Dear RCEM membership

I’m going to be providing a periodic update to you using the Blog facility in 2023 which I hope you will find of interest. Do let me know if you have any topics or issues you would like me to cover in future editions. You can contact me at Gordon.miles@rcem

Emergency Medicine Crisis

As the year turned we saw Emergency Medicine very much deep in crisis.  The acute pressure peaked during December and waits of 24 hours in the Emergency Department were regularly reported! Clearly the system was not functioning well with exit block plaguing Departments across the country.

During the Christmas break, our media team were very busy as our President and his team of Vice Presidents and College Officers spoke out clearly in a call to action to the Government.  The media pressure was such that in January the Prime Minister called a crisis meeting and our President represented our specialty with the Prime Minister writing notes on the briefing sheet our Policy Team colleagues had provided.

A promise of extra funding for social care followed which at least indicated an awareness of the problem even if that funding, whilst welcome, was really a drop in the ocean and would take time to be turned into extra social care capacity.

The lobbying therefore continues and the President was again in action on Tuesday 24th January when giving evidence to the Health Select Committee. Watch the recording here.  Note in the background our Policy and Public Affairs Manager Pooja Kumari over Adrian’s right shoulder as you view it and Daisy Harmer Senior Policy Administrator behind his left shoulder.

So a strong start for the College as the voice of the specialty this year.

Examinations

We are continuing to develop our systems and processes that underpin our examinations.  I have spoken at length on the difficulties of last Spring and we are steadily working to rebuild your faith in our examinations operations. 

We have reinforced our team working on this with a new management structure drawing in some new talent and promoting within, our teams have also expanded in number too. 

Since the results error last Spring we have now issued 12 sets of results without issue.  Our new checking processes are working well and include external validation.  Our aim is to get to a situation of accurately predicting the day we issue results but for now we are confirming only which week they will be issued in rather than a specific day.  Once we have implemented the new systems enhancements that are currently being worked on we expect to be able to confirm a set date for a results issue.  Until the new systems we are building are operating faultlessly our manual checking will continue and it is that which can require more time flexibility hence our confirming only the week we shall issue in. 

We continue to meet with the Emergency Medicine Trainees Association and the Forum for Emergency Medicine Specialty and Specialist Doctors to discuss our approach, changes and get their feedback on our services.

ePortfolio

We have recently recruited an Eportfolio manager to bolster our team as we want to develop the Eportfolio over time.  We purchased this system in a way that is configurable so we could change it in line with suggestions from the users and so we are working to do just that. 

The complexity of options for trainees, ACPs and PAs means that we have increased our staffing to support this work.

Events

We are working on developing our ability to offer hybrid events in 2023, these being events that allow delegates to be physically present or online.  We have a great programme of events for you in 2023 and I hope you can come along.

Developing events that work in the room for the physical delegates and online for the virtual delegates is not straightforward. In some cases, it isn’t possible, but where we can we are doing this.  The cost of this is not insignificant as it involves contracting in expert technical support and software to do it: a day of a conference track online ‘beamed out’ from the auditorium costs around £4,000.  We are conscious that those with children may prefer the online option and the flexibility that gives. That said parents can bring their children to conferences, we make sure there is a room for children and parents to go, but we don’t expect parents to not bring children into the auditoriums.  We welcome them!  

If there is demand, we can also consider crèche facilitates.  So far we have not appeared to have demand for that save for at our Diploma Ceremonies, so I would welcome views on this.  I wonder if it is something that we don’t see a demand for because we don’t offer it – tell me if that is the case.

It is easy to add costs for additional features to events but the rub comes when members ask us why membership costs or conference tickets are set at a certain level.  So, when we are experimenting with changes it is to gauge demand, we want to be sure they add value. 

You can access our Events programme here: https://rcem.ac.uk/events-calendar/.

Committees

We have a range of Committees working to further advance the specialty across a wide range of topics.  The full range of Committees can be seen here:

We are always on the lookout for volunteers https://rcem.ac.uk/volunteering-opportunities/  I know that the specialty is under pressure and time away from clinical duties can be hard to obtain, but if you can manage it then it can be very rewarding to help develop the specialty.  If you haven’t been involved in College work that is not a problem as you will be warmly welcomed and supported.

If you have a view on what we should be doing, how and when or are simply interested in developing your skills in a different environment this is for you. 

There is something here for everyone, ranging from clinical quality, safety, best practice, to  informatics, research, education, conferences, examinations, Regional and National Boards, governance, equality, diversity and inclusion as well as the impact EM makes on the environment.   We advertise vacancies on our website here:  https://rcem.ac.uk/volunteering-opportunities/

If you would like an informal chat about how to get involved, then just let me know. 

