Should we pay A&E consultants more or simply be more creative?

A recent parliamentary report has suggested that consultants working in accident and emergency departments should be offered incentive payments in an effort to tackle staff shortages in this area. It is argued that there is a chronic shortage of A&E consultants that are qualified and experienced and some hospitals are struggling to attract permanent staff. Doctors don’t view a career in A&E as being as attractive as other fields and as such there may be a crisis in staffing in this area in the near future. 

Whilst it is true that many A&E departments currently have vacancies it isn’t clear that this is just because doctors don’t want to work in A&E.  There have been significant changes to A&E services in recent years as the government has sought to downgrade some departments and these staffing issues must be considered against this background. 

Many doctors say that they wouldn’t want to work in A&E as it is a high stress environment where a whole range of people come when they can’t get help elsewhere. I have a lot of sympathy with this position – who would want to spend Friday evening in their local A&E? This is where everyone needing help pitches up.  Those who have been in car accidents or suffered serious trauma are brought in ambulances, there is the drunk who turns up at least once a week, the individual with mental health issues who is having a period of crisis and doesn’t know where else to turn and the older person who has become a ‘frequent flyer’ as they aren’t able to access support through any other means.

Many of these individuals don’t necessarily require treatment from a highly skilled A&E consultant.  By having a greater range of clinical professionals beyond the A&E consultant we might be able to treat many of those who turn up more quickly, more appropriately and more cheaply.  Having mental health triage teams, social care workers and more GPs in A&E may help alleviate some of these difficulties. 

If we managed services outside of hospitals more effectively we might be able to stop people going to A&E in the first place.  If individuals had another place to turn to when experiencing a period of crisis then they may be able to access different forms of care and this is only going to be exacerbated given the demise of NHS Direct, confusion over the 111 service and the decommissioning of local walk in centres.  Investing in out of hospital care could significantly reduce the number of hospital admissions. 

Thinking specifically about consultants there is the question of whether paying well paid professionals an additional amount of money will make this career more attractive?  Or even if it does make this route more attractive whethe it will be attracting the sort of people we would want to these roles. There is much written in the field of emotional labour that suggests other possible routes to support individuals in stressful roles beyond incentive payments.  We know that we aren’t as successful at supporting those in stressful roles as we should be and perhaps we need to be a bit more creative in thinking about what else would attract doctors to work in A&E departments.   

Public sector budgets will only get tighter in the future and paying particular professionals to do stressful jobs where we have a skill shortage is not a sustainable answer.  It is also potentially divisive and may further fragment the workforce or be a way of further privatising the NHS through making it unsustainable.  If we are to tackle this issue we need to be more creative and not just simply jump to old familiar financial levers. 


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