• Royal college of Emergency Medicine says funding negotiation ‘on going’ for plan
  • Arm’s length bodies insist funding finalised for plan unveiled last month
  • Arm’s length bodies refuse to comment on how much funding is available

The Royal College of Emergency Medicine has said talks are ongoing over funding for a much vaunted national plan to address the emergency care workforce, despite national officials saying it has already been agreed. 

The strategy, Securing the future workforce for emergency departments in England, was launched last month jointly by NHS England, NHS Improvement, Health Education England and the Royal College of Emergency Medicine.

In an exclusive interview with HSJ, RCEM president Taj Hassan said funding negotiations were still “on going” despite a recruitment for new trainees for the scheme due to start in January.

But a spokeswoman speaking for the three arm’s length bodies insisted “full funding” had been agreed “at the time of publishing the plan”. The ALBs however refused to say how much funding had been agreed.

Dr Hassan hailed the plan as the “most comprehensive workforce strategy the college has ever been involved in [in] our history” and praised the NHS arm length bodies for backing and developing the blueprint.

But the funding remained an area for further discussion, he said. “The problem is that it was done at pace and there are on-going discussions about how we are going to fund this strategy. The commitment is there. Everyone is agreed that we need the money to make it happen, [but] that discussion is going on between Health Education England and NHS England.”

Neither Dr Hassan or NHS central bodies would comment on how much the programme will cost to run. It was however reported last month that the figure would be in the region of £10m over the next four years.

HSJ understands funding will ultimately come out of HEE’s budget. It is also understood a decision on how much funding for the new leadership programmes and other incentive programmes designed to address attrition also still needs to be finalised.

Dr Hassan argued the programme would deliver substantial longer term savings by cutting the locum bill. “[Emergency departments] spend about £400m on locum and agency a year – about 20 per cent of NHS’s total locum spend. This is about transforming that locum spend into substantive positions. A registrar in emergency medicine costs about £55,000, a locum doing the equivalent work costs about £130,000.”

The ED medical consultant workforce grew from 1,187 to 1,632 whole time equivalents between 2012 and 2017. But A&Es remain hugely dependent on locums. RCEM calculated in July this would need to more than double, adding an extra 2,200 extra A&E consultants, in the next five years in order to keep pace with demand and fill in existing gaps.

The strategy builds on HEE’s emergency medicine programme, which over the last three years has seen the number of emergency medicine training posts increased from 225 a year to 300 a year.

It commits to pushing this to 400 new trainee posts per year for four years, although “the additional 100 posts are more of a mixed economy. They can come in at a more senior level,” Dr Hassan said.

As well as increasing the overall numbers of ED staff the strategy also aims to address the high attrition rates of existing ED trainees and consultants, currently running at 40 to 45 per cent for all staff, and retention rates.

New measures in the strategy included a pledge of “investment” from April 2018 “in a leadership/personal development training programme for every emergency medicine trainee in England to help reduce attrition”.

It added: “Starting in April 2018, we will provide funding to and work with a third of the trusts (45) highlighted in the General Medical Council training survey as having the biggest problems with their training environment, to develop and implement clinical educator strategies.”

A statement produced on behalf of NHSI, NHSE and HEE said: “At the time of publishing the plan, full funding was agreed with NHS Improvement, Health Education England and NHS England, including the need for additional investment in our existing and trainee workforce.

“Funding for the plan is made up of existing money already in the system, which will be used more effectively to support and develop our A&E workforce, as well as a some centrally funded additional monies to support national initiatives.

“We are now in the process of making final arrangements to implement the plan.”

The British Medical Association last month  raised concerns the workforce strategy’s pledge to hugely increase the number physician associates could see patients treated by junior staff, when a more senior clinician would be more appropriate.

The strategy said the NHS would “increase significantly over the next few years [the physician associates training pipeline]: we will have 3,200 quualified PAs in 2019 compared to around 350 now…This will provide significant additional clinical resource for EDs”.

BMA council chair Chaand Nagpaul, said: “Physician associates are a valued part of the NHS but it’s important to be clear about the scope of their work, which is to provide an intermediate level of care and help reduce workload pressures.

“Only doctors can provide certain types of care so the government need to ensure that standards won’t be affected by these changes and the quality of patient care will be protected and maintained.

Dr Hassan told The Times the plans would improve care quality. “Change is always difficult for some people, but at the heart of it is a senior decision maker, a consultant in emergency medicine.

“The demand and complexity of work in emergency departments will increase and we know that we only have so many doctors. So to meet that we need to broaden the workforce and this is absolutely the right thing to do,” he said.