Published: 15/07/2004, Volume II4, No. 5914 Page 5

Accident and emergency departments are suffering difficulties from a shift by non-consultant grade doctors to better-paid GP out-of-hours services, emergency care czar Professor Sir George Alberti has warned.

Sir George said the shift to primary care work, following the dramatic increase in out-of-hours pay, was 'an expanding problem'.

Although there are no current figures on the move by staff and associate specialist-grade doctors, Sir George said he needed 'hard facts'.

Department of Health emergency medicine adviser Matthew Cooke warned that SAS doctors in A&E are already leaving emergency work for primary care because they can 'literally double' their salaries.

'You are talking about people going up from£40,000-£50,000 a year to£60,000-£100,000.'

Some parts of the country already survive with locums and report that there is a problem.

Chesterfield and North Derbyshire Royal Hospital trust director of personnel and hospital services Terry Alty said: 'We have a problem in attracting the noncareer, middle-grade medical staff.

We haven't picked up anything locally about losing these people to out-of-hours services but we can see the potential for difficulty.'

Dr Andrew Newton, SAS lead at Weston General Hospital, part of Weston Area Health trust, said his department could not recruit enough SAS-grade doctors. The problem would become acute as more out-of-hours services come online because companies offer 'very attractive' remuneration.

The SAS grade doctors can currently earn from£29,845-£70,648 and have fewer training and career opportunities than other doctors.

Of 6,500 SAS doctors, according to a 2003 Department of Health report, 71 per cent qualified outside the UK and often teach specialist registrars and senior house officers who earn more than them.

British Medical Association staff and associate specialists committee chair Dr Mohib Khan said a new contract for his grade of doctor was proposed 'but we haven't even started negotiating yet.'