News and views from The Royal College of Emergency Medicine. Please use the "On this page" menu below for contents.
This is my first newsletter as your President of our College. I must thank Katherine Henderson for all of her tireless work of the last three years and her efforts to properly induct me into this role. Despite all the challenges that we face, she leaves the college in a strong place as an authoritative and representative voice for Emergency Medicine.
October has been a busy month for the College. I really enjoyed the Annual Scientific Conference in Belfast, the local organising committee and the events team put on an excellent three days. At the conference we held our AGM, but we ran over during the session meaning we didn’t have time to address some of the questions asked. However, we’ve collated them, and you’ll find our answers to those questions within this newsletter.
During the AGM our Chief Executive talked about the issues we’ve had with Exams and what we have done and are doing to improve. However, we know that there are still some delays in getting some exam results out. This is due to increased checks, but we are clear that it is better to be right rather than fast. We understand and apologise for the frustration that this causes, but we are working to fix this. More positively, we have confirmed exam dates and application windows for 2023 and have increased capacity for our OSCE exams and made some other changes, as we seek to improve.
The restorative benefits of a face-to-face educational meeting must not be underestimated, and I would encourage all of you to attend a College conference, study day or CPD meeting at least once a year. There are a number of enjoyable conferences this autumn, please consider attending the EMTA Conference in Blackpool and the EMSAS Conference in Milton Keynes. There are a number of excellent study days too in November such as ‘Managing the transition from trainee to consultant’ and ‘The really useful guide to leading and managing your ED.’ North of the border, the Scottish policy forum is always interesting and good value.
Work continues to be a challenge, hopefully our new starters in the specialty are finding their feet. RCEM executives and the policy team continue to advocate externally on your behalf both to NHS England and the devolved nation equivalents. England recorded its worst four-hour access standard performance in type 1 Emergency Departments in September and similar pictures were seen in the devolved nations.
I represented the specialty at a House of Lords Select Committee about access to emergency care. I have taken part in numerous roundtable online events with ministers and MPs. The messages that we transmit have not changed, we continue to argue that the crowding and poor performance is a consequence of exit block, inadequate inpatient capacity and a failure to fund and reform social care. We continue to advocate for better staff retention, better workforce planning and meaningful metrics. Unlike many colleges we continue to be vocal in the media about our challenges, there is little we say in public that we do not say in private though obviously we go into more detail than a carefully crafted sound bite.
The Quality in Emergency Care Committee has published two relevant guidelines this autumn. There are updates on Infection Prevention and Control and Acute Behavioural Disturbance.
Continuous flow models have hit social media and some of the mainstream press in a heated and unhelpful manner. Our view is that continuous flow models are a mitigation for poor bed capacity, the evidence base is weak. However, the situation is so dangerous in emergency departments and ambulance services that trusts should be obliged to at least consider and trial them. It is unlikely that one size fits all. These need trust wide leadership to become effective.
Nationally there have been shortages of blood with NHSBT issuing an amber alert. This like much of the NHS, has been driven by staff shortages. The positive response from the public suggests moving to a red alert status is unlikely. Currently there is a small increase in the number of COVID-19 cases and while flu has arrived it has not reached epidemic proportions yet. I would urge all of you to get your flu and COVID-19 vaccines and to encourage your staff members as well.
The CQC published an important report called the State of Care 2021 / 22 earlier this month. They correctly identify the immense pressure that are Emergency Departments are under. This report is valuable because it takes a whole system view and identifies and provides objective analysis about the challenges facing workforce; it’s well worth a browse if you have 10 minutes.
Dr Adrian Boyle
President, Royal College of Emergency Medicine
At our AGM earlier this month, we were delighted to welcome Jason Long, Maya Navari and Salwa Malik to their roles as Vice President. You can follow them on their new Vice President Twitter accounts:
Dr Salwa Malik – @RCEMvp_Salwa
Dr Maya Naravi – @RCEMvp_Maya
Dr Jason Long – @RCEMvp_Jason
Dr Ian Higginson remains as VP for another term and can be followed on Twitter at @RCEM_VP.
The College thanks our outgoing VPs, Dr Carole Gavin and Dr Lisa Munro-Davies, for their work over the past three years and wishes them every ongoing success in what they do.
Dr John Thompson has now demitted from his role as Vice President for Scotland and we are delight to welcome Dr JP Loughrey to the role. JP can be followed on Twitter via @VP_Scot_RCEM.
We wish John well and thank him for his dedication, advocacy and fantastic work for both the College and EM in Scotland.
College Dean vacancy – apply now
We are looking to appoint a new Dean. The Dean is core to the College’s educational activities. The College’s Education Directorate has recently gone through a period of great change. Some of the recent changes include:
The Education Directorate must now concentrate on ensuring:
The Dean will be instrumental in assuring that the work across the Education Directorate is coordinated and College Committees are updated appropriately.
The Dean also is a Trustee of the College and so also sits on the College Board and Council.
We hope to interview shortlisted candidates during the week of 14 November, this date subject to confirmation.
For more information on the role of Dean and if you have any questions please contact the Interim Dean, Jason Long (email@example.com).
To apply please send a covering statement explaining how you meet the person specification (see role profile) and your CV to firstname.lastname@example.org before the closing date of 31 October.
On 4 October we held our Annual General Meeting at our Annual Scientific Conference in Belfast, with members also able to join us online.
