.ac.uk)

Are you making the most of your EMJ subscription?

For members with an EMJ subscription access is available online as well as through the traditional monthly paper copy. If you have any queries about the delivery of your subscription or how to access the EMJ online the membership team are happy to help –membership@rcem.ac.uk

There is also the option to make your EMJ subscription online only if this is your preferred way of reading the EMJ and/or you would rather a greener alternative. This preference can be amended via your online account or please email us if you would like to switch to your preference.

RCEM Merchandise

Following our recent rebranding, new RCEM merchandise is now available in our online shop. Thermal travel mugs, hoodies, notebooks, water bottles and other items can be bought via https://www.rcemshop.co.uk/ so get your merch and show your EM pride!

RCEM Lifestyle Rewards

All members have the benefit of being able to enjoy RCEM Lifestyle Rewards at any time via www.rcem-rewards.co.uk. Members receive new exclusive discounts and added value offers every month on a wide range of luxury products, services & experiences.

This month’s special selection of Lifestyle Rewards offers are:

	Red Rickshaw Authentic & Breath taking Ingredients We empower cooks to create authentic cuisines from around the globe with premium quality, fresh and seasonal ingredients. Save 15% across the range
	Eco Soaps Natural & Handmade… Save 20% on our range of handcrafted, natural soaps & skincare made in the Scottish Highlands. Especially suitable for sensitive skin.
	Claire’s Amazeballs Flavours with benefits. Simple. Happy. Amazing. Homemade, healthy energy balls that excite taste buds and supply the body with natural goodness. Members save 10%
	Oliver Co. London Minimalist vegan accessories made from premium sustainable fabrics. Add personalised embossing for the perfect ethical gift. Save a stylish 10%
	C-MONSTA Your wetsuit kit dried together… Save 15% off The Ultimate Wetsuit Hanger! Wetsuit, boots and gloves, dried together. Robust and lightweight. Built and tested by cold water surfers
	NOTCH YOUR PASSION, YOUR NOTCH Celebrate sports, hobbies, achievements, love, milestones, positivity, family, pets, with a personalised NOTCH Bracelet. Save 10%
	Hand Picked Hotels A Unique Collection of Hotels Super Summer Saver. Let the summer fun begin with this exciting limited time offer at selected hotels, with a host of complimentary extras!
	Montagu Arms Hotel Unique Charm & Timeless Elegance Discover rural England at its most enchanting with our selection of UK short breaks and special offers!
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Examinations

Results Update

The College can now confirm that exam results have been issued for the following exams:

May FRCEM OSCE
June MRCEM OSCE
July FRCEM SBA (extraordinary diet)

The results were issued later than originally scheduled due to enhanced quality controls, process improvements and results sign off procedures., this includes a shadow results process being ran by an External Education Advisor. The following results will also be issued slightly later than planned but will be released in the week beginning Monday 22 August:

June MRCEM Primary
July MRCEM OSCE (Chennai)

The Exams Team is now working to establish new results release dates for the remaining exams this year that incorporate the identified improvements.

Examiners Needed

We are extremely grateful to all examiners who volunteer their time to support the delivery of our OSCE examinations. Existing MRCEM & FRCEM examiners are invited to schedule examining dates for the following OSCE examinations via their Ripleys account:

MRCEM OSCE London – 28 Nov-07 Dec 22
FRCEM OSCE London – 07-16 Nov 22

Any examiners unable to access their Ripleys account can contact Ruby at exams@rcem.ac.uk , who can resend their log in details and/or book dates on their behalf.

The College recently posted a video from Will Townsend, College Dean, highlighting the need for MRCEM OSCE exam. The College requires 18 Examiners a day for the MRCEM OSCE to run successfully. If you are interested in becoming an Examiner and supporting the College in this capacity, please see here for more information. SAS grade clinicians are eligible become Examiners. The College is underrepresented by woman and ethnic minorities at Examiner level, and we would welcome applications from individuals within those demographics.

If you have any questions, please do not hesitate to contact the Exams Team on exams@rcem.ac.uk.

