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Hospital seeks ‘non-medical consultant’ to supervise A&E

Published on: 31 May 2022

A hospital is seeking to appoint an advanced clinical practitioner to work on its emergency department “consultant rota”, meaning they would likely be able to supervise its emergency department in place of a medical consultant.

The move is controversial with some doctors, but could potentially make it easier to staff struggling rural departments.

Blackpool Teaching Hospitals Foundation Trust is advertising for a “non-medical consultant” to work in ED, saying it has developed a framework which “builds on the Royal College of Emergency Medicine’s curriculum and credentialling process” for ACPs, who are normally registered nurses.

RCEM has supported the development of ACP roles, and they now make up a significant minority of its membership. Its credentialling framework enables them to take on some tasks and roles normally carried out by doctors.

The Blackpool advert says the senior ACP would work on its “tier 4” rota – a role normally reserved for medical registrars – as a “senior decision maker” and “will ultimately involve clinical work on the tier 5 (consultant) rota”.

It lists RCEM credentialling as a “desirable” but not “essential” criteria for applicants, who it says would typically have three years in advanced practice in an emergency department and would need to have completed two years of RCEM’s ACP curriculum.

Tier 4 and 5 doctors typically supervise an accident and emergency department and are the senior clinician on a shift, potentially managing the most acutely unwell patients while supervising the department.

RCEM’s policy is that all emergency departments require ”a tier 4 or 5 doctor, immediately available, at all times”.

It has previously said ACPs can undertake duties up to tier 3, and in response to controversy over the recent job advert has restated this on Twitter. The college also told HSJ: “RCEM continues to align its ACP workforce developments with the national advanced practitioner workforce developments of NHS England and Improvement and Health Education England.”

It has also said it expects the future to “include progressive entrustment of ACPs” in EDs.

Both the advert and RCEM’s response has angered some junior doctors, who point to the differences in training between ACPs and doctors. Becoming a medical ED consultant requires a five-year medical degree, two years as a foundation doctor and probably six years or more core and specialty training – involving rotations to different hospitals and several exams – before consultant roles are applied for.

An ACP is likely to be a registered nurse with several years’ experience in A&E, who follows a masters level programme based on a curriculum drawn up by RCEM, then demonstrates competences to get “credentialled” by the RCEM. The RCEM says credentialled ACPs can perform clinical duties at the level of a CT3 physician – someone who is in their fifth year of working as a doctor.

The Doctors’ Association has written to the RCEM raising concerns about ACP roles, saying a senior doctor should always maintain responsibility for ED “given the broad and lengthy training… that enables management of the most complex patients”.

Blackpool FT declined to comment further on its job advert. But the trust is known to struggle to recruit doctors and has been offering recruitment premiums for up to four years for some roles. The salary on offer in Blackpool – between £65,664 and £75,874 – is below the starting rate for a medical consultant.