Hospital Dr News

Children’s unit closure fears as NHS rota vacancies pose threat to patient safety

Children’s doctors have called for a shake-up in how hospital services are delivered as more than two thirds of lead paediatricians say they are concerned about how the service is going to cope in the next six months.

The annual Rota Vacancies and Compliance Survey, published by the Royal College of Paediatrics and Child Health, finds that vacancies and gaps on middle grade rotas continue to be hard to fill, with evidence suggesting there are not enough appropriate staff to plug current gaps.

This has sparked fears over patient safety, trainees’ wellbeing and sustainability of delivering services.

Doctors point to increasing numbers of the workforce opting to work less than full time. This coupled with changes in immigration rules stating that doctors who fail to earn £30,000 a year within four years of employment are unable to continue working in the UK, are some of the factors contributing to the vacancy rate.

Dr Simon Clark, Workforce Officer at the Royal College of Paediatrics and Child Health, said: “Doctors choosing paediatrics as a career are likely to be family focused, which is an important attribute for their professional role. We see that many are choosing to start their own families sooner within the postgraduate paediatric training programmes.  And as around 75% of doctors in paediatric training programme are female, there are a high proportion of doctors on maternity leave. There are also a high proportion of doctors choosing to work less than full time once they have their own children.”

“Such flexibility within the speciality brings workforce planning challenges, and as this survey highlights, that has left 77% of clinical leads either very, or moderately concerned about how the service will cope in the next six months. If we don’t have safe staff numbers to deliver services, then there is a very real threat that we could see units closing their doors.”

The college says service planning is essential if we are to address the issues raised in the survey. It calls for:

– Collaborative working: drawing on the paediatric workforce across a region or network to manage gaps, not just relying on staff already working on site.

– Multi-professional working: Expanding the numbers of appropriately qualified nurses and physician associates to deliver acute and community care.

– Enhancing training for GPs: Working in close collaboration with the Royal College of General Practitioners as they consider the possible development of extended training to include a minimum time of dedicated acute paediatric experience in GP training. This will enable more child health services to be delivered in the community and support keeping children out of hospital.

Dr Simon Clark said: “This survey clearly shows that we cannot continue to operate paediatric services as we are. In the long term, we need to look at prevention so we need more GPs with appropriate paediatric training to further support them in recognising and managing the sick child. We also need to look how paediatricians work with nurses and physician associates to deliver acute and community care.

“And in the short term, collaboration is going to be key. The NHS cannot afford to be filling rotas with locums and it is not safe to rely on doctors who have already worked long shifts to plug gaps – trusts must utilise the wider workforce. Sharing workforce across institutions and potential service reconfigurations may also provide service efficiencies. Only by engaging in short, medium and longer term strategies will we be able to deliver a cost effective service that delivers high quality and consistent care for children in the UK.”

The survey has been collecting evidence on the state of compliance with the Working Time Regulations (WTR) and extent of rota vacancies since 2009 across the UK’s neonatal and paediatric units. It also found that:

– The vacancy rate is 6.9% on tier 1 rotas and 19.5% on tier 2 rotas. Overall there has been an increase in the vacancy rate from 10.5% in December 2012 to 12.1% in December 2014.

– The vacancy rate is highest on neonatal rotas (22.7%). On general paediatric rotas the recorded vacancy rate has risen over the same period from 14% to 18%.

– Across both rota tiers, 47.3% of vacant posts are filled by locums.

– The highest vacancy rates are on tier 2 rotas in Northern Ireland (35.6%) and Wales (27.5%).

– EWTR Compliance in practice has fallen since winter 2012/13 in Northern Ireland (25%), Wales (81.8%) and England 86.5%.

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