Intended for healthcare professionals


Safe staffing: this is how many doctors we really need

BMJ 2018; 362 doi: (Published 18 July 2018) Cite this as: BMJ 2018;362:k3136
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Click here for a visual summary of safe medical staffing levels.

  1. Matthew Limb, freelance journalist, London, UK
  1. limb{at}

The Royal College of Physicians has pioneered benchmarks for medical staffing levels in UK hospitals and is urging NHS trusts to check how their wards measure up. Matthew Limb reports

The Royal College of Physicians (RCP) has developed the first recommendations for safe medical staffing levels in UK hospitals.1 It urges NHS trusts to measure their workforce against these “indicative” standards (see visual summary) to guard against shortages that pose risks to patients.

College registrar and president elect, Andrew Goddard, says there is “staggering” variation in the numbers of doctors per bed in the UK but no clear tally of how many doctors, nurses, or other healthcare professionals are needed in the acute medical setting at any point in time.

“Everybody’s been afraid to measure it, because they haven’t known what to compare it to. This is the first time that anybody’s actually put a standard down to say, ‘This is what we think we should have—let’s now measure against it to see what we do have,’” he says.

After Mid Staffs

Five years ago, in his final report on Mid Staffordshire NHS Foundation Trust, the chair of the public inquiry, Robert Francis, recommended that “minimum safe staffing and skill-mix levels should be drawn up by the National Institute for Health and Care Excellence [NICE] and policed by the Care Quality Commission [CQC].”

Since then, attempts to develop such levels have had mixed fortunes and have focused on nursing2; though both Wales and Scotland have introduced safe staffing legislation,3 the RCP work is the first to suggest hard figures.

Guidance on Safe Medical Staffing, published on 13 July,1 sets out the number of hours that different levels of clinicians (including physician associates and advanced nurse practitioners as well as doctors) need to be present in various hospital …

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