SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

Appropriate staffing is integral to an effective emergency department. Evidence suggests
that consultant-delivered care brings benefits for patients receiving emergency care however
significant variation exists in the numbers of hours that emergency medicine consultants are
present in London‟s emergency departments. Input from experienced, senior doctors twentyfour
hours a day, seven days a week is required to ensure the delivery of high quality care
and timely patient flow. However this practice is uncommon in London. 10
Currently, the nine acute sites require at least 45 surgeons on their rotas to provide cover.
However this level of cover isn‟t delivering the standards defined in Chapter 7. To achieve
the standards set out in Chapter 7 requires 10 WTEs per site (see Chapter 16), therefore the
nine sites would need 90 surgeons. Figure 9.11 illustrates the current number of emergency
surgeons against the number required to deliver the standards across different numbers of
major hospitals, it shows that we currently have just over half the required number of
emergency surgeons to achieve the standards.
Figure 9.11: Minimum required number of emergency surgeons for different numbers of major
hospital sites
Current WTEs in NW London
45 WTE
currently
X 9
Number of major hospitals
X 9
X 8
X 7
X 6
X 5
X 4
X 3
Minimum required emergency
surgeons for rota cover to
achieve standards
c. 90 WTE*
c. 80 WTE*
c. 70 WTE*
c. 60 WTE*
c. 50 WTE*
c. 40 WTE*
c. 30 WTE*
*WTE = whole time equivalents
Even if there were more specialist doctors and their teams available, spreading them across
more than five sites would mean that they would each see fewer patients and therefore be
unable to build and maintain the skills and expertise they need to ensure delivery of high
quality care. The probability of seeing more complex or rarer cases also diminishes which
has an impact on doctor‟s experience. A full 24/7 emergency care site requires a sufficiently
large population catchment to ensure that consultants and their specialist teams maintain
their skills by conducting a sufficient number of operations. This particularly applies to
emergency surgery, critical care and interventional radiology.
10 London Health Programmes (2012) Emergency departments: case for change
9b. Decision making analysis stage 5 295