The number of A&E consultants across the UK needs to be doubled to provide adequate cover, experts have warned.
The number of A&E consultants across the UK needs to be doubled to provide adequate cover, experts have warned.
Only a minority of emergency departments have enough senior staffing to ensure patient safety, says the College of Emergency Medicine.
Only a minority of emergency departments have enough senior staffing to ensure patient safety, says the College of Emergency Medicine.
Without experienced doctors, patients are being treated and discharged unchecked by a consultant, it says.
Without experienced doctors, patients are being treated and discharged unchecked by a consultant, it says.
Others could be put at risk because they attend NHS urgent care centres instead of A&E departments, it adds.
Others could be put at risk because they attend NHS urgent care centres instead of A&E departments, it adds.
The College of Emergency Medicine warned there was "no evidence of the clinical or financial benefits" of urgent care centres and said patients could have their choices limited by not being able to attend A&E.
The College of Emergency Medicine warned there was "no evidence of the clinical or financial benefits" of urgent care centres and said patients could have their choices limited by not being able to attend A&E.
The government has been overseeing a radical reform of emergency care with a focus on treating patients in primary care - at urgent care centres and polyclinics - to ease the pressure on A&E.
The government has been overseeing a radical reform of emergency care with a focus on treating patients in primary care - at urgent care centres and polyclinics - to ease the pressure on A&E.
Junior doctors should not be left unsupervised to deal with difficult diagnostic problems Dr John HeyworthIncoming president of the College of Emergency Medicine
Junior doctors should not be left unsupervised to deal with difficult diagnostic problems Dr John HeyworthIncoming president of the College of Emergency Medicine
But the College thinks this is a the wrong approach and instead wants to see more focus and investment for hospital emergency departments - where expertise lies.
But the College thinks this is a the wrong approach and instead wants to see more focus and investment for hospital emergency departments - where expertise lies.
Each year in the UK some 16 million patients attend A&E.
Each year in the UK some 16 million patients attend A&E.
All patients should be reviewed by a senior emergency department doctor. But in many hospitals this is not happening - particularly at busy times such as the weekend and evenings - because of staff shortages.
All patients should be reviewed by a senior emergency department doctor. But in many hospitals this is not happening - particularly at busy times such as the weekend and evenings - because of staff shortages.
The College says the current model where the majority of care is being delivered by inexperienced junior doctors is entirely inappropriate.
The College says the current model where the majority of care is being delivered by inexperienced junior doctors is entirely inappropriate.
It says consultant posts need to increase from 740 to 1,500 by 2012.
It says consultant posts need to increase from 740 to 1,500 by 2012.
According to the College, enough senior doctors are coming up through the ranks to fill these hospital posts, but there is not enough investment to pay them to do the job.
According to the College, enough senior doctors are coming up through the ranks to fill these hospital posts, but there is not enough investment to pay them to do the job.
Patient safety
Patient safety
Dr John Heyworth, incoming president of the College said: "Junior doctors should not be left unsupervised to deal with difficult diagnostic problems.
Dr John Heyworth, incoming president of the College said: "Junior doctors should not be left unsupervised to deal with difficult diagnostic problems.
"These are challenging patients and it is important they are seen and assessed by doctors who are highly trained and experienced to ensure life threatening conditions are diagnosed and treated immediately.
"These are challenging patients and it is important they are seen and assessed by doctors who are highly trained and experienced to ensure life threatening conditions are diagnosed and treated immediately.
"Doctors in training can't reasonably be expected to deliver the same care."
"Doctors in training can't reasonably be expected to deliver the same care."
He said although the government had provided some additional investment for emergency care, it was neither enough or in the right area.
He said although the government had provided some additional investment for emergency care, it was neither enough or in the right area.
"The government needs to invest in healthcare facilities that are proven and popular with patients such as emergency departments and out of hours primary care services, rather than new and as yet unproven urgent care centres and polyclinics."
"The government needs to invest in healthcare facilities that are proven and popular with patients such as emergency departments and out of hours primary care services, rather than new and as yet unproven urgent care centres and polyclinics."
Until there are enough consultants in post, hospitals should prioritise patients in the resuscitation area, the College says.
Until there are enough consultants in post, hospitals should prioritise patients in the resuscitation area, the College says.
Those with a headache, chest pain or abdominal pain and sick children under the age of five considered for discharge as well as unscheduled return attendances should be reviewed by a senior doctor, it adds.
Those with a headache, chest pain or abdominal pain and sick children under the age of five considered for discharge as well as unscheduled return attendances should be reviewed by a senior doctor, it adds.
Dr Jonathan Fielden, chairman of the BMA's Consultants Committee, said: "We urgently need more emergency medicine specialists to improve the quality of care for patients.
Dr Jonathan Fielden, chairman of the BMA's Consultants Committee, said: "We urgently need more emergency medicine specialists to improve the quality of care for patients.
"A focused expansion in consultant numbers - not just in emergency medicine but in many other specialities across the NHS - is the best way of ensuring that we achieve our shared ambition of high quality care for all."
"A focused expansion in consultant numbers - not just in emergency medicine but in many other specialities across the NHS - is the best way of ensuring that we achieve our shared ambition of high quality care for all."
A Department of Health spokeswoman said: "We have already significantly increased the number of Emergency Consultants - from 386 in 1997 to 749 in 2007 - with 3,203 doctors in training in A&E, thanks to increased investment in training.
A Department of Health spokeswoman said: "We have already significantly increased the number of Emergency Consultants - from 386 in 1997 to 749 in 2007 - with 3,203 doctors in training in A&E, thanks to increased investment in training.
"The local NHS must ensure that they provide urgent and emergency care services that are responsive to people's needs - including ensuring appropriate staffing levels."
"The local NHS must ensure that they provide urgent and emergency care services that are responsive to people's needs - including ensuring appropriate staffing levels."
Are you concerned at the level of A&E care in your area? Are you affected by the issues in this story? Send us your comments and experiences using the form below.
In most cases a selection of your comments will be published, displaying your name and location unless you state otherwise in the box below.
