Emergency medicine staffing crisis imminent unless Government acts, RCEM warns

30th May 2023

Burnout, retirement and a reliance on locum staff are among a host of concerns raised in a new report from the Royal College of Emergency Medicine (RCEM), which urges the UK Government to take action to support and maintain the emergency medicine (EM) workforce.

The report, entitled ‘Emergency Medicine Workforce in England’, published on 28 May, reveals the extent of the capacity and staffing issues experienced by emergency departments, which is having a negative impact on staff morale and retention, as well as on patient care.

For example, there should be one whole-time equivalent consultant for every 4,000 annual attendances, but the report states that this ratio currently stands at 1:7052. What’s more, some 45% of the total EM workforce is made up by trainee doctors, posing a potential threat to service provision, especially out of hours.

Another particularly pressing issue, the RCEM notes, is the ageing pool of consultants employed within emergency departments. Some 29% of its consultant members are now aged over 50. Many are doing fewer hours during this stage of their careers, and ‘with a third of the workforce approaching retirement age at the same time, we may witness a mass exodus of experienced senior clinicians’, the report states.

These issues have resulted in an overreliance on locum staff, which takes a significant percentage of the wage bill.

Extra EM training places needed

Highlighting that the system is stretched beyond capacity and requires the next generation of EM doctors to bolster it, the RCEM’s president Dr Adrian Boyle said: ‘You have to keep the topping up the team, and that is why we are urgently calling on the Government to commit to ensuring there will be at least 120 extra training places for EM doctors every year for at least six years.’

This recommendation from the report, which would see more than 700 new trainee EM doctors being trained between 2024 and 2030, aims to help achieve safe staffing levels, ease pressure on existing staff and support capacity and resilience in emergency departments.

Dr Boyle concluded: ‘We are still waiting for the long-promised NHS workforce plan. And it is becoming increasingly important that this is published as soon as possible to avoid the crisis in the NHS worsening; and that it contains specific numbers, details and costings. Nothing less would be a disservice to our members, their colleagues, to patients and the public.’

Staffing shortages are being seen across the UK and Europe, with a mass-exodus of hospital and healthcare staff being widely reported. In the UK, the much-anticipated NHS workforce plan has indeed been delayed once again as rumours circulate around its prohibitively high cost.

Biobank pilot to be launched by MHRA to better understand genetics and medicines safety

26th May 2023

A genetic ‘biobank’ will be launched on 1 June 2023 by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) to understand how a patient’s genetic make up can impact the safety of their medicines.

Known as the Yellow Card biobank, the biobank will contain genetic data and patient samples and be used by scientists to determine whether a side effect from a medicine was caused by a specific genetic trait.

A joint venture with Genomics England, the genetic research resource is the first of its kind to be launched by a drug safety regulator.

Operating alongside the MHRA’s existing Yellow Card reporting site for suspected side effects and adverse incidents involving medicines and medical devices, the new venture forms part of a long-term vision for more personalised medicine approaches.

Targeted prescriptions

By understanding the underlying mechanism of an adverse drug reaction (ADR), it is hoped that pharmacogenetic testing strategies could be developed so that ADRs could be prevented rather than requiring a reactive approach.

In turn, this will enable doctors to target prescriptions so UK patients will receive the safest medication for them, based on their genetic makeup.

‘We are excited by the upcoming launch of the Yellow Card biobank, which demonstrates that we are at the absolute forefront of innovation in the field of drug safety monitoring,’ said Dr June Raine, MHRA Chief Executive. ‘Almost a third of adverse reactions to medicines could be prevented with the introduction of genetic testing… This has the potential to transform our safety monitoring activities – enabling us to meet a real need by using high-quality patient data to reduce side effects of medicines.’

Participant recruitment

Recruitment for the biobank will commence on 1 September and participants will be visited at home by a nurse who will take a blood sample to be added to the biobank. The sequencing of participants’ genetic material will begin in spring 2024. Initial research findings are due to be published in 2025.

The pilot phase will start by looking at allopurinol and related rare, severe skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis. Other topics of focus for the pilot phase will be confirmed in due course.

Genomics England will support the MHRA with the sequencing and storage of genetic material through use of its well-established and secure infrastructure.

Commenting on the ‘transformative partnership’ with the MHRA, Professor Matt Brown, Chief Scientific Officer for Genomics England, added: ‘Many [severe ADRs] are influenced by underlying genetic risk factors, substantially heightening an individual’s vulnerability.

‘By joining forces with the MHRA, we are poised to gain greater understanding of these genetic influences – discoveries that will be vital if we are to move to harness the power of genomics to proactively protect patients from these harms.

‘Together, we hope that this is the first step towards redefining the future of drug safety.’

ADRs continue to be a significant burden on the NHS and account for one in 16 hospital admissions.

Fifteen years of the Spanish Patient Safety Strategy: pitfalls and lessons learned

28th April 2023

The Spanish Ministry of Health (SMoH) coordinates collaboration between 18 health regions, scientific societies, patients and other stakeholders. Its overall objective is to improve patient safety in all clinical settings in the health service.

In this webinar, Dr Yolanda Agra Varela, General Director Public Health, SMoH, provides an overview of the Spanish Patient Safety Strategy. Initially implemented in 2006, stakeholders revised the strategy to cover 2015-2020. Here, Dr Agra Varela discusses the learnings from the strategy including the main barriers and facilitators identified.

Healthcare adverse events in France

Patient safety remains a health policy priority in France. The 12^th Quality and Safety Network webinar, organised by HOPE and PAQS, describes how the third French national adverse events survey showed a statistically significant drop in preventable adverse events and of their severity between 2009 and 2019.

Learning objectives include:

•  Understand the results of the third national adverse events survey
•  Discuss the main challenges and conclusions
•  Give insight about how these results will be used further in France’s national policy.

Quality indicators and public reporting in Flanders

The Flemish Institute for Quality of Care (VIKZ) is a network organisation that measures, follows up and publicly reports on healthcare quality indicators and safety to drive quality improvements.

In this webinar, Svin Deneckere, Director of VIKZ, focuses on quality indicators and public reporting in Flanders. He presents the organisation’s methodologies, preliminary results and future objectives.

National patient safety initiatives in the Netherlands

The Dutch Hospital Patient Safety Program started in 2008. It initially ran for five years, and its aim was to decrease adverse events by 50% in all Dutch hospitals.

A second National Safety Program launched in 2020. This focuses on reflection, interprofessional collaboration and explaining process variation in daily practice. It also looks to foster more patient involvement and shared decision making. The ultimate aim is to reach a significant reduction in preventable patient harm.

This webinar provides an overview of patient safety in the Netherlands and discusses these two initiatives and their implementation, outcomes and ongoing impact.

Development of a Regional Strategy for Patient Safety Improvement

Management of Belgium’s healthcare system is complex, with federal financing and regional regulation and strategy for areas such as patient safety improvement.

The development of a Regional Strategy for Patient Safety Improvement involved two surveys. The first looked at system-level, organisational and clinical-level interventions and resulted in a list of top priorities.

PAQS released a second survey at the end of 2018. It asked healthcare professionals to consider the current situation and how it could be improved.

This webinar discusses healthcare in Belgium and analyses the survey results and the development of the regional strategy.