Clifford Mann: actions to address the significant challenges facing emergency medicine

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  • Posted:Monday 05 October 2015

Clifford Mann, President of the Royal College of Emergency Medicine, looks at the challenges facing emergency medicine, including demand, capacity and output.


More from the event: Urgent and emergency care


Dr Martin Kittel

General Practitioner & GP Director Commissioner,
Forest Health Group & Bracknell & Ascot CCG
Comment date
04 November 2015
This is a stimulating video and contains a lot of truths. However, the solutions presented, with emergency medicine more carried out in the community, appear great on the surface, but of course the GP recruitment crisis is deepening day by day.

With General Practice funding having dropped from 10% of total NHS spend to 7.5%, increasing demand and a declining workforce there is no way the hubs suggested will be working.

In 2006 there was a real buzz to become a GP. With the new contract and increased spend the GP crisis was averted and the training courses were full with high quality candidates. No GP training schemes face 25% vacancies.

At a recent visit to my local training scheme none of the GPs present wanted to become a partner in a practice. Emigration was talked about, locuming or being salaried (similar to agency work for A&E these doctors may not know their patients and at times can add pressure to the system.)

Also, there were only 2 men and 12 women when I visited the scheme and this will further reduce capacity as the male full time GPs retiring are replaced by lady GPs may struggle to balance the requirements of work and family placed upon them.

Some University Deans reportedly actively advice against a career in General Practice. And with debt of £100,000 after leaving medical school there is little likelihood that many will choose it above many more lucrative careers available to them.

GPs are now working at the limit of their ability with constantly rising demand and never ending requests. Many work 12-14 hours days, 6-7 hours per session. And that doesn't include updates, study, learning, email in the evening, appraisal and revalidation.

So, the connotation that there is ample capacity in the community to soak up A&E problems, reduce referrals and deal with problems in GP doesn't work. Remember, when the activity in A&E rises we often see the same in GP, OOH, our UCC and everywhere else in the system.

The solutions must be different: 1) Much more self care training and coaching for the general population (see also Kings Fund 10 priorities for commissioners document), it is just no longer viable to see so many patients in A&E, who need a plaster sticking on or a bit of ice on their sprained ankle. 2) group consultations for chronic disease management 3) front of A&E triage and turning away of patients (currently no financial incentive for trusts to do this). 4) reduce MRETs from 70%, an incentive to print money, back down to say a more viable 40-50%.

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