- Scarborough Hospital has long struggled to recruit emergency medical consultants
- Senior clinicians believe a new model can be devised whereby patients could initially be seen by “advanced clinical practitioners”
- RCEM described proposal as a “highly risky strategy”
- Simon Stevens has spoken of the need to “reinvent a viable model of small acute hospital services” in towns such as Scarborough
WORKFORCE: Health leaders in Yorkshire are considering options for running an emergency department without dedicated consultants.
Scarborough Hospital, which is run by York Teaching Hospital Foundation Trust, has long struggled to recruit emergency medical consultants, commonly known as A&E consultants, and is exploring options to make its services sustainable.
Senior clinicians believe a new model can be devised whereby patients could initially be seen by “advanced clinical practitioners”, who have typically trained as nurses or paramedics, but then passed on to the specialty consultant in the relevant department more quickly.
The Royal College of Emergency Medicine has raised concern over the proposal, describing it as a “highly risky strategy”.
NHS England chief executive Simon Stevens has recently spoken of the need to “reinvent a viable model of small acute hospital services” in towns such as Scarborough.
Ed Smith, an A&E consultant and clinical director at the Scarborough site, told HSJ that advanced clinical practitioners could be employed in greater numbers than consultants.
He said: “Getting enough [A&E consultants] to Scarborough to make it work is challenging. We’ve effectively got four consultants and one locum, and it doesn’t give us 24 hour cover in the department.
“[Advanced clinical practitioners] tend to be people who have had training in managing the undifferentiated acute patient, such as a nurse or paramedic, and the idea is that we could get patient to the specialist consultant more quickly.
“We’re not advocating removing senior decision making clinicians from our emergency services… it would involve all the senior clinicians within the hospital in delivering the emergency service in a coordinated fashion.
“Provided we can provide the same quality of service we feel this is a safe and effective option. It’s all still to be worked up though.”
However, he acknowledged the department’s accreditation may change, so it “might not be called an A&E”.
Scarborough and Ryedale Clinical Commissioning Group has committed to maintaining “core services” at the hospital, which are identified as emergency care, obstetrics and paediatrics.
The advanced clinical practitioner role is relatively new, with the training designed by the RCEM and Health Education England. RCEM guidance states they are intended to be part of a “multi-professional” team in the emergency department.
Clifford Mann, president of the RCEM, told HSJ the proposals for Scarborough “would be replacing a system which is proven, well tested and evidence based”.
He added: “There’s a reason that emergency medicine is a specialty and every emergency department has these consultants.
“To say turning the clock back 50 years is a step in the right direction is a highly risky strategy.
“The solution [to the staffing problems] is to properly recruit and retain staff. It’s like saying ‘we haven’t got enough maths teachers so we’re going to ask the dinner ladies to step in and we’ll teach it in a different way’.”
He said most trusts have six or seven A&E consultants but the “minimum” should be 10.
In a speech at the Cambridge Health Network in November, Simon Stevens said: “When you look at the struggling small and medium size district general hospitals in this country a number of them are actually around the coast. And so you think about a Scarborough, a Medway, a Weston, a Barnstaple, a West Cumberland Infirmary…
“What they have in common is they are kind of on the edge of the country, they are geographically isolated. Morecambe Bay is another…
“Part of what we nationally have got to do is bring to bear support for places like that to help them fundamentally reinvent a viable model of small acute hospital services.”
NHS England was approached for comment.