Royal College of Emergency Medicine Menu Menu
Working as an EM Clinician

Working as an EM Clinician

Information on working as a Clinician in Emergency Medicine

Consultant Working & Job Planning

The following resources within this section are designed to assist with consultant working and job planning. Find below information on:

  • The Consultant Contract and Job Planning for EM Consultants
  • Supporting Professional Activities in Consultant Job Planning (SPAs)
  • SPA Activity Exemplar
  • Role of the EM Consultant On Call
  • Exceptional Circumstances

RCEM Workforce Recommendations 2018: Consultant Staffing in Emergency Departments in the UK

Find below the Royal College of Emergency Medicine’s RCEM Workforce Recommendations 2018 / Consultant Staffing in Emergency Departments in the UK:

* Please note that the references to Consultant staffing in the remainder of the historic RCEM guidance has been superseded by the above publication. *

The Consultant Contract and Job Planning for Emergency Medicine Consultants

The BMA has prepared guidance which provides a broad overview of the principles of the 2003 Consultant contract together with specific advice appropriate for Emergency Medicine consultants. The objective is to enable Emergency Medicine consultants, and thus their patients, to work within and benefit from the 2003 contract. In view of the differences in contract between each of the UK nations the document has aimed to cover the general principles with details based on the English contract and then to highlight specific differences for other nations.

The guidance was prepared by the Emergency Medicine subcommittee of the Central Consultants & Specialists Committee with input from the RCEM Professional Standards Committee. The document is based, with permission, upon the 2005 guidance published by the Association of Anaesthetists of Great Britain and Ireland. Both committees gratefully acknowledge the generosity of the AAGBI in allowing us to benefit from their work.

This is a working document and the BMA and RCEM welcome comments and suggestions for improvement in order to periodically update and revise the guidance as necessary. Please send any comments to Sam.Mcintyre@rcem.ac.uk or contact the BMA CCSC EM subcommittee.

Supporting Professional Activities in Consultant Job Planning (SPAs)

The Academy of Medical Royal Colleges has published a statement on SPAs (Feb 2010). This includes recommendations from RCEM which reflect issues relevant to Consultants in Emergency Medicine. RCEM welcomes this statement and would note the benefits for patients of Consultants having adequate SPA time to develop and maintain a high quality service.

Further to the Academy statement, Mr Don MacKechnie has written an open letter in response to a number of recent queries regarding the College‘s position on what it considers an appropriate number of SPAs for a new EM consultant post.

The College advocates, as stated in the 2003 contract, that for full time consultants the Job Plan will typically include an average of 7.5 Programmed Activities for Direct Clinical Care duties and 2.5 Programmed Activities for Supporting Professional Activities.

SPA Activity Exemplar

The College provides here a worked example of how to set about calculating the number of hours of non-clinical (SPA) time that Consultants working in Emergency Departments require.

The College remains convinced that to deliver a safe, effective and efficient service each consultant will need at least 10 hours per week engaged in the activities this document describes. The list of activities described is not exhaustive and each department will have some specific local requirements. Similarly some of the activities listed here will not be relevant.

The department described is a mixed Emergency Department (ED) and Major Trauma Centre which sees 90,000 new patients per year. The senior workforce is made up of 12.95 whole time equivalent consultants. Elements of this document obviously relate to local practice and agreement, and to local objectives and stage of development. The total time is also more than that is currently available to the existing team, and prioritisation will be required. However, it is hoped that this exemplar will act as a useful framework, which can be applied to discussions with hospital management teams across the United Kingdom and Republic of Ireland.

Role of the EM Consultant On Call

The Royal College of Emergency Medicine is the professional body responsible for setting standards of clinical and professional practice in Emergency Medicine in the UK. This statement outlines the view of the RCEM on this matter.

Emergency Departments (ED) must have an Emergency Medicine (EM) Consultant on-call at all times. An on-call EM consultant has similar responsibilities to other on-call consultants. In consequence they may be required to:

  • provide direct senior clinical input into serious/complex cases out-with the expertise of other hospital teams
  • provide telephone advice on clinical, medico-legal and ethical issues.