Changes to International Examining Criteria

The Examinations Sub-Committee recently reviewed the criteria for International Examiners and introduced interim equivalence for international MRCEM examiners who do not hold MRCEM or FRCEM. The Examinations Sub-Committee have agreed that international MRCEM OSCE examiners (not holding MRCEM/FRCEM) must meet the following revised eligibility criteria:

Be an Associate Member of the College in good standing
Hold a postgraduate qualification in Emergency Medicine (e.g. Masters in Emergency Medicine, MMED in Emergency Medicine)
Have at least seven years’ experience post qualification
Have completed an EM postgraduate training programme of at least three years duration

Individuals who have failed to get MRCEM or FRCEM cannot be examiners. This interim equivalence will be applicable to all international MRCEM examiners for the next two years until August 2024. This standard will be revisited before it expires.

Other Ways to Get Involved

There are lots of other ways to support the ongoing development and delivery of our examinations. We are looking for more individuals to join our Question Writing working groups and develop questions and scenarios for future written and OSCE examinations (MRCEM Primary, MRCEM SBA, FRCEM SBA, MRCEM OSCE & FRCEM OSCE). If you are interested or would like to find out more, we would love to hear from you – please contact the team at exams@rcem.ac.uk.

Training

Advanced Clinical Practitioners

New Curriculum

A new ACP curriculum is expected to be launched in September 2022.

The purpose of the curriculum is to train EM-ACPs to work in the Emergency Department within the multidisciplinary team, providing urgent and emergency care to all undifferentiated patients attending ED nationwide (adult and/or paediatrics depending on scope of practice).

We have produced this video featuring Dr Ruth Brown introducing the new ACP curriculum

Further news about the development of the curriculum will be posted on our website over the next few weeks. Information to come includes a working draft of the curriculum, information on transition, events and new guidance. More information can be found at rcem.ac.uk/acp-curriculum

ACP Forum Representatives

We’re seeking members to join the ACP Forum as representatives for all regions.

The ACP Forum works on the main issues affecting ACPs in practice, as well as working on projects to improve the working practices of EC-ACPs across the UK. The ACP Forum is a standing committee of the Royal College and reports to Council. They work closely with the RCEM Training Team.

For the full job description and for details on how to apply, please visit our website.

EM Training

Intermediate/Higher Speciality Trainees

Those who are imminently starting Intermediate or Higher Training will be contacted shortly to confirm the start date of their new post.

To ensure you have the correct curriculum access on your Kaizen ePortfolio, the training team need to audit those who have reached their critical progression points. When you receive an email asking you to confirm your progression, please respond by confirming the start date and level of your next post – Your ePortfolio will then be updated over the coming weeks.

eLearning

Latest publications

Here’s a selection of some of July’s most popular publications:

July 2022 (Podcast)
Can’t See the Wood for the Trees (SBA)
The Climate Crisis – How will air pollution affect my patient’s health? (Blog)
Heat Stroke (SAQ)
TERN Top Papers July 2022 (Research)
Delirious after Dialysis (Clinical Case)

Other news

Statutory launch of Integrated Care Systems – everything you need to know

As part of the provisions of the Health and Care Act 2022, integrated care systems (ICSs) have moved to a statutory footing as Friday 1 July.

This means that: 42 integrated care boards (ICBs) will be legally established, covering every part of England.
They will form integrated care partnerships (ICPs) with the NHS, GPs, upper tier local authorities, wider community, voluntary and social enterprise partners to jointly plan and provide health and care services based on the needs of the people in their areas.
Clinical Commissioning Groups (CCGs) will no longer exist and their relevant legal functions will transfer to ICBs.

You can find out more about integrated care systems, including public resources and other materials, and read more about the work that is already underway here.

Flexible working guides

The NHS Staff Council and NHSEI have produced two new flexible working guides for frontline managers and for staff.

The King’s Fund – Why should health policy matter to clinical staff?
In this new blog from The King’s Fund, GP trainees Dr Ree’Thee Bhatt and Dr Devina Maru share their experiences of working in health policy roles. They also outline why an understanding of policy-making is crucial to enabling clinicians to influence change in the health and care system.

