Hospital emergency departments are staffed by a combination of consultants, middle grade doctors, and doctors in training.
In recent months it has become increasingly difficult for Lancashire Teaching Hospitals NHS Foundation Trust to staff the middle grade doctor rota at its emergency departments. This issue has arisen for a number of reasons: there is a national shortage of emergency medicine doctors; the trust hasn’t been allocated enough doctors in training who help staff rotas; and the application of the national agency cap has affected the ability to secure locums to fill gaps in the rota.
We have taken a number of actions to recruit a permanent workforce including continuous international and national recruitment activities, changing how our service works and adapting some job roles, to maintain services, and appointing some GPs to provide additional support to the emergency department.
In response to the current staffing pressures we have not applied the agency cap for emergency department doctors. However despite this we have not been able to secure the additional locum doctors we need. Our consultants have been working extra shifts to cover the middle grade doctor rota. However this isn’t sustainable and this approach is beginning to affect our ability to cover the consultant rota.
Despite all of these efforts we have not been able to secure the number of staff we need to continue to safely staff the rotas.
We currently have just eight of the 14 doctors we need to staff the middle grade rotas. This means we can only staff just over 200 hours of the 457 hours on the middle grade rota a week.
The System Resilience Group, which includes the senior leadership and clinical leads of the hospital trust, commissioners, local authority, Lancashire Care NHS Foundation Trust and the North West Ambulance service, has met regularly to review the situation, assess risks and consider all the potential options for the future provision of services.
The group has assessed that it is not possible to staff the rotas after 18 April, and there are no other safe options for delivering care - so the emergency department at Chorley will be temporarily replaced by an urgent care service until the staffing crisis is resolved.
The urgent care service will be provided at the urgent care centre, at Chorley & South Ribble Hospital. The service will be provided by a combination of emergency department consultants, nurse practitioners, GPs, nurses and healthcare assistants.
The vast majority of people who currently attend the emergency department at Chorley have conditions that can be treated safely and appropriately by an urgent care service.
Historically major trauma patients, patients who need a specialist service, patients who need to be admitted to hospital for surgery, and children who need paediatric care are already taken directly to Royal Preston Hospital by ambulance or transferred from Chorley after initial triage and treatment. Additionally from Monday 999 ambulances will take patients to Royal Preston Hospital or other nearest appropriate hospital rather than Chorley, and patients who attend Chorley themselves, but who need to be admitted, or need specialist services will be transferred to Preston for assessment.
The Urgent Care Centre will be open between 8am and 8pm. Outside these hours patients should phone 111 for advice or attend their nearest emergency department. From Monday, the Euxton GP out of hours service will also be based at the Urgent Care Centre to provide additional support.
Professor Mark Pugh, Consultant Anaesthetist and Medical Director of Lancashire Teaching Hospitals NHS Foundation Trust said, “Changing the current service provided at Chorley is a direct response to the immediate and significant staffing problem. We simply cannot staff the rotas, and it is an unacceptable risk to patient safety to attempt to provide an emergency department service with no doctors available to see people. These measures are temporary, and we will continue to do everything possible to secure all the staff we need and reinstate the emergency department service at Chorley.”
Dr Gora Bangi, Chair of Chorley & South Ribble Clinical Commissioning Group said, “After reviewing the clinical and service recommendations of Lancashire Teaching Hospitals, it is clear that this is the only safe and viable option available to maintain safe care for patients given the current staffing challenge. However the System Resilience Group will review the situation on a week by week basis, with a view to reinstating the emergency department service as soon as that’s possible.”