President’s Blog February 2014

Life in the parish has been busy of late and activity has led to significant progress. As you will all know we published our ’10 priorities’ document last Autumn and it has had a major impact. Top 3 issues currently being progressed are :-

1. As I write we are about to meet with the Secretary of State and the Medical Director of HEE to agree a fully funded expansion of ACCS posts. These will be EM posts and will be appointed from August 2015. There will also be a government/HEE/CEM initiative aimed at MTI and tier 2 recruitment offering overseas doctors at ST3 level and above the opportunity to train for 4 years. This will enable these people to obtain high quality training and sit the college examinations whilst not depriving their own countries of their long term expertise.
2. The need to reform the remuneration to Trusts for acute work is essential if we are to overcome unsafe and inefficient, excessive occupancy rates. This will enable acute work to be appropriately valued and improve flow through hospitals. The Keogh review has undertaken to lead to new guidance on both tariffs and commissioning arrangements and the College welcomes this. We are meeting with Monitor who are responsible for tariffs and in our recent meeting with Sir David Nicholson and Sir Bruce Keogh the importance of tariff reform was accepted.
3. Terms and Conditions. Equity is our purpose in pressing our case with the BMA who are in negotiation with the employers, discussing both trainee and consultant contracts. They fully recognise the need to reflect both the frequency and intensity of out of hours work, the difficulties in recruitment and retention will not abate until these issues are addressed. Although terns and conditions haven’t alone caused this crisis, they will be a key component of resolving it.

Talking of the Keogh review it is clear that although the evidence base identifying key problems is authoritative the same cannot be said for many of the solutions. This of course is not the fault of the review team as high quality evidence relating to demand management in acute care would barely fill a very small book.

Nevertheless there are a number of important opportunities within the report. The first is tariff reform. The report identified this as a key instrument of change and in this we are agreed. The second is the distinction between different types of emergency department. This is really a formalisation of the existing situation and the recognition that in some cases this will be the clinical rationale for re-organisation. Put simply there are, and will be, those EDs which are supported by a wide range of specialist definitive care teams (stroke, PCI, Major trauma, paediatrics) and those which do not have access to such teams and from these about 2% of patients will need to be transferred in a safe and timely fashion to a unit with the appropriate definitive care team. This is what should happen now, but often the necessary networks and referrer driven pathways are absent or fragile. The College continues to engage at the highest level with the ongoing review teams and will press home our key concerns and proposals.

On a completely different note it is great to be able to welcome the new editor of the EMJ – Ellen Webber. She is our first overseas editor and will continue to develop and expand the influence of the journal.

One key aim that she and I share is the development of EMJ associated media including podcasts and blogs. These will be launched early in 2014 and will take a broad perspective on key EM issues. They will often include contributions from leading EM doctors in North America and Australasia comparing insights into contracts, tariffs, EM configurations, work/life balance, medical training, competency assessment and alike. There will also be succinct summaries of key documents e.g. ‘Shape of Training’, ‘CEM 10 priorities’  ‘Seven Day Service’ and many more that most would wish to read but may not have time to do so!

Dr Cliff Mann FCEM FRCP
President
The College of Emergency Medicine
@CEMPresident