NHS Confederation – What are integrated care systems?
On 1 July 2022, integrated care systems (ICSs) became responsible by statute for planning and funding health and care services. They are a core part of the NHS long-term plan from 2019 and build on how services have been working together at local levels to orientate health and care much more around the people they serve rather than their organisational boundaries. Their establishment represents the first large-scale structural change to the NHS since 2012. This briefing explains what ICSs are, how they will work, and what they mean for the public.

Nuffield Trust – Was the NHS overwhelmed last winter?
Throughout the pandemic, politicians and other policy-makers have emphasised the need to protect the NHS from collapse or overwhelm but even before Covid-19, the health service struggled to stay above water given worsening capacity, staffing and demand issues, especially during the colder months. This briefing looks at what happened to urgent and emergency hospital care last winter, when another wave of the virus hit the country during a time when it would be stretched to its absolute limits even without a pandemic.

NHS Providers: new hospital programme survey
To understand trusts’ experience and progress to date, NHS Providers carried out a survey of trusts currently included within the new hospital programme covering questions around funding, delays and the value of the programme. Nearly two in three leaders who responded said delays to the programme affected their ability to deliver safe and effective patient care, with all those facing delays reporting cost implications.

NHS Confederation – NHS Oversight Framework 2022/23: what you need to know
The NHS Oversight Framework describes NHS England’s approach to oversight of integrated care boards and trusts for 2022/23. It builds on the approach outlined in the NHS System Oversight Framework 2021/22. This briefing contains an overview and analysis of the framework and highlights the main changes for 2022/23.

House of Commons Committee of Public Accounts – The rollout of the Covid-19 vaccine programme in England
This report calls for efforts to be redoubled to reach those not vaccinated or fully vaccinated as it warns that nearly three million adults in England are unvaccinated against Covid-19. It finds that comparatively low vaccination rates persist in many vulnerable groups and have even dropped further for some. It calls for NHS England and UKHSA to urgently evaluate which methods are most effective for increasing uptake, including fresh approaches to tackle the persistent low uptake observed in some ethnic groups.

Ipsos MORI – GP Patient Survey 2022: national report
The GP Patient Survey (GPPS) is an England-wide survey of patients aged 16+. It provides GP practice-level data about patients’ experiences of general practice. Ipsos administers the survey on behalf of NHS England. This report sets out the national headline and summary findings for the 2022 GPPS. The proportion of patients reporting a good overall experience of the GP practice decreased to its lowest level for five years (72.4 per cent) – a 10.6 percentage point decrease compared with the 2021 survey (83.0 per cent). This had steadily declined from 2018 to 2020, followed by an increase in 2021.

The Health Foundation – Projections: general and acute hospital beds in England (2018–2030)
This research reviews past trends in hospital bed numbers and sets out projections for the number of general and acute beds required in 2030/31 under different assumptions about the time patients spend in hospital. Under the central projections, an additional 23,000 to 39,000 beds would be needed in 2030/31 to deliver 2018/19 rates of care. Policy-makers have options available to meet demand, but anticipating and planning for the long term is critical to ensure the NHS has the capacity it needs.

Nuffield Trust – Fronting up to the problems: what can be done to improve the wellbeing of NHS staff?
The NHS is not in a position where it can lose staff, but many workers in the health service have faced almost unimaginable difficulties during the pandemic. How worried should we be about NHS staff health and wellbeing? This long read looks at how bad the situation is and what can be done to improve things.

Department of Health and Social Care – Women’s health strategy for England
This document sets out the government’s strategy for women’s health in England. It details the government’s ambitions over the next 10 years and outlines the actions being taken to improve the health and wellbeing of women and girls in England.

DHSC: NHS Pension Scheme: proposed uplifts to the member contribution tier thresholds
Further to the consultation NHS Pension Scheme: proposed changes to member contributions from 1 April 2022 and the associated regulations, this consultation document sets out how the pensionable earnings thresholds in the member contribution structure will be uplifted to account for the Agenda for Change pay increase. The consultation document also includes part of a table that was omitted from the regulations, and the draft regulations contain technical amendment to correct this omission. The closing date for comments is 12 August 2022.

