RCP London 2018: Safe medical staffing
The RCP London's Guidance on safe medical staffing working party report aims to help those planning and organising core hospital medical services to answer the question: ‘How many doctors or their alternatives, with what capabilities, do we need to provide safe, timely and effective care for patients with medical problems?'.
Within the medical profession there is widespread concern that levels of medical staffing have fallen dangerously low. From 2013 to 2018, more than one in five census respondents reported that gaps in trainees’ rotas occurred so frequently as to cause significant problems in patient safety. Half of all advertised consultant appointments in acute internal medicine and geriatric medicine went unfilled due to a shortage of suitable applicants.
The results of the RCP Medical Registrar Survey (Appendix 2) and feedback from RCP members and fellows suggest that the out-of-hours workload of the medical registrar on-call is inappropriately onerous, with implications for patient safety.
The practice of a single medical registrar both leading the medical intake and providing on-call medical cover for the hospital is unlikely to be successful and contributes to the heavy out-of-hours workload of the medical registrar on-call.
It is essential that as much patient care as possible is delivered during the normal working day, rather than out of hours. We think that this is a key issue for patient safety, and the daytime staffing of wards should be such as to minimise ‘legacy’ work.
Service must always support training and we have concerns that the significant increase in consultant-delivered care may limit the opportunities for trainees to acquire experience in decision making. We urge trusts to recognise trainees’ educational needs when implementing consultant-delivered services.
There must always be sufficient time available to speak with patients and their families and carers to ensure that all the relevant issues are known to the medical team who are caring for that patient. This is particularly important when a patient is unable to represent themselves adequately.
This report represents the start of an ongoing process to help hospitals ensure that they have sufficient medical staff to meet the needs of their patients and deliver safe patient care. The RCP will work with the NHS to refine the method in different hospitals.