Information on working as a Clinician in Emergency Medicine
The following resources within this section are designed to assist with consultant working and job planning. Find below information on:
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* Please note that the references to Consultant staffing in the remainder of the historic RCEM guidance has been superseded by the above publication.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 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.
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.
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.
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:
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.
* 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.
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.
We urge all working in Emergency Departments or responsible for emergency care systems to take the time to read the strategy. Then ensure that:
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.
Civility saves lives
National Guardian’s Office
Blogs & videos
The ED Spa works on the principle of 5 elements of well-being:
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