Each ED and hospital should be staffed and resourced to a level sufficient to manage predictable peaks in workload, 24 hours a day, seven days a week.

All hospitals should have clinical and managerial teams on site able to deal with predictable events that may pose a clinical risk to individual or multiple patients, including increased attendance numbers, crowding due to acute bed shortages (exit block) or staffing issues.

Consultants are ‘on call’ to deliver expertise in clinical cases beyond the experience / skill level of resident clinicians. This enables cost effective delivery of senior clinical expertise. By definition therefore, tasks that do not require senior clinical expertise e.g. acting-down to cover staff absence, are not ‘on call’ responsibilities and must be addressed via other mechanisms. Where capacity deficits have created queues, these too should be addressed through standard operating procedures that mobilise other clinicians within the hospital or redirect appropriate patients to medical, surgical or paediatric assessment units. Good risk management should seek to maximise resources available to deal with such problems., and avoid concentrating multiple risks in a single area.

If exit block is considered to be such a problem that the ED is rendered unsafe, then the duty management team including the executive on call and the relevant medical and surgical consultants must attend the hospital. Exit block is a problem of ‘downstream’ capacity – an ED consultant can only mitigate the effects in the ED whilst colleagues seek solutions within the hospital and community.

All escalation policies should follow the guidance published by the Royal College of Emergency Medicine and endorsed by NHS Improvement (England) and the Scottish Government.

The decision as to whether an ED is unsafe should normally be taken by the nurse and doctor in charge of the ED.

UK employment law requires all employees to have 11 hours of uninterrupted rest in every 24-hour period. In the NHS this is to ensure the health and safety of patients as well as that of employees. Compensatory rest arrangements (taken when the above rest periods are interrupted) are very disruptive to ED rotas and as such the need to trigger them should be minimised.

It is particularly unsafe to require any employee with overnight on call responsibilities to work frequently or substantially in excess of their rostered shift times. This is a significant issue for consultants working late evening shifts and then on-call overnight. No employee should be required to extend their shop-floor shift beyond 12 hrs. Fatigue is not a defence when faced with litigation or regulatory sanction.

Exceptional circumstances

  • The on-call EM consultant will provide clinical leadership of the emergency department in the event of a “Major Incident”.
  • Arrangements for consultant presence 24/7 for other forms of alert or escalation protocol are unfeasible given current UK staffing levels.
  • Trusts running separate trauma consultant rotas should have clear guidance in place regarding activation of the trauma team. Ordinarily the trauma team leader role cannot be conflated with other roles or responsibilities.

* For the purpose of this document, the term “consultant” refers to that doctor, on the ED senior on-call rota, who has the responsibility to respond to any telephone calls for advice or to return to the ED for the specific reasons discussed in the document.

Note: Supervision to trainees in Emergency Medicine of ST4 and above, can, normally, only be provided by a consultant who is on the specialist register in Emergency Medicine.

Sustainable Working

Creating successful, satisfying and sustainable careers in Emergency Medicine

Key guidance

The College has developed this important strategy to improve the working lives of clinicians working in Emergency Departments in the UK. The guidance documents are specifically aimed to help guide Clinical Directors of Emergency Medicine, clinicians, employers and commissioners of emergency healthcare.

Key elements

  • Work patterns: For Emergency Medicine doctors these need to be well structured, sustainable and satisfying. The College has produced suggested solutions for working practices especially for out of hours and night time working by senior medical decision makers through annualised job planning. Recommendations on the ways in which annualised job plans can enhance working patterns are described.
  • Models of ED function: These have changed over the years and the approaches that clinicians must consider both working in the ED in different roles, how to describe the specialty and profile it to others is vitally important.
  • Flexible careers: Working practices for females and males in Emergency Medicine are changing and the specialty lends itself to allowing better work-life balance and integration as well as enhancing portfolio careers for those choosing to work less than full time.
  • Decades of clinical life: The ways in which careers can be developed pro-actively through each decade of a clinical career to maintain satisfaction and longevity are described.
  • Team working and leadership: A range of tips on how to optimise your team and leadership skills as well as better develop these skills in members of your team are described.
  • Maintaining well being: Creating tailored strategies to maintain well being and embedding them into daily practice are critical to career sustainability. Equally important is the need to recognise early features of chronic stress to prevent possible burnout in colleagues. This is an area that the College will continue to expand on in the future.
  • Valuing trainees: Much formal work is ongoing via Health Education England, the GMC and other agencies in this area. In our guidance, a range of top tips from trainees and trainers provides an overview of things that cost little and yet can have a dramatic impact on the future career paths of the young trainee.