General Medical Council (GMC) – National training survey: 2022 results
The GMC’s annual national training survey, completed by more than 67,000 UK doctors – all either trainees or trainers – reveals a continuing worsening trend in answers to questions about workload and burnout. While most trainees rated the quality of their training highly, and nine in ten trainers said they enjoyed their roles, the risk of burnout is now at its worst since it was first tracked in 2018. The GMC is calling for clinicians’ wellbeing and training to be at the heart of workforce planning as health services continue their post-pandemic recovery.

NHS Confederation – The Covid-19 inquiry: learning the lessons
A final version of the terms of reference for the Covid-19 inquiry has now been approved by the Prime Minister. Although public hearings are not expected before 2023, the inquiry team is now formally established under the Inquiries Act 2005 and can begin its work. This report sets out the NHS Confederation’s view on the situation facing the NHS when the pandemic began, how events unfurled and core considerations for the Covid-19 inquiry.

The Health Foundation – NHS workforce projections 2022
This analysis shows that the NHS in England could face a shortfall of around 38,000 full time equivalent (FTE) registered nurses by 2023/24 relative to the numbers needed to deliver pre-pandemic levels of care. This is despite the expectation that the government could meet its own target of recruiting an additional 50,000 FTE registered NHS nurses by the end of the parliament. It argues that the government needs to acknowledge the growing demand for care driven by an ageing population and an increased number of people with complex health conditions. It also explores potential gaps in the nursing workforce over a longer time period beyond the next election.

House of Commons Health and Social Care Committee – Workforce: recruitment, training and retention in health and social care
This report finds the NHS and social care face the greatest workforce crisis in their history, compounded by the absence of a credible government strategy to tackle the situation. The report outlines the scale of the workforce crisis: research suggests the NHS in England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives; evidence on workforce projections say an extra 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade; and hospital waiting lists reached a record high of nearly 6.5 million in April 2022. The Committee finds the government to have shown a marked reluctance to act decisively. The refusal to do proper workforce planning risked plans to tackle the Covid backlog – a key target for the NHS.

House of Commons Health and Social Care Committee – Expert panel: evaluation of government’s commitments in the area of the health and social care workforce in England
This evaluation by a panel of independent experts considered how the government had progressed overall against seven commitments it has made in three policy areas across the NHS and social care: planning for the workforce; building a skilled workforce; and wellbeing at work, including reducing high rates of bullying in the NHS. The panel rated the government’s overall progress ‘inadequate’ in meeting these targets.

House of Commons Public Accounts Committee – Management of PPE contracts
This report identifies ‘significant failings’ in the management of PPE contracts that have led to a stockpile of almost four billion items that are not needed. It finds little evidence of action being taken against potentially fraudulent suppliers despite the Department of Health and Social Care’s estimate that as much as 5 per cent of PPE expenditure may have involved fraud. The report urges that more robust and transparent practices should be put in place to prevent such losses in the future.

Net Zero NHS embedded into legislation
The NHS has become the first health system to embed net zero into legislation, as the new Health and Care Act comes into force (1 July, 2022).

The Health and Care Act of 2022 recognises that the response to climate change is good for the health of the public, and places new requirements on all NHS Trusts, Foundation Trusts, and Integrated Care Boards to meet net zero and tackle air pollution. It grants new statutory guidance powers to NHS England to support the fulfilment of these new duties, ensuring every Trust and ICB has its own localised Green Plan and Board-Level lead.

Since the NHS became the world’s first health system to commit to carbon net zero – by 2040 for the emissions it controls, and by 2045 for the emissions it can influence – excellent progress has been made. NHS staff have performed the world’s first net zero delivery and surgery; launched the first zero emission ambulance; embedded the response to climate change into the governance and strategy of every Trust; and secured over £550 million for energy efficiency and renewable energy initiatives.

Find out more about what this news means for the NHS here: Greener NHS » Organisations (england.nhs.uk)

The European Emergency Medicine Congress – 15-18 October 2022
Have a look on the online programme to get a full scope of all the different tracks, interactive formats and hands-on sessions. There will be interprofessional tracks and tracks dedicated for i.e. nurses, paramedics, young doctors and there’s even a German spoken track. You can work on your practical skills during the pre-courses and morning workshops.