Unfortunately, we ran over time and were unable to answer your questions on the day, but we’ve gathered them together below with our answers.
With the cost of living rapidly increasing, including our mandatory memberships and examination fees, do you support the junior doctors striking over the next year?
We understand our members concerns about conditions, particularly in this cost-of-living crisis, but as a charity and because of the mandate outlined in our Royal Charter, we must frame such issues in a way that reflects the impact these challenges have on patient care.
As such, we view this through the lens of workforce retention; retaining staff is crucial for emergency care and patient safety, yet all parts of the NHS are haemorrhaging staff and more must be done holistically to retain them. Staff must be valued.
A government that identifies itself as being on the side of the patient must tackle retention and staffing issues to prove this. We strongly encourage the government to take action in this area.
It is for the British Medical Association (BMA) to argue for and agree details of pay and conditions, and we encourage the government to engage with them as part of wider efforts to solve retention issues.
The College is of the view that industrial action is a matter for individual members of the BMA but that members of the College other than junior doctors will endeavour to ensure patient safety is not compromised should strike action proceed.
Providing emergency care to patients neither endorses nor undermines the arguments of any party to the dispute. We support our members right to choose.
Could the college confirm that pre-CCT but post-fellowship trainees will not be charged the same rate as consultant membership?
All post FRCEM but pre CCT members will have their membership rate extended for the subscription year following their FRCEM pass. Members who fall into this category will be contacted by member services later this year.
Given that so many of our colleagues are finding full time training unsustainable due to the workload and conditions, will the college consider readjusting the definition of what full time training means?
The Training Standards Committee will discuss this.
What is the college going to do about the FRCEM SBA and running out of spaces last week – some candidates had to sit from home and then connections failed?
What is your response to the difficulties faced by the September FRCEM diet where candidates were told with a few days’ notice that their exam was cancelled, before then being offered an online platform that crashed multiple times?
This issue was caused by our supplier, Pearson Vue, cancelling centre bookings at very short notice. We always prefer candidates use centres to avoid connection issues and the vagaries of home broad band. In this case we were given no alternative by our supplier other than to offer candidates the chance to sit from home. It is extremely frustrating for candidates, and this is a factor in our internal review work.
Gordon, the mistake that happened with FRCEM SBA affected only UK candidates or both UK & international candidates & what proportion each?
The error did affect a range of candidates from the UK and overseas. Those who failed but were close to passing were impacted and these comprised candidates largely from the UK, but also Ireland and the Middle East. For GDPR reasons I do not want to give more specific data on where the candidates were located as it might lead to them being identified.
Who did you get feedback from regarding last year’s ARCP being well received? I was the ACCS EM deanery rep that year and took direct feedback from all trainees in my deanery following the curriculum change and the feedback on how well supported trainees felt in the lead up to and during ARCP was resoundingly terrible. Also, as a trainee I was not asked for any feedback about the ARCP process from RCEM so presumably your feedback was either only from trainers or a very select number of trainees?
We had feedback from a range of sources. This led us to the view that where trainers and trainees were well prepared then it worked as expected. It sounds as if the commentator here had a disappointing personal experience which was at odds with some of the feedback we have received. We encourage that individual to reach out directly to ePortfolio@rcem.ac.uk to discuss what we can do to make this work better for those coming through the process. We continue to meet regularly with the Emergency Medicine Trainees Association to take their feedback on our services so feel free to also pass you views on to them, so that they can make sure we are also picking this up at our meetings with them.
The College is in the process of recruiting an ePortfolio Manager. The ePortfolio Manager will be responsible for the operational management of the ePortfolio platform, ensuring that it is fit for purpose to support Training Team activities for clinicians in training and allied health professionals. They will also ensure that the ePortfolio platform and Training Team processes deliver excellent user experience to its users.
Any comments on CESR program investment and improvements?
The CESR pathway is growing in popularity and last month we had already received more applications to date than we did for the previous year. To ensure that the College can respond appropriately to queries and provide a satisfactory service to CESR applicants we have funded a permanent CESR Officer to work with the Senior CESR Officer to support CESR applicants and applications. We are also reviewing how CESR applications are reviewed and will trial panel reviews to review if these increases the review time for applications.
Thanks for your honesty and effort this year over the exams Gordon and teams. Still work in progress though.
Yes, this is work in progress, there is a wide range of improvements and process reviews we have underway. We have, as I said, already reinforced the results processes and included extensive internal and external checking before the results are released. The improvements we want to make in our IT systems will need us to procure and implement new systems which will take some time to undertake.
Do members of the college miss out on the ‘photocopier’ chats by working at home – has this affected efficiency?
The College staff have to attend the office for a minimum of five working days a month and come in additionally when needed. This is designed to ensure that the benefits of face-to-face interaction are not lost. We don’t see a loss of efficiency through the revised arrangements as our systems have been designed to make this model effective.
Would you consider pushing for training numbers to be WTE rather than total numbers?
Yes, we need good data to understand this, but it is very likely that there are enough trainees working less than full time that we should argue for more training numbers when we discuss with NHSE and HEE or devolved equivalents
Non trainee with experience more then 5-10 years in ED, can become examiner…can participate in ARCP process?
Yes, they could but there is not an official process/policy on this. RCEM does not dictate who sits on an ARCP panel – this is a local Deanery level. Perhaps this is what we could develop and future proof the area.
As part of our internal review work, we will be reviewing the criteria to be a question writer for our exams. This will be a great way to get involved in the exam process at RCEM.