What next?

We urge all working in Emergency Departments or responsible for emergency care systems to take the time to read the strategy. Then ensure that:

  • You act upon those components that you can directly influence.
  • Give the strategy to your Clinical Director (if you are not one) and your team. Decide upon the areas of the strategy that most apply to you and devise a local implementation plan.
  • Decide how you can best influence the Executive team and non-Executive team at your Trust/ Hospital Board as well as commissioners to firstly read and then act upon the strategy.
  • Devise a timetable to monitor progress.

Anti-bullying

Our members’, and all healthcare professionals’, workplaces should be free from all forms of bullying and harassment. Our Sustainable Working Practice Committee along with other RCEM committees are developing work to tackle bullying in the workplace and in our view the working environment should allow healthcare professionals to work with dignity and respect, without the unacceptable threat of bullying and harassment. Bullying and harassment undermines physical and mental health and can lead to reduced performance and increased sickness absence.

Below are some useful resources from RCEM and other organisations that are there to support you.

RCEM

RSCed

GMC

BMA

Civility saves lives

National Guardian’s Office

Wellness resources

Resources

Blogs & videos

Key messages

  1. Looking after your body – be active
  2. Looking after your mind – keep learning and take notice
  3. Connecting with people – invest in relationships and give

The ED Spa works on the principle of 5 elements of well-being:

  1. Connect: Take time to invest in meaningful relationships with family, friends, colleagues and communities. Strong, meaningful relationships will encourage and support you.
  2. Be Active: Play sport, walk, run, dance, garden, cycle, swim and many more. Find the thing you enjoy that gets you active.
  3. Give: Be grateful, be kind, do something nice for a friend or a stranger.
  4. Keep learning: Learn a new skill, find a hobby or take on a new challenge.
  5. Take notice: Pay attention and be in the moment, notice how you are feeling.

More information on the principles of the ED Spa and how to create one in your own ED ware coming over the next few months. You can also follow or contact the ED Spa on twitter.

Great wellness organisations

RespectED

Our workplaces should be free from all forms of bullying, harassment and undermining. The Sustainable Working Practice Committee along with other RCEM committees are developing a campaign which aims to give you access to resources and solutions to help you tackle bullying and undermining. This behaviour undermines physical and mental health and can lead to reduced performance and increased sickness absence.

Bullying and harassment in the NHS is conservatively estimated to cost the taxpayer £2.281 billion per annum. We know from research by Professor Jan Illing and colleagues that bullied staff are less likely to work in effective teams, raise concerns or admit mistakes, but we also know this can have dire consequences for patient safety and care.

Emergency Medicine has its own set of challenges. See the EMJ Supplement April 2019: Bullying in the Emergency Department – stopping the vicious cycle.

If you are experiencing this type of behaviour – or know a colleague who is suffering, or think you may be bullying or undermining a colleague or patients, this page is for you. This type of behaviour can often be insidious, not always overtly disruptive but is corrosive. Seek help. Talk to somebody and do it now. You are your workplace culture. Below are some useful resources from RCEM and other organisations that are there to support you.

RCEM is working with partners from across healthcare professions to offer advice and other initiatives, such as the anti-bullying Alliance, aimed at developing practical solutions to address bullying in the medical workplace.

Please view the Video below.

Working as an EM Technician Play

Below are some useful resources from RCEM and other organisations that are there to support you.

RCEM

RSCed

RCOG

GMC

BMA

Civility saves lives

National Guardian’s Office

RCS (Eng)

  • This four-part podcast series focuses on themes of culture change developed in collaboration with the Royal Australasian College of Surgeons.
Back to top Back to top