NHS trust may shut emergency department at night because of staffing “crisis”

BMJ 2016; 354 doi: (Published 10 August 2016) Cite this as: BMJ 2016;354:i4414
  1. Gareth Iacobucci
  1. The BMJ

An NHS hospital trust is considering closing its emergency department at night owing to a chronic shortage of staff.

United Lincolnshire Hospitals NHS Trust (ULHT) said that it had reached “crisis point” and warned that patient safety could be at risk if it did not take drastic action at Grantham and District Hospital.

The trust, which runs three emergency departments in Lincolnshire, said that it had been “seriously affected” by a national shortage of emergency medicine doctors and did not have enough medical staff to fill shifts in three departments 24 hours a day, seven days a week.

After considering its options the trust said that it may close Grantham’s emergency department at night, as the hospital had fewer patients attending, fewer admitted, and less seriously ill patients than the nearby Lincoln County Hospital or Pilgrim Hospital in Boston. A final decision on opening hours is expected on 11 August.

“We are now in a situation where we are unable to recruit locums, so our consultant doctors have filled the gaps by doing extra shifts,” said the trust. “Our staff are under enormous pressure, and the situation is now unsustainable.”

ULHT said that its emergency departments normally operate with 15 consultants and 28 registrar or middle grade doctors. At present it has only 14 consultants, 10 of whom are locums, it said, and just 12 middle grades. The trust warned, “We have reached a crisis point, and we may put patients at risk if we don’t act.”

Suneil Kapadia, medical director at ULHT, said, “We haven’t made a final decision yet, and we hope to avoid this, but the reality is we will need to temporarily reduce the opening hours of A&E [accident and emergency] at Grantham.

“The quality and safety of patient care is the trust’s number one priority, and we haven’t rested on our laurels. We have tried to recruit in the UK and internationally, and we have offered premium rates to attract agency doctors whilst investing £4m [€4.7m; $5.2m] in urgent care services. Despite this, we have reached crisis point.”

The trust said that it was working with other emergency care providers, East Midlands Ambulance Service, and commissioners to try to mitigate the impact on local services.

Allan Kitt, chief officer of South West Lincolnshire clinical commissioning group, said, “Any temporary emergency closure is very concerning. Whilst we are disappointed that we may be forced to take this action, we do believe that closing A&E at Grantham overnight is the best way to ensure that services for our patients remain as safe as possible.

“We will be working closely with ULHT, local GPs, and our community services to develop a range of services to ensure that those people who have less serious illnesses but might currently use A&E can get a service locally during the temporary closure. We will be sharing these plans with the public in the next week.”

Clifford Mann, president of the Royal College of Emergency Medicine, said that the case demonstrated the pressing need to tackle the nationwide workforce crisis in emergency medicine by recruiting and retaining more doctors.

“As well as potentially putting patient safety at risk, placing an ever increasing workload on overstretched staff can create a vicious circle in retention and recruitment with many overworked trainees simply choosing to leave the country or indeed the specialty altogether,” he said. “The wider picture is there is a real crisis in emergency medicine, as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E departments.”

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