An update from Scotland

It’s a pleasure to begin this crucial means of communication, with this post for Members and Fellows in Scotland but no doubt of interest (hopefully) to all members, as we progress through the most difficult winter our young(ish) specialty has faced. Ensuring you all know what we are doing to advocate for better, safer, and more rewarding conditions for our staff in EDs, to do all we can to improve the training experience, and to speak truth to power on behalf of our EM patients, will form the basis for these more regular updates. Please do get in touch if there are things you want to hear about or ask.

Committee structure

There have been a number of changes in the personnel involved in the RCEM Scotland National Board over the past few months. We must, of course, note the contribution and diligence of Mr John Thomson, our former chair and VP(Scotland) who stepped down from the role over the autumn; John’s pragmatism and passion for EM shone through in all he did for the board and continues to do for EM in Grampian, and we’re indebted to him.

Dr JP Loughrey (me!) has stepped up from role of Vice Chair into the vacant Chair and VP(Scotland) position. I am a Consultant in the QEUH in Glasgow and with the EMRS prehospital and retrieval medicine team out of ScotSTAR. My main interests are in major incident planning and preparation, which seems relevant in these difficult times.

Replacing me as Vice-Chair is Dr Fiona Hunter, a Consultant in University Hospital Monklands and in the QEUH in Glasgow. Fiona was successfully selected in a poll of members and fellows in Scotland, up against three extremely strong candidates. Fiona’s been involved in RCEM exams for a number of years and is one of the lead-examiners, and has much to bring to the national board. It is of huge comfort that, even in the face of current challenges, so many people want to become involved in the college’s work in Scotland, and we hope that passion and determination can continue to be nurtured.

Our ACP representative has changed hands, as Karen Johnstone passes the role on to Alex Bann (scotlandacpforumrep@rcem.ac.uk), and Dr Jamie Pope has stood down after serving his time as Trainee Rep (with a replacement tbc). Dr David Chung, familiar to you all I’m sure, will remain on the Scottish Board as past-chair, offering counsel and solace to the incumbent Chair and Vice Chair as they navigate through the turbulent months ahead.

Events

We hosted another successful Scottish Policy Forum in November 2022, attended by several Medical Directors and AMDs, a range of Emergency Medicine clinicians, leads and clinical directors from across the country, where we heard from a broadly diverse group of speakers on topics from ‘Social Determinants of outcomes in ED patients’ to ‘The Training Experience’. We will host our clinical day in May 2023 in Glasgow, and we’ll be looking to cover some of the topics we may previously have not considered in the depth they deserve – for instance, Paediatric EM and some of the research in this area. As ever we will have abstract submissions, oral presentations and posters, to showcase the range of research and QI in Scottish EM.

Training Update

We have advocated for an uplift in trainee recruitment for some years now; thanks to the work of the TPD Rep on the Board (Dr Andy Paterson), our Senior Policy Advisor (Tamara Pinedo) and the former chairs (Dave Chung and John Thomson), this representation to NES and partners has now resulted in a modest uplift in trainee numbers for the coming intake, of an additional 10 ST1 places across Scotland. We need this uplift to continue year-on-year, and will make this case to those in control of funds and training places.

Towards the end of 2022, we received a letter from the Scottish EM trainee representative on behalf of trainees in Scotland, outlining some concerns about the outcomes for the EMTA training survey. This, coupled with the findings of the GMC training survey, have led us to write to the Cabinet Secretary for Health and the Chief Medical Officer for Scotland, along with NHS Education for Scotland, seeking solutions to the problems identified. Please be assured that we are in total agreement that the training experience could, and should, be much better. We will strive to improve this for our next generation of EM Physicians, our current colleagues and future Consultants.

Workforce Census

Without the hard work of the aforementioned group (Andy, Tamara, Dave, John), the previous Census document might not have had the impact it in actual fact has. It’s an extremely powerful dataset, with clear description of the shortage of Senior Decision Makers in EM, the combined burden of overwhelming pressure from exit block and overcrowding, rota gaps, and the increasing trends towards portfolio careers and less than full-time working. The board are planning to revisit the Census, so please look out for it in the inboxes of Clinical Leads and Directors, please take the time to complete it and give us as much solid information as we can have to try to improve things for you, your teams, and your patients.

Press

We might be a small specialty, but we are a vocal one. There continues to be a huge interest in the crisis in emergency care in the UK, including here in Scotland, with many requests from written press, radio and TV. Without the support of the communications team, who do so much behind the scenes to prepare us to speak on your behalf, and to ensure that those wishing to interview us ask truly relevant and important questions.

Summary

We find our EDs full of boarded patients awaiting admission to wards, of ambulances stacked outside, of unacceptable risk being borne in one area of the acute care system; this is not acceptable. We know this, and we will continue to advise the Cabinet Secretary, National Clinical Director and Chief Medical Officer of real, practical, pragmatic solutions. Demand management is not the answer – we still have broadly comparable patient attendances to pre-pandemic levels. Only by focusing on improving acute bed availability and increasing capacity, by reducing the record levels of delayed discharges in our hospitals, by urgently enhancing social care availability and by protecting all staff in emergency departments from the dreadful conditions we’re working in, will we see any level of improvement. We will meet the Cabinet Secretary again this month to update and inform their decisions, and keep you updated.

Dr JP Loughrey
Chair, RCEM Scotland National Board / VP (Scotland) RCEM
@VP_Scot_RCEM
vpscotland@rcem.ac.uk