Our Buildings

Our original building 7-9 Breams Buildings near Chancery Lane is in use as we retain the Ground Floor meeting space for College meetings.  The remaining four floors are offered for rent, two floors are let and we are in active discussions over the other two.  The market conditions are rather challenging but progress is being made here.

Since 2020 and the pandemic we have evolved an effective working from home approach which means our employees attend the office for a minimum of 5 days a month.  That means that despite having increased the headcount to 76 personnel we our existing buildings are more than sufficient. An App allows employees to book a desk for the days they attend the office and our systems work well to support home working.

Octavia House in Southwark, South London is our main base, with staff working there on a hot desking basis and of course this is our examinations centre. 

We have been discussing with our Board the longer-term future of our properties. The current market conditions are not ideal for a sale so if we decided to let Breams Buildings go we wouldn’t get best value and then might be faced in future a need for more space.  The flexibility of retaining it and setting up short term lets on the space we don’t use now seems prudent.  If, in 3-5 years, we are sure we don’t need the space then a sale on a long-term lease of say 125 years would give us the freehold value now and our successors would in 125 years have the property back.  If the Surgical colleges can think in terms of centuries, I’m sure Emergency Medicine, that most immediate of specialties, can also look to the longer term too!

Budget and Subscriptions

At this time of year our membership subscriptions fall due for renewal.  These subscription rates are set after bringing proposals to the Annual General Meeting in the Autumn.  Last Autumn we were in Belfast at the Annual Scientific Conference and our AGM was held there – if you missed it and wonder what an AGM is all about you can find the recording here.

We held the increase in our subscriptions to 2% at a time when the operating costs of running the College have been rising nearer 10%.  Given the cost-of-living challenges experienced by us all I thought it might be helpful to remind you that you can claim tax relief on these subscriptions and our examinations fees.  The relief is at by our highest a regional rate so a 40% taxpayer will see a 40% allowance against these fees.  It is a shame the way the system works because I would prefer to be able to reduce our subs by 40% and claim that difference from the Government because I know that rebate gets lost in the mix when included in annual tax computations.  I hope you claim the tax relief anyway!

One thing we have realised and acted on is that the new curriculum means that people are passing the Fellowship examinations earlier than in the past.  This is great news of course and it means that Fellowships are achieved a couple of years ahead of the CCT.  Recognising that situation, we have introduced a new subscription rate for those affected by this so that until they have either CCT’d of CESR’d or three years have passed they do not pay the full Fellowship Fee but instead pay £552 (tax allowable).  We have discussed this again with EMTA and they have expressed concerns that this solution doesn’t resolve the issue and as a result we will discuss this further at our Executive Committee to see if we can offer any additional flexibility.

Green ED

Our mission to contribute to solving the ongoing climate crisis also continues.  We want to play our part by helping create an environmentally sustainable emergency healthcare system Understanding how sites of acute care provision within hospitals can mitigate their environmental impact is a crucial challenge to address.

As a result, the College has continued to expand on initiatives that promote sustainability within the organisation and the NHS. In 2019, RCEM declared a climate emergency, divested from fossil fuels, co-launched the annual Lancet Countdown Report, and has, so far, implemented a wide range of initiatives that are improving our environmental performance through more efficient use of our resources—for example, ensuring zero landfill waste, promoting recycling, reducing transport emissions, and working with suppliers who ethically source materials. It also set up the Environmental Specialist Interest Group (ESIG), tasked with researching and developing ways to assess and improve the environmental sustainability of everyday clinical practice as part of a broader advocacy and education remit.

This led to the development of the Green Emergency Departments (GreenEDs) accreditation. GreenED is designed to be a clinician-led initiative that will test and disseminate a framework of standards that drive environmental and operational sustainability in emergency medicine (EM). The aim is to embed the framework into your Emergency Departments (EDs) by providing a straightforward guide to improving environmental sustainability.

We completed an 8-month pilot in eight EDs in June 2022. The pilot evaluated a practical framework for staff to drive operational sustainability in the ED setting (a full report will be published soon).

The great news is that we have secured NHS funding to scale up the GreenED initiative from the current pilot to be available to all interested UK emergency departments as a fully integrated programme, including administration, online database and technological support and recognised accreditation for achieving each category (Bronze, Silver and Gold) in the framework. We are rapidly developing this and aim to go live this summer.

This approach is unique and pioneering in the medical community and we invite all Emergency Departments to join us in delivering quality, sustainable healthcare. To express your interest, contact environment@rcem.ac.uk

Conclusions

I hope this update is of interest.  If it has raised any questions or comments, these are welcome as I am looking to develop this into a series of updates over time. 

As CEO I am constantly working to provide faster systems, easier to use processes, quicker phone answering and so on. I and my team are doing that.  We are building capacity, developing and implementing process enhancements, working on new technology. Our plan for our examinations will continue to roll out over the next two years so some of the changes we are making will take time to deliver but deliver them we will.

Best wishes

Gordon