Exam dates and application windows for 2023 have now been confirmed.
We are extremely grateful for all the feedback and input we’ve received from candidates, trainee representatives, examiners and committees in developing these exam dates. This feedback has helped us to ensure that the exams calendar for next year improves our way of working and will enhance the customer service we offer to all our stakeholders.
Below are the key changes to note.
Increased capacity for OSCE Exams
Demand for MRCEM & FRCEM OSCE exams has continued to grow in recent years as the number of candidates progressing through our written exams has increased. We are pleased to confirm that we have increased capacity for both MRCEM & FRCEM OSCEs in 2023.
An additional 200 spaces will be available to MRCEM & FRCEM OSCE candidates in 2023, a 12.5% increase compared to 2022.
We’re also increasing capacity for MRCEM OSCE exams in the UK, to 1080 spaces (three diets of 10 days, with 36 candidates each day), with FRCEM OSCE capacity increasing to 640 spaces (two diets of 10 days, with 32 candidates each day).
Whilst we are increasing the total number of days of MRCEM OSCE exams, these will be run over three diets rather than four. It is important to note that this reduced number of diets will not affect the total number of examining opportunities for candidates each year. The existing application and results release timelines means that candidates could apply to and sit a maximum of two OSCE diets each year; this will remain the same when running three diets instead of four.
A key factor in this proposed change is to help alleviate pressures and difficulties around examiner recruitment, which has been a particular issue with MRCEM OSCE exams in recent years. Since February 2022 we have recruited 94 UK Examiners and 26 overseas Examiners. You can find more information about how to become an examiner or other ways to get involved with exams here.
Consistent application windows
From 2023, application windows for all exams will be two weeks long.
Once an application has been submitted, candidates will receive an acknowledgement email including details of when applications will be reviewed by, which is typically three weeks after the application window closing date.
For OSCE exams, candidates will receive details of when allocations will be confirmed by, and candidates applying to written exams will be given dates of the respective Pearson VUE booking window, which will open once applications have been approved.
This change will give greater transparency to candidates throughout the registration process and ensure a more efficient approval and booking process.
See the 2023 exam dates on the Exam Calendar & Fees page.
RCEM runners complete Royal Parks Half Marathon 2022 to raise funds for EM research
On Sunday 9 October 2022 over 16,000 participants took part in the 15th anniversary of the Royal Parks Half Marathon covering 13.1 miles past London’s tourist sites and Royal parks.
Amongst them RCEM was proud to be represented by three runners fundraising to support funds for our charitable work, supporting Emergency Medicine departments internationally in low-income countries, medical research programmes and well-being support for EM staff in the UK.
Our three RCEM runners were supported and cheered on at various points on the course by a RCEM cheer squad joining an amazing atmosphere on a sunny autumn morning. The RCEM runners were all fantastic, all managing to complete the 13.1 miles and all surpassing their fundraising targets with over £2,000 raised collectively at the time of writing. A big thank you to all our runners for all their dedication to their training as well as their efforts in raising funds for us!
If you would like to support our fundraising efforts you can donate to our runners via: www.justgiving.com/campaign/RCEM-RoyalParks2022 or donate as a one of for regular giver via the RCEM donation page.
Our next event will be the London Landmarks half marathon on Sunday 2 April 2023, so if you are interested in finding out more would like to take part then please contact email@example.com
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: –
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.
RCEM PhD Fellowship
The RCEM PhD Fellowship application window is now open. Applications are invited from trainees in Emergency Medicine (EM) from CT1 and above, who wish to develop academically.
Applications must be received by Friday 13 January 2023. For further information, including an application form and application guidance, please visit our Research webpages.
Spring Grant Call
The Research Committee’s semi-annual grant call is now accepting applications for funding. Members can apply for up to £10,000 to support their EM research project.
Applications must be received by Friday 31 March 2023. For further information, including an application form and application guidance, please visit our Research webpages.
Royal College of Emergency Medicine and NIHR awards 2022
The Royal College of Emergency Medicine and NIHR awards 2022 are now open. The award categories are:
Applications close on 24 November 2022. For further information on the different awards, as well as application forms and guidance, please visit the National Institute for Health and Care Research website.
Undergraduate Essay Prize
Applications are invited for the 2023 Royal College of Emergency Medicine Undergraduate Prizes.
Applicants are required to be an undergraduate student at a recognised teaching institution within the UK but are not required to be a member of the Royal College of Emergency Medicine.
Applications must be received by Friday 24 February 2023. For further information, including an application form and application guidance, please visit our Research webpages.
James Lind Alliance Emergency Medicine Priority Setting Partnership
Last month the RCEM/JLA EM Priority Setting Partnership Refresh held an in-person workshop at Octavia House.
A mixture of patients and clinicians discussed the questions that had been submitted to the refresh, and proposed a new top 10 list of research priorities:
All frontline health care and social care workers should be offered vaccination by their employer. This is an employer’s responsibility to help protect their staff and patients or clients and ensure the overall safe running of services. Employers should commission or implement a service which makes access to the vaccine easy for all frontline staff, encourages staff to get vaccinated, and monitors the delivery of their programme. The complementary NHS influenza vaccination offer for primary care staff has not been extended for the 2022 to 2023 influenza season. Influenza vaccinations for primary care staff, like other frontline healthcare staff, revert to being an employer’s occupational health responsibility.
