Wales Emergency Medicine: Staff shortages & health service in crisis

A landmark survey of Emergency Medicine staff in Wales has found that there are far too few clinicians to cope with demand within the stricken health service.

The Royal College of Emergency Medicine’s ‘Wales’ Emergency Medicine Workforce Census 2023′ is an in-depth analysis of the state of the Emergency Medicine workforce, providing an insight into the working patterns of clinicians and allowing a forecast to be made around the future workforce needs of Emergency Departments in Wales.

The census had responses from all 12 major Emergency Departments in Wales and found:

• There is one WTE Consultant per 7784 annual attendances, considerably less than the RCEM recommended figure of 1:4000.
• Of these 101 consultants, 19 are planning to retire in the next six years – a fifth of the consultant workforce.
• There were 90 gaps in the consultant rota, 33 in the middle grade rota and eight in the junior rota. Inability to recruit was the primary reason for rota gaps.
• This is leading to departments in Wales not meeting RCEM best practice recommendations of having an EM consultant presence for at least 16 hours a day in all medium and large systems.
• When asked for future staffing needs, departments across Wales reported needing an increase of 75% consultants, 120% increase in the ACP/ANP/PA workforce, 44% increase in the ENP workforce, 30% increase in the Higher Specialist Trainees/ Non-consultant Senior Decision Maker and a 50% increase in Junior Doctors in the next six years.

Dr Suresh Pillai, Vice President of the Royal College of Emergency Medicine Wales, said: “The findings of this vital census are stark and really shows why Emergency Care in Wales is broken; we simply have too few staff.

“We are way off the RCEM recommended ratio of one WTE Consultant per 4000 attendances. This means existing consultants are stretched extremely thinly in Emergency Departments. We need more consultants for the safe supervision of trainees and junior staff.

“It’s no wonder that many are exhausted, burnt out and looking to leave. Exhorting staff to work harder and ‘find efficiencies’ to improve care just won’t wash – they are already at their limits, doing their very best. Any service that is not properly resourced will eventually collapse, and this survey makes it abundantly clear that the crisis emergency care finds itself is down to having too few staff, attempting to deliver too much. That’s not the fault of patients or because there is ‘too much demand’, it’s the result of a failure to plug the significant gaps in staffing and address retention issues.

“We need sustainable long-term workforce planning to ensure there is a pipeline of doctors coming through. We are way behind where we need to be in terms of staffing and things will only get worse in the years to come if this isn’t addressed. Nearly one fifth of the consultant workforce plan to retire in the next six years, but departments are saying they need at least 75 more right now.

“We’re keen to work with the First Minister, Mark Drakeford, to discuss the Emergency Care crisis and need for long-term workforce planning; the Welsh government must provide the funding to increase the EM consultant workforce by an additional 100 consultants as a matter of urgency, and to facilitate this we must see an expansion to the number of EM training places offered by 15 and maintained year on year.”

The census also found that junior doctors were also being overstretched:

• At the time of collection there were 52 trainees in the ST1-6 programme as well as 95 non- Emergency Medicine trainees working in EDs across Wales
• Junior doctors work one weekend every three weekends, consultants work one weekend every 6.2 weekends.
• Junior doctors in training also do the most night shifts with an average of 52 per year.

Dr Suresh Pillai said: “Junior doctors are being asked to do too much and we need to see an expansion in training places as soon as possible, to spread the load and help fewer feel the need to drop out of training.

“It’s clear that current conditions are having an impact. Increasing numbers of trainees are choosing to work less than full time in an effort to achieve more sustainable careers. This is entirely understandable, but it has an impact on care; people choosing to leave or work less means an ever-greater burden is put on existing staff, resulting in compromised care and burnout, meaning they want to do the same. We have to address this urgently and make the specialty – and health care – more attractive to trainees.

“The total number of consultants that we would like to see by 2027 as a minimum is 225, but current trainee numbers are not substantial enough to reach this aspirational target following the training cycle, during which some will naturally drop out. In addition to the extra training places needed, the government must look to launch an extensive recruitment campaign to attract trainees to train and work in Wales. Without these places and a concerted effort to increase staffing, the future of Emergency Care in Wales looks very bleak indeed. We hope the Welsh government recognises this and we hope we can work together to improve conditions for staff and the quality of care for patients.”