Pay consultants more at busy A&Es, say MPs

Health minister Dan Poulter says the government is looking at making a career in A&E more attractive to consultants. Photograph: Felix Clay for the Guardian

Consultants working in struggling accident and emergency departments should be offered pay increases to halt a chronic shortage in qualified and experienced staff, according to a parliamentary report.

The public accounts committee, which scrutinises the use of public money, said A&E services finding it difficult to attract and retain permanent specialists should be allowed to offer improved terms and conditions.

The MPs made the suggestion in a report released on Tuesday which criticises both the Department of Health and NHS England for not having a “clear strategy for tackling the chronic shortage of A&E consultants”.

Dan Poulter, the health minister, said that the government is considering ways of making a consultants’ career in A&E more attractive and that the issue is being addressed as part of current negotiations.

“It takes six years to train an A&E consultant, and there is no easy fix – but our long-term plans are robust, increasing the number of training places by 75 next year, and planning for all trainee doctors to spend time in A&E. We are also looking at making an A&E career more attractive as part of our negotiations on the consultant contract,” he said.

A health source refused to be drawn on whether ministers were considering increasing consultants’ pay.

The report will make difficult reading for Jeremy Hunt, the health secretary, and Sir Bruce Keogh, NHS England’s medical director, who have faced pressure to review their plans to introduce changes in accident and emergency services.

Margaret Hodge, the committee’s chair, said that any attempt to improve emergency admissions services in the NHS is being stymied by the chronic shortage of specialist A&E consultants. Nearly a fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012.

“With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.

“Struggling hospitals, such as those placed in special measures, find it even harder to attract and retain consultants. There are currently no incentive payments to make working in these hospitals a more attractive prospect. So we raised with the department the possibility of paying consultants more to work at struggling hospitals,” she said.

The committee’s report on emergency care suggested that doctors could be enticed to work at struggling hospitals if they were paid more.

Emergency admissions to hospitals have increased by 47% in the last 15 years, according to the report. But it is not clear who is actually accountable for the delivery of local A&E services, the report said.

A tripartite group comprising NHS England, Monitor and the Trust Development Authority is intended to oversee the performance of the emergency care system. However, it is unclear under what circumstances the tripartite group would intervene at a local level, the MPs said.

The MPs welcomed government plans to provide 24/7 consultant cover in hospitals but said they were concerned about the slow pace of implementation.

Hunt’s department also drew criticism for £250m injected into the NHS last winter to help 53 struggling departments as well as a further payment of £150m. The committee said that it was not convinced the money was used to best effect.

Dr Paul Flynn, chair of the British Medical Association (BMA) consultants committee, said that consultants working in emergency medicine faced increasingly challenging, high-pressured and stressful work environments. “The government needs to urgently address issues such as workload pressures, resourcing, and work-life balance if the NHS is to attract doctors in training and the consultant numbers that are needed, not least because spending large amounts on locum doctors is not financially sustainable in the long run.”

In November, Hunt announced plans to establish a two tier accident and emergency services across Britain, with some hospitals top be downgraded as either “emergency centres”, which would assess patients and start treatment, and “major emergency centres”, which would provide specialist care such as for strokes or heart attacks.

Pay consultants more at busy A&Es, say MPs