As for last season, the definition of a frontline healthcare worker for the influenza programme will be aligned with that of the COVID-19 vaccination programme to include both clinical and nonclinical staff who have contact with patients. One of the quality indicators in the 2022 to 2023 Commissioning for Quality and Innovation (CQUIN) is a goal of vaccinating between 70 to 90% of staff.
Please do speak to your employer about getting your flu jab.
Our latest podcast discusses the best of our October 2022 issue, covering a superb qualitative study exploring the experience of older adults in the Emergency Medicine Journal with a wonderful accompanying editorial; a look at variation in practice for treating pre-orbital and orbital cellulitis in children; the association between anticoagulation and mortality in major trauma; point of care testing for tetanus immunity and more.
Read the highlights: emj.bmj.com/content/39/10/723
You can subscribe to the EMJ podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest podcast every month.
Shortage of blood – a note from Professor Stephen Powis, NHS England’s National Medical Director
Launched less than a month ago the COVID-19 autumn booster is currently available to people aged 65 years and above, people at increased risk from the virus (including those with a weakened immune system), frontline health and care workers, care home residents and pregnant women. Over 5 million have topped up their protection ahead of winter.
Vaccinating frontline healthcare workers remains a priority, promoting staff wellbeing and benefitting patient care. Last year around 80% of healthcare workers were vaccinated for Covid and 59% for influenza. We have an opportunity to build on this which will be important given the likely impact of cocirculation for the first time.
We wrote to you last month to provide operational guidance for the delivery of the campaign. Please support and promote these efforts, which include encouraging colleagues to attend booster appointments and, where possible, offering combined seasonal influenza and Covid vaccination appointments.
You may have seen a recent national audit by NHS Blood and Transplant which showed limited compliance with the use of tranexamic acid in surgical patients. Results from the POISE-3 clinical trial published in May reconfirm the quality, safety and cost-effective benefits of tranexamic acid use in moderate surgery in adults, where blood loss is expected to be >500ml. This further supports the NICE quality statement on blood transfusion.
The UK Royal Colleges Tranexamic Acid in Surgery lmplementation Group has been established to highlight the affiliated NICE guidance and promote good practice. This is especially pertinent as national blood stock supply is currently limited and predicted to fall further this month. Increasing the use of tranexamic acid may reduce the risk of cancelling elective surgery because of limited availability of blood stocks. Please share this with your colleagues, especially those in your surgical and anaesthetic departments.
RCEM Volunteering Opportunities
We’re looking for Chairs and Vice Chairs to support committees across the UK, along with new committee members!
Are you interested in representing fellow members and advocating for patients in your region? Are you looking for opportunities to develop both personally and professionally? If so, then please check out our volunteering page for opportunities to get involved.
Current vacancies include:
For further information contact us at firstname.lastname@example.org. Finally, please share this call out with your networks.
Nitrous Oxide and Prehospital Emergency Medicine – Information Sheet for Emergency Care Providers
Nitrous oxide is a commonly used gas in prehospital and emergency settings in the form of a 50:50 mixture of oxygen and nitrous oxide, e.g. Entonox®. Used correctly, nitrous oxide can be a very safe and effective analgesic medicine. For some patients it may be the best option pain relief. However, there are broader implications of use of the drugs for both delivery of patient care, and the environment.
The NHS in England has pledged to be carbon net zero by 2040. The NHS is responsible for 4- 5% of total UK carbon emissions, and anaesthetic gases have been identified as a ‘carbon hotspot’.
This information sheet, put together with the College of Paramedics, Association of Ambulance Chief Executives, and the British Association for Immediate Care looks at the impact use of Nitrous Oxide has on the environment and what the alternatives are to its use.
RCEM Annual Report & Accounts 2021
The college has published the Annual Report and Accounts for 2021. This report details the activities of the college being carried out by your fellow members on behalf of your college.
Read the full report and accounts here.
#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
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:
You can also follow our current VPs for the devolved nations:
The really useful guide to leading and managing your ED
Date: 3 November 2022
This one-day event will focus on being a senior doctor, and how to look after your senior doctor team, with topics useful for those new in the role as well as those with more experience, and those seeking to lead senior teams.
View the programme online and book now
The small, remote or rural ED
Date: 4 November 2022
The UK’s remote, rural and small emergency departments present particular challenges in terms of workforce and sustainability. This study day aims to share best practice and equip delegates with the tools to manage these seemingly unassailable difficulties.
View the programme online and book now
Ultrasound Train the Trainers Workshop
Date: 9 December 2022
This course is aimed at consultants, higher specialty trainees, and experienced associate specialty doctors who are keen to lead and teach ultrasound skills. The course covers the 2021 RCEM ultrasound curriculum and changes to the assessment process and includes hands-on training sessions.
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:
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.
We are delighted to announce the return of the Royal College of Emergency Medicine Scotland’s in-person Policy Forum event. This event will take place on 8th November 2022 in Edinburgh. This is the first face to face Scottish policy forum since 2019 so we are excited to be delivering a jampacked programme. Book HERE.
There will be talks on the impacts of social deprivation and modernizing NHS24. We will also hear updates from the ambulance service, the Scottish Drugs Taskforce, and key findings from the Scottish Workforce census amongst many others.
Additionally, there will be an opportunity to meet with the Royal College of Emergency Medicine’s College President, Dr Adrian Boyle. Finally, the day will close with a drinks reception and the chance to network.
