Casualty units hit by doctor shortage
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Hospital casualty departments across Britain are facing a serious staffing crisis, which means that some treatments may have to be carried out by nurses rather than doctors.
Gerald Malone, the Minister for Health, yesterday told hospitals to introduce a range of measures, including allowing more nurses to do some of the less important treatments, reducing the paperwork burden on doctors and stepping up recruitment of staff-grade junior doctors. As further evidence of the problems facing accident and emergency departments, the British Medical Association will today warn that casualty departments are "cracking under the strain" of rising emergency admissions and too few resources.
Figures compiled by the Department of Health show that almost 300 out of 1,300 senior house officer posts in England - more than one in five - are set to be vacant on 1 February, the date when junior hospital doctors rotate jobs.
Stephen Miles, secretary of the British Association of Accident and Emergency Medicine, said the situation looked to be worse than last year when some hospitals first faced serious shortages.
Only a minority of trusts are affected, according to the department. But some hospitals in Trent, the West Midlands and South Thames are thought to have more than half their junior doctor casualty posts unfilled.
Yesterday Mr Malone wrote to NHS trust and health authority chairmen telling them that they can lift the limit on recruiting staff-grade doctors to A & E - a non-training post below consultant grade. He said that for some units that would provide a "permanent" solution.
Guidance due to be issued today will also detail a string of other measures from using nurses more to treat minor injuries, easing paperwork burdens on junior doctors, improving the quality of the training to make the posts more attractive, and offering them year-long, rather than six-month, contracts.
At the same time Sir Kenneth Calman, the Chief Medical Officer, is to review emergency services outside hospitals to ensure that the new primary care centres and other out-of-hour services being set up under a pounds 45m deal with general practitioners are organised to provide "seamless" emergency care.
Mr Malone said he was making it clear to chairmen that "we don't just expect them to sit on their hands if they have a problem, but to act". After a meeting on the crisis he called before Christmas, best practice had been identified and it was now up to NHS trusts to implement that, he said.
His warning comes as the BMA releases a report today detailing a "crisis" in A & E departments of persistently rising admissions, continued waits on trolleys and of trusts owed up to pounds 1m or more for extra casualty work for which their purchasers are refusing to pay.
Blood rationing, page 5
Leading article, page 14
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