More acute medicine and GIM training posts needed

More training posts in acute medicine have to be created if the ‘front door’ pressure on hospitals is going to be alleviated.

This recommendation is a key part of new advice, published jointly by three royal colleges, on how NHS trusts and health boards can deploy trainee doctors to ensure safe patient care and alleviate the clinical pressure on medical registrars.

The rising number of acute hospital admissions and a shortage of core medical trainee doctors specialising in acute medicine, or dual accrediting in general internal medicine (GIM), has led to substantial pressure on Acute Medical Units across the UK.

In a joint statement, the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow set out a series of measures to alleviate this pressure.

They include:

– diverting funds used to employ expensive locums to create more training posts

– considering innovative solutions to fill recruitment gaps, such as using international dical graduates

– organising patient flows in order to minimise the number of steps in a patient’s journey, and making effective use of the whole workforce (e.g. nursing and clerical staff, physicians associates, phlebotomists)

– providing alternatives to acute admissions (e.g. outpatient access to specialty clinics; acute specialist clinics; community services)

Many NHS trusts and health boards wish to ask doctors currently not specialising in acute medicine or general internal medicine to support work on the Acute Medical Unit. The joint statement offers advice on how to do so safely.

Acute medical admissions to hospital are generally managed by senior trainees known as medical registrars. Medical registrars can often be the most senior medical decision-makers in the hospital out of hours, and are responsible for coordinating management of the most unwell patients.

The authors of Single specialty registrars supporting the acute take: Advice for NHS trusts and local health boards, explicitly state that this is not a long-term solution to the substantial challenges facing acute care.

In the long-term, a greater proportion of doctors must be trained in the skills of acute and general medicine.

Sir Richard Thompson, president of the Royal College of Physicians of London, said: “Acute Medical Units are the front doors to our hospitals, and across the UK they are struggling to cope with the rising number of acute admissions. This statement sets out short-term recommendations to alleviate that pressure.

“To solve the long-term crisis we need new systems that deliver care where patient need it, supported by a workforce skilled in treating patients with multiple complex conditions.”

Dr Frank Dunn, president of the Royal College of Physicians and Surgeons of Glasgow, said: “The training component of unscheduled care has been subsumed by service delivery because of the dependency of trusts and health boards on junior doctors in this critical area.

“Systems must be put in place where there is an appropriate balance between training and service delivery which is driven by the level of expertise of each trainee. The experience of trainees in unscheduled care is likely to be greatly enhanced by achieving the appropriate degree of support and supervision and with this optimisation of training.”

Read the guidance.