The event is open to everyone! CPD certificates will be sent to those who attended the live session ten working days from the end of the event. Please note, you are required to attend the live event to receive your CPD certificate.
Click HERE to book your place and see the full programme.
Date: 8th November 2022
Time: 9:00 – 17:30
Location: Apex Grassmarket Hotel, 31 – 35 Grassmarket, Edinburgh, EH1 2HS
‘Mental Health Emergency Care’ is the latest report in our series of explainers looking at the web of issues facing Emergency Departments. The report highlights that while patients with mental health presentations account for a very small proportion of Emergency Department attendances, they spend a disproportionate amount of time waiting for a mental health bed if they need admission.
The report pulls together data from across the health and care sector and finds that patients presenting with mental health problems are twice as likely to spend 12-hours or more in Emergency Departments than other patients.
The report also looks in detail at factors contributing to these long waits, such as the reduction in mental health beds, inadequate numbers of children and adolescent mental health professionals, and poor organisation of professionals to assess patients under the Mental Health Act. It also examines the consequences for patients and departments and makes wide reaching recommendations.
Updated guidance on syringe labelling in anaesthesia and critical care areas from the Association of Anaesthetists.
The RCEM QI guide has been updated! This is a practical guide for clinicians undertaking quality improvement in Emergency Departments. This guide is designed to assist Fellows and Members who are undertaking Quality Improvement (QI) work in their Emergency Departments. It is intended to help bridge the gap between improvement science and implementation. This guide is complimentary to the many of the excellent guides that already exist, such as the Academy of Medical Royal College’s report on Training for Quality Improvement and those produced by the Health Quality Improvement Partnership. This guide is pragmatic, providing a useful ‘how to’ guide, but is also aims to introduce the reader to the common terminology, jargon, concepts, and processes within the QI field. It also introduces the narrative of QI: it’s development, the role in healthcare, ethical considerations, and the relationship between QI and RCEM.
The RCEM / NPIS Guideline on Antidote Availability for EDs has been updated (Oct 2022)
The RCEM Coronavirus Infection, Prevention and Control Guidance has been updated (Oct 2022)
Thank you to Dr Haroon Rashid who has shared two new patient advice leaflets developed at Manchester Royal Infirmary.
Both can be read on our Local Guidance pages under ‘discharge advice’
If your Emergency Department has guidelines or patient advice that you are willing to make available to others via this page, please contact email@example.com.
As we approach 2023, 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 as we head towards 2023 so we can ensure you’re paying the correct membership subscription.
Update your details here: https://login.rcem.ac.uk/iCore/Contacts/Sign_In.aspx
RCEM provides reductions on subscriptions to those who are: –
Reduced subscriptions are also provided in recognition of the following:
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.
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 today to pay for your 2023 subs by Direct Debit by logging into your account.
It’s important for us to ensure the demographic data we hold on our members is up to date. If you haven’t already, please provide and/or review your data in your account on the link below. This information will help us to help us to ensure we can help you in the long term, by making sure that we are representing and including all demographics in our work.
Provide your EDI data here by logging into your account.
Further information on the criteria for membership discounts is available on our website and if you have any queries about your membership subscription, please contact us via firstname.lastname@example.org, by phone on 0207 404 1999 or via LiveChat on 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: www.rcem.ac.uk/subscriptions2022.
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 email@example.com to let us know and we’ll get this in the post to you.
Remember all professional learners including students, trainees and ACPs are able to access TOTUM PRO membership.
With over two hundred UK discounts and thousands worldwide from both famous brands and local independents, a TOTUM PRO membership opens up a whole world of fantastic savings on everything from dining out and keeping fit to fashion retail and travel abroad.
A one-year membership is £14.99 members save on average £550!
For more information and to access membership, login to your RCEM account.
We are now offering free, 24/7 confidential helpline support for all our members via a Health Assured Individual 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:
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
The EMJ provides a wealth of guidance on what you can do to have the best possible chance of your submission being published. All the information can be accessed via these links and there is even a step-by-step guide from the EMJ’s Editor-In-Chief via their YouTube channel.
RCEM merchandise is available via our online shop. Thermal travel mugs, hoodies, notebooks, water bottles and other items (including new pin badges and ties) can be bought via www.rcemshop.co.uk so get your merch and show your EM pride!
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:
It’s an all-in-one outdoor oven… A game-changing innovation in outdoor cooking. It’s a charcoal oven, it’s a pizza oven, it’s a smoker, and it’s a bbq grill. Free Charlie rack worth £250…
|Montagu Arms Hotel
Unique Charm & Timeless Elegance
This luxurious hotel is the perfect setting for your Christmas or New Year break.
There’s no better place to spend this magical time of year…
Rustic Garden Art Made in Devon…
Members save 10% on fabulous handcrafted rustic garden structures all made in Devon.
A great addition to any garden!
Reaching New Heights…
Warm up your evening with our unique and mesmerising Firestorm Pellet Stoves, our eco-friendly Patio Heaters.
Members save 10%
Master Every Moment…
Simple Moments of Brilliance to make cooking simpler, better, faster, and easier.
Members save 15% across the range!
|Careys Manor Hotel & SenSpa
A World of Pure Relaxation…
Fantastic Christmas and New Year Breaks.