Doctors in Training Induction programme updated
The Doctors in Training (DiT) Induction elearning programme has been reviewed and updated by subject specialists ahead of the new academic year.

Following feedback from practising clinical staff as well as doctors currently in training, sessions from the programme have been updated to improve the experience for learners.

DiT is aimed at foundation doctors (F1 and F2) and focuses on professional skills in the workplace through 3 patient journey scenarios, along with an assessment to confirm compliance.

It addresses some identified gaps in knowledge for doctors prior to starting their next year on 1 August.

It is also suitable for returning doctors and doctors from overseas working in primary care, secondary care and community settings.

The 3 patient journey scenarios are based around areas that doctors in training have highlighted as those they find most challenging. They include:

Blood transfusion and consent
Safe prescribing and venous thromboembolism (VTE)
Mental Capacity Act and death certification

The learning objectives for this programme have been specially written by experts.

More information, including access details, is available on the Doctors in Training Induction page.

Applications open: Health and Social Care Expert Panel to recruit two additional members
The Health and Social Care Committee is seeking to fill two vacant seats on its Expert Panel. The panel, chaired by Professor Dame Jane Dacre, will provide the Committee with an independent evaluation of Government progress in key areas of health and social care policy.

Individuals who wish to be considered for appointment should send a brief CV—no more than three pages—, a covering letter of no more than 500 words and a declaration of relevant interests to hsccom@parliament.uk by 5pm on Thursday 18 August.

The covering letter, which should be addressed to the Chair of the Committee, should set out the candidate’s relevant expertise, give an indication of the amount of time they could realistically devote to panel work, and confirm the ability to take on work at short notice if required. The declaration of interests should include anything that a reasonable person might consider could influence the advice which might be given to the Committee: for example, active membership of a campaign group or relevant financial arrangement. Declared interests from successful applicants will be published.

For further information or to discuss the role, contact the Head of Secretariat for the Expert Panel, Yohanna Sallberg by email: hsccom@parliament.uk.

National Ambulance Service Medical Directors – Extreme heat emergency clinical guidance
As annual temperatures in the UK and across the world continue to rise and there are more frequent and severe heat waves, learning from international experience becomes more important.

Early in the summer of 2021, in British Columbia, Canada they experienced an unprecedented extreme heat event that tragically led to the deaths of hundreds of people. Temperatures were at least 15°C higher than usual across the entire province, but some areas and some people were affected more than others. Most of the people who died were older (excess deaths occurred mainly in the over 50’s) or were people who had health conditions that put them at higher risk. Most of the deaths occurred inside private homes that got dangerously hot.

They have shared the learning from this event to improve health outcome in countries with similar climates who experience a severe heat wave.

NHS Mandate
The Government’s mandate to the NHS for 2022-23 has been updated following the implementation of the Health and Care Act.

DHSC evaluation strategy
The Government has published its evaluation strategy setting out the DHSC vision for high-quality evaluation of its policies, programmes and projects across the department and its partner organisations.

GMC launching Associates recruitment
The GMC has launched a recruitment campaign for associates to undertake CESR evaluations. To help support a timely and efficient CESR process, the GMC is inviting applications from doctors in all specialties. It’s designed as a supportive measure to colleges in recognition of some longstanding difficulties in undertaking CESR evaluation, to enable them to focus on manageable workloads and consequently bring the service timescales back within target and statutory requirements. The GMC has already set up a variety of working methods with some colleges, including providing clinical input, administrative input and undertaking some CESR evaluations themselves. The GMC will continue to work flexibly with each college so they can find the best solution for each specialty.

Academy of Medical Sciences’ policy position – COVID-19: what next?
The AMS has published its latest position statement and blog outlining their views on what should be considered, both for COVID-19 and more broadly, as we proceed into winter 2022 and beyond.

RCEM Newsletter - July 2022

Welcome from the President

College News

Events

Policy

Quality and Audit

Membership

RCEM Lifestyle Rewards

Examinations

Training

eLearning

Other news

BMJ Careers