Intended for healthcare professionals


College highlights “workforce crisis” in emergency medicine

BMJ 2013; 346 doi: (Published 15 May 2013) Cite this as: BMJ 2013;346:f3180
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}

Emergency departments in the UK are facing their biggest challenge in well over a decade as a result of “very serious medical workforce challenges” and unsustainable workloads, the College of Emergency Medicine has said.1

The college’s survey of more than half of the emergency departments in the UK found high vacancy rates for emergency medicine doctors and a reliance on locums, which have been proven to have significant clinical and financial risk implications for the NHS.

The college has recommended “urgent work” to create safe and sustainable working patterns for doctors in emergency medicine, which will also create good training environments and attract trainees of the future.

The College of Emergency Medicine surveyed 131 emergency departments across the UK in the financial year of 2011-12 to understand and benchmark the quality of emergency care in the NHS.

The survey found that the average number of whole time equivalent (WTE) consultants per emergency department has increased to 7.4, up from 3.8 in 2007-08. However, this average falls well below the college’s recommendation of a minimum of 10 WTE consultants per emergency department and up to 16 consultants in larger departments.

The survey also identified high vacancy rates for senior doctor posts across the UK. In 2011-12, an average of 8% of consultant posts were vacant per emergency department, as were 12% of posts for staff and associate specialist (SAS) doctors, 12% of clinical fellow and trust grade posts, and 15% of higher specialty trainee posts. These high levels of empty posts have placed a “severe strain” on the ability of emergency departments to staff rotas, the college said.

Vacancy rates for core trainees and foundation doctors are relatively low, it adds. However, a high attrition rate between core training and higher specialist training suggests that an unreasonable burden of service delivery is placed on junior staff, which the college suggests is negatively influencing trainees’ choice of specialty.

As a result of the vacancy rates, there is a heavy reliance on locums to fill senior doctor positions in emergency departments across the UK. On average, an emergency department will employ locums in 9% of consultant posts, 17% of SAS doctor posts, 17% of clinical fellow and trust grade posts, and 12% of higher specialty trainee posts.

The report also points to growing workloads in emergency departments, which college vice president Taj Hassan has said are creating “intolerable” working environments for consultants and middle grade doctors.

The college estimates that rates of emergency department attendance have risen by around 3-5% year on year. Almost a quarter (22%) of emergency departments see more than 100 000 patients a year, of whom 10% are serious cases requiring immediate or urgent action.

In response to its survey findings, the college has made 10 recommendations that it hopes will “effect positive change for the benefit of our patients who seek our help in an emergency.”

College president Mike Clancy said: “We must get this right. The public rightly expects that the emergency department is their ultimate safety net when they are acutely ill or injured. Effective clinical care means safe high quality care seven days a week that is consistent across the UK.”