A quintessential country hideaway with a sensational spa in the ancient New Forest National Park…
|Big Severn Adventure
Canoe the magnificent River Severn… Your Big UK Canoeing Adventure Begins here. Experience the thrill of navigating your way down Britain’s longest river. Members save 20%.
|Its Got Soul
Shoes for busy feet!
A family business that designs and manufactures fashionable and comfortable shoes for ladies who are on their feet all day.
Members save a stylish 15%
Luxury Bedding for Less…
From sumptuously soft bed linen to timeless bedspreads and accessories, it’s time to add luxury to your lie in…
Members save 15%
Distinctly British Clothing and Footwear…
One of today’s most sought-after brands for contemporary, elegant British-styled outdoor clothing… Members save 10%.
Bringing the flavours of the world direct to your home… Authentic, unique and difficult to find ingredients sourced from the Middle East, the Mediterranean and beyond, direct to your kitchen. Save 20%.
|Oliver Co. London
Minimalist Sustainable Accessories
Minimalist vegan accessories made from premium sustainable fabrics. Add personalised embossing for the perfect ethical gift.
Save a stylish 10%
YOUR PASSION, YOUR NOTCH
Celebrate sports, hobbies, achievements, love, milestones, positivity, family, pets, with a personalised NOTCH Bracelet.
|Tilly & Blue
Heartfelt Pet Portraits…
Memorialize your Pet with a traditional, lifelike portrait painting, brimming with heartfelt detail.
Members save £10 plus free shipping.
Four for Three Promotion!
An extensive collection of beautiful photo frames with a unique print & fit service.
Members enjoy a special Four for Three promotion!
2023 Examination Dates
Examination dates and application windows for next year have now been announced and can be found here. We are extremely grateful for all of the feedback and input we’ve received from candidates, trainee reps, examiners and committees in developing the examinations calendar for next year, which includes 200 new spaces for our UK OSCE examinations and consistent application windows. You can read more about changes to our examinations calendar here.
A group of senior UK examiners travelled to Malaysia in September to help deliver the first MRCEM OSCE examination in Malaysia. The examination was hosted by Dr Shaik Farid Abdull Wahab at the College of Emergency Physicians Malaysia and ran perfectly. Huge thanks to Farid and his team for organising, hosting, and delivering such a high-quality examination for 135 candidates. This was also our first examination using the newly approved Domain Based Marking system, which is now in place for all OSCE examinations.
To transition to the 2022 Curriculum on ePortfolio, please create an event named ‘Curriculum Migration’ by selecting ‘Create a new event’ on your ePortfolio dashboard. Upon submission of this form, the College will process the request and will aim to have enabled your transition within 10 working days.
We have been receiving a number of queries regarding how the foundation skills should be signed off. ACPs must be able to demonstrate capability at entrustment level 4 in all foundation skills, ideally within the first three months of commencing or transitioning to the 2022 RCEM ACP curriculum. How capability is assessed will be a local decision agreed by the RCEM ACP Educational Supervisor. To support this, we have created a Foundation DOPS (ACP) form which ACPs, in discussion with their Educational Supervisor, may wish to use as a tool to assess each individual skill. Completed Foundation DOPs will sit in the timeline but will not be linked to Foundation Procedural Skills within Goals.
Evidence required for credentialing by the ACP Credentialing Panel will be an ACP Adult (or Children) Foundation Sign-off form on Kaizen, completed by the RCEM ACP Educational Supervisor. This form, which will automatically link to Foundation Procedural Skills within the ACP’s portfolio, can only be created by an ES who has completed the 2022 curriculum RCEM ACP Supervisor training and has been assigned the RCEM ACP Educational Supervisor role on Kaizen and, therefore, completion of this form may be delayed beyond three months, providing capability to the appropriate entrustment level has been demonstrated. Foundation DOPS for each individual skill may be reviewed and used as supporting evidence by the RCEM ACP ES to confirm capability when completing the sign-off form
Full Transition Guidance, Credentialing Help sheets will be published on our website by the last week of November. Please see our curriculum page for updates:
Fry → risr/
Kaizen → risr/advance
Our ePortfolio platform is called ‘Kaizen’ and is hosted by a company called ‘Fry’.
Fry are currently undergoing a rebrand to reflect their service and product offering. Fry will be rebranded as ‘risr’.
What does this mean for us as Kaizen users?
Going forward, Kaizen will be renamed risr/advance. There will be light touch visual changes, including logos, fonts (which have been accessibility tested and verified) and colours.
These changes will go live from Tuesday 15 November 2022. You will still be able to access ‘Kaizen’(RISR/advance) via the current URL www.kaizenep.com until late October 2023, after this risr/ will make changes to the domain to reflect the rebrand.
This rebrand will have no effect on the functionality of the EPortfolio or the formatting of events and users are not required to perform any actions to activate these changes – just sit back and enjoy the transition.
You will receive an email (from firstname.lastname@example.org – invitation to Kaizen) with your username and a link for you to set a password.
Please ensure you check your spam folder, as it may end up there.
Once you have added a password, please login to kaizenep.com and select Royal college of Emergency Medicine as the Organization. – Please see guidance below
How to login
We recommend reading the FAQs section on how to use the ePortfolio (how to add posts, how to add supervisors, how to create assessments and common queries such as My supervisor is not able to view me).
Please ensure the end date at the top of the Add a supervisor event is set up. Supervisors and College tutors will be able to view your ePortfolio only within the date range you set up for them.
