The reality of undersupply and poor manpower planning

Bringing back fear – what the NHS emphasis was on at the start is being abandoned – by undersupply rationing and poor manpower planning.. The BBC also reports 12th April 2016: Staff shortage prompts Chorley Hospital A&E temporary closure

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Chris Smyth reports in The Times 14th April 2016: A&E closes overnight after doctors reject limit on pay

An accident and emergency unit has been forced to close at night because locum doctors are refusing to work there after their pay was capped.

Lancashire Teaching Hospitals has downgraded emergency care in Chorley because it can find only half the doctors it needs to keep the unit running. It is the first time that pay caps have forced the NHS to scrap a service, and doctors warned that others may follow.

Managers say that regular locums are no longer willing to work for lower rates imposed by the government, accusing other hospitals of finding “below the radar” ways of paying more.

As the bill for temporary NHS staff heads towards £4 billion this year, the government has introduced caps: a registrar can be paid no more than £43.17 an hour and a consultant no more than £101.43, except in emergencies.

Cliff Mann, president of the Royal College of Emergency Medicine, said that the caps had caused a serious staff shortage in A&E units. Some hospitals were paying doctors for hours they have not worked to top up their pay and encourage them to fill shifts, he said.

The Lancashire trust said that the caps had been the final straw for a hospital already struggling with a national shortage of emergency doctors.

The Chorley unit will be open between 8am and 8pm, with patients having to travel 14 miles to Preston outside these times.

Karen Partington, chief executive of the hospital, told the Health Service Journal that only eight of 14 middle-grade medical posts were filled in the two A&Es.

“When the agency cap was introduced in November we held the line and a number of doctors did say they were going to stay and work, and work under the caps. We held the line because I felt it was the right thing to do,” she said.

“When the February cap came in, again we held the line but then we discovered that other [hospitals] were not and not declaring it, or recruiting people under the cap with other benefits that were below the radar.”

When pay rates were lowered again in April the hospital offered to pay more but had no applicants. “I think we didn’t receive any CVs because we had become known as an organisation that held the line [on pay]. The issue is not the cap, it’s about how it was applied. Trusts didn’t act collectively,” she said.

Dr Mann said last night: “I would be very surprised if Preston and Chorley were the only hospitals faced with this predicament at the moment. If you’re already running a skeleton staff and then two more slots are gone the whole rota falls over. This surely shouldn’t be the way we decide which hospitals are open 24/7.”

Professor Mark Pugh, medical director of the hospitals, said: “Changing the 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.”

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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