Safety fears as junior doctors abandon A&E

The GMC made targeted visits to seven hospitals between December and February. It found many junior doctors were not planning to choose A&E as a career due to the the workload and intensity of the job.

The checks were prompted by rising concern about education and training in emergency medicine, particularly around very junior doctors working unsupervised at night.

The GMC’s report found many A&E departments were relying on doctors in the early years of training due to shortages of more senior clinicians.

It said: “With less clinical experience, and often no previous experience in emergency medicine, they are often not able to make difficult decisions quickly.”

Junior doctors told the regulator this made them feel “marginalised” and contributed to the decision not to apply for further A&E training.

The GMC found patients “frequently” waiting in A&E departments “because of pressures elsewhere in the hospital and in some cases a lack of beds”.

It also found many departments struggled to have out-of-hours access to mental health services, leading to long waits in A&E for those patients.

Inspectors also found consultants “working beyond their contracted hours and doing the work of other doctors to fill rota gaps”, adding: “At most of the departments we checked, we were told current rotas at all levels were not sustainable.”

Many juniors said their senior colleagues had “little or no work-life balance”, with many juniors planning to take a career break, work abroad or spend time with their family.

The GMC said it currently has concerns about the standard of training in 16 hospital emergency departments.

These concerns include a lack of clinical supervision both during weekdays and overnight; insufficient staffing levels, poor quality locum doctors and junior doctors being asked to work beyond their competence or carrying out inappropriate tasks.

In April 2012 an audit of emergency departments found 20 sites that did not have on-site supervision from a senior doctor overnight.

According to the GMC, only 61 junior doctors accepted an A&E training place across the country despite 115 receiving offers and 177 initially applying.

GMC chief executive Niall Dickson said: “Training the next generation of senior doctors in this area of medicine is absolutely vital and we need to make sure they are given the supervision and support they need to develop.

“It is crucial that they are valued and continue to pursue a career in this specialty. If we do not get this right we will not attract the doctors we need to work in emergency medicine.”

The seven hospitals examined were the University Hospital of North Tees; the James Cook University Hospital in South Tees; Leeds General Infirmary; Kings Mill Hospital in Nottinghamshire; Queens Medical Centre, Nottingham; Royal Bournemouth Hospital and Jersey General Hospital.