If you are unable to link events to the curriculum (select Key Capabilities within your forms), please contact email@example.com with your training programme (Run-Through/Core/Higher) and deanery
Once we have received this information, we will amend your portfolio accordingly.
They’re back! Join us every other Wednesday and Thursday; on zoom, for an opportunity to get into the nitty gritty of your EPortfolio issues and questions with our team. Not sure how to link and tag to the curriculum? Can’t seem to find an assessment? Just simply unsure of how to use the tool at all… We’ve got you!
These are open drop-in sessions, where you can ask questions about how to navigate and manage your Kaizen EPortfolio, and have any issues resolved. Feel free to pop in, have your queries resolved and then pop out!
Click here to join the meeting (Wednesdays and Thursdays – 11 am to 12 am and every two weeks – dates below)
All drop-in sessions are strictly to address Kaizen difficulties you might encounter (e.g. an assessment I linked to a Learning outcome is not showing in the goals section) and to provide guidance on EPortfolio use. For question about Training/curriculum you might want to speak with your supervisor, or you can write an email to firstname.lastname@example.org.
Until Next time!
Monday – Friday 09.00-17.00
General eportfolio queries, please contact: email@example.com
Enrolment queries, please contact: firstname.lastname@example.org
Call: +020 7404 1999
Here’s a selection of some of October’s most popular publications:
Trust Doctor ST3+ Emergency Medicine
Blackpool Teaching Hospitals NHS Foundation Trust
£33,885 to £51,069 a year pa pro rata
The purpose of this post is to provide broad and detailed knowledge, skills and expertise to the Department of Emergency Medicine, at senior level
Specialty Doctor Emergency Medicine
United Lincolnshire Hospitals NHS Trust
£50,373 to £78,759 a year per annum
This is an exciting opportunity to join the talented team at Grantham District Hospital supporting the Emergency Department team
Specialty Doctor – Emergency Medicine
Hywel Dda University Health Board, Haverfordwest
Depending on experience £50,620 – £79,144 pa
We are looking to appoint enthusiastic, focused and forward-thinking Specialty Doctors to join our highly supportive Emergency Department
A full list of vacancies is available here.
NHS England has produced guidance for NHS organisations outlining six key aspects that trusts should focus on to support the health and wellbeing of their staff in the coming winter months. It was produced to address the likely operational pressures arising during these months and outlines the importance of prioritising staff wellbeing and high-quality patient care.
The six key actions for NHS employers relate to:
The NHS Employers webpage links to the NHSE guidance and additional resources for supporting staff.
This Nuffield Trust blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
Nuffield Trust analysis of initiative in some hospitals have been trialling an approach of moving a set number of patients into inpatient wards each hour regardless of bed availability.
Framework agreement between Department of Health and Social Care and Health Education England 2022 to 2025
This framework agreement defines how the Department of Health and Social Care and Health Education England will work together to serve patients, the public and the taxpayer. It sets out roles, responsibilities, governance and accountability arrangements.
Centre for Health Economics – The potential for payment reform to influence emergency admissions: the case of blended payment in the English NHS
This research paper investigates hospitals’ inclination to admit patients who attend their accident and emergency (A&E) departments. It considers the potential impact of the blended payment reform on emergency admissions.
Skills for Care – The state of the adult social care sector and workforce in England 2022
Key findings from this year’s annual report include: there are 165,000 vacant posts – an increase of 52 per cent and the highest rate on record; the number of filled posts (posts with a person working in them) has dropped by 50,000 – the first drop in the number of social care workers ever; average vacancy rates across the sector are at nearly 11 per cent, which is twice the national average; care workers with five years’ experience are paid 7p per hour more than a care worker with less than one year’s experience; and the average care worker pay is £1 per hour less than health care assistants in the NHS that are new to their roles.
The Health Foundation – A framework for NHS action on social determinants of health
This long read outlines a framework to understand potential approaches for NHS organisations seeking to address social factors that shape health, focusing on the role of local and regional action – for instance, in the new integrated care systems (ICSs). It reviews existing frameworks, examples from NHS policy and practice, and evidence on interventions often promoted in the NHS in England. It highlight gaps in knowledge that must be addressed to clarify the role of the NHS in addressing social needs, and identifies policy priorities for the future.
NHS Confederation – A renewed vision for the NHS
This report outlines NHS Confederation members’ views on what national bodies and the government should consider when planning for the future, including how Long Term Plan priorities may need to be adjusted post Covid-19.
DHSC – NHS Pension Scheme: response to consultation on proposed amendments to continue the suspension of restrictions on return to work
The government consulted on proposals to continue temporary retire and return easements in the NHS Pension Scheme to 31 March 2023. Consultation respondents argued that the suspension of Special Class Status abatement should be extended for longer than was initially proposed. This consultation response confirms that the government will extend the suspension of Special Class Status abatement to 31 March 2025.
The King’s Fund – Poor NHS buildings mean poor NHS care
While the government is promising to build ’40 new hospitals’, this blog considers the reality for patients and staff in existing NHS buildings and the cost of dealing with the maintenance backlog.
GMC – The state of medical education and practice in the UK: the workforce report 2022
This report finds that the number of doctors joining the workforce overall has grown by around 17 per cent over the past five years, but that growth is not consistent. It varies considerably between different groups of doctors, leaving a shortfall in primary care that puts at risk patients’ ability to access GP services. The number of specialty and associate specialty (SAS) and locally employed (LE) doctors on the GMC register has increased at six times the rate of GPs, largely driven by doctors coming from overseas. Current rules actively prevent these doctors from working in areas such as primary care, and the GMC is proposing the government change the Performers List criteria to allow more doctors to work in general practice.
NHSE – Operating framework for NHS England
This operating framework sets out how NHS England will operate in the new structure created by the 2022 Health and Care Act. The framework describes the roles that NHS England, integrated care boards (ICBs) and NHS providers will now play, working alongside partners in the wider health and care system. It shows how accountabilities and responsibilities will be allocated to improve local health and care outcomes in a way that maximises taxpayer value for money. The framework has been co-created with 300 system leaders, organisations and stakeholders, including Health Education England and NHS Digital.
National Audit Office – Introducing integrated care systems: joining up local services to improve health outcomes
This report examines the setup of integrated care systems (ICSs) by the Department of Health and Social Care, NHS England, and their partners and the risks they must manage. The report is not an assessment of whether the programme has secured good value for money to date because ICSs have only recently taken statutory form. Instead, it is an assessment of where they are starting from and the challenges and opportunities ahead. It makes recommendations intended to help manage those risks and realise those opportunities.
NHS Confederation – The link between investing in health and economic growth
This analysis finds that growth in health care investment has a clear relationship with economic growth. The analysis brings together longitudinal data from multiple sources linked at the local level across all of England. It shows that for each £1 spent per head on the NHS, there is a corresponding return on investment of £4 – showing an economic benefit to investing in our National Health Service.
CQC – The state of health care and adult social care in England 2021/22
This year’s annual assessment is that the health and care system is gridlocked and unable to operate effectively. Most people are still receiving good care when they can access it – too often, however, people are not able to access the care they need. Without action now, staff retention will continue to decline across health and care, increasing pressure across the system and leading to worse outcomes for people. Services will be further stretched, and people will be at greater risk of harm as staff try to deal with the consequences of a lack of access to community services, including adult social care.
The RCGP has published a report “Fit for the Future Retaining the GP Workforce” which explores the extent of the current retention crisis by drawing on available data to identify why GP workforce numbers are decreasing month on month and the factors that drive poor retention. The King’s Fund has also surveyed GP trainees on their plans for their own careers and on the future of general practice more generally.
Amidst rumours that the proposed Health Disparities Whist Paper may be ditched by the Government, over 155 organisations have signed a letter from the RCP-convened Health Inequalities Alliance to urge Health and Social Care Secretary to publish health disparities white paper.
A smartphone app called GoodSAM sends alerts to first aiders when someone nearby has had a cardiac arrest (their heart stopped beating). Research found that, when a first aider responds to the alert, the person’s chances of survival doubled.
Survival rates for people who have a cardiac arrest when they are not in hospital are poor. Only 1 in 10 of these people survive to hospital discharge. Timing is critical; every minute’s delay in restarting the heart reduces the chance of survival.
GoodSAM is one of several apps that alert first aiders, and it is available around the world. In the UK, ambulance services have integrated the GoodSAM app into their systems. When they receive a call for a suspected cardiac arrest, the app sends an alert to users within a certain distance. Users must have a first aid or professional healthcare qualification.
Researchers looked at the numbers of people who survived until they were discharged, following an out-of-hospital cardiac arrest. The study, in London and the East Midlands, showed that people were twice as likely to survive when an alert was sent than when it was not (for instance if no nearby first-aiders were registered to the app).
The researchers say that more needs to be done to increase the number of app users.
Read more at: https://evidence.nihr.ac.uk/alert/more-people-survived-cardiac-arrest-first-aiders-goodsam-alert/
NHS England’s new sickle cell awareness campaign, part of a bigger drive to improve sickle cell care across the NHS, aims to increase awareness of the key signs and symptoms of a crisis. Anyone can be born with Sickle Cell disorder, but it is most common amongst people from a black Caribbean or black African background.
Immediate action should be taken if an individual has any of the following symptoms, as they could be signs of a crisis or complication: pain; fever; one-sided paralysis or weakness in the face, arms or legs; confusion; difficulty walking or talking; sudden visual changes; unexplained numbers; severe headaches, breathlessness, chest pain or dizziness.
Launched to coincide with Black History Month, the ‘Not Family, But Blood’ campaign highlights that although the Black community is diverse, one unifying thing is the power to treat sickle cell and provide life changing blood donations.
Sickle cell is more prevalent in people of Black heritage and ethnically matched blood provides the best treatment, but more Black donors are urgently needed to meet the increasing demand.
The rising demand is driven by increasing patient numbers, as people live for longer, and greater use of complete blood transfusions – known as red cell exchanges – which improve patient outcomes.
NHS staff can complete a new free e-learning module to support increased knowledge of the condition and how to treat it. The training module also includes information on healthcare inequalities related to the condition: https://www.e-lfh.org.uk/programmes/health-inequalities/
Become a blood donor through the GiveBloodNHS app, by calling 0300 123 23 23, or by visiting www.blood.co.uk. If a local session is full, please book an appointment for a later date – your blood is still needed, and you will save lives.
Health Education England elearning for healthcare (HEE elfh) has recently updated its adult asthma elearning programme with updates to sessions and a new programme webpage on children and young people with asthma.
For more information and to access the new children and young people sessions, please visit the Children and Young People Asthma programme page.
Updated adult sessions can be found on the Adult Asthma programme page.