On Tuesday 7 February, United Lincolnshire Hospitals NHS Trust agreed to extend the opening hours of Grantham A&E to 8am to 6.30pm, 7 days a week. We anticipate that the new opening hours will come into effect on 27 March 2017 provided that the staffing numbers don’t fall before then.
In August, ULHT made the difficult decision to temporarily change the opening hours at Grantham A&E due to a severe shortage of middle grade doctors at Lincoln and Boston A&Es. Since 17 August 2016, Grantham A&E has been open from 9am to 6.30pm 7 days a week.
There is a national shortage of A&E doctors, and ULHT is very much affected by this. We are overly reliant on short and long term agency doctors to fill staff rotas. Reducing the opening hours of Grantham A&E has allowed us to provide better patient care in Lincoln – where the most serious cases from across the county go to. Grantham A&E doctors have provided up to an additional 85 hours of middle grade and consultant support per week at Lincoln. Though not ideal, this was the safest option for the provision of emergency care for the people of Lincolnshire including those who live in the Grantham and district area.
Dr Suneil Kapadia, medical director at ULHT says: “I recognise people want Grantham A&E to reopen 24/7 and will be disappointed with our decision, but before we can reopen the A&E overnight, we need to be confident that we can staff the doctors’ rotas consistently for at least 8 weeks in the future. To ensure we provide a safe service for Grantham people and those throughout Lincolnshire, it’s important we aren’t in a situation where we reopen A&E one day and then need to close again the next week due to doctors leaving. We need services to be safe and sustainable. ULHT remains committed to fully reopening Grantham A&E but only when safe to do so”.
“We are making steady progress in recruiting doctors. We now have three more middle grade doctors working regularly for us than in August – one at Lincoln and two at Pilgrim – and have secured the commitment of another 5 doctors, who we hope will be with us for 3 months.
“We currently have 17.6 middle grades for all our A&Es at Lincoln, Pilgrim and Grantham. Although the numbers are higher than in August, they are still below the required number of 21 to have all 3 departments open 24/7. Even if we had 21 doctors, this is still below our ideal number of 28. The numbers of senior medical staff can vary from month to month and we already know that two doctors will be leaving the Trust in the near future”.
At February’s Board meeting, ULHT reviewed the opening hours of Grantham A&E and considered the views of 10 of the most senior medical consultants, A&E medical and nursing staff, stakeholders and the public in making this decision. Our own data shows that the healthcare system is still coping with the overnight closure of Grantham A&E and that on the whole the impact has been small in the number of attendances and admissions at other A&Es.
Our clinical management board (the committee made up of our most senior doctors from across the Trust) supports this decision. They recommend that A&E remains closed overnight but to extend opening hours to cover 8am to 9am if safe to do so. Our commissioners also support the continued overnight closure of A&E.
While we are working hard to recruit doctors to work longer contracts, the reality is agency staff have the pick of places to work and often can leave a placement at short notice. We agreed on the threshold of having a minimum of 21 middle grade doctors before we reopen Grantham A&E with our commissioners and our regulators, as the level required for us to staff 3 A&E rotas 24/7 consistently and safely.
Our recruitment drive will continue. We are still advertising in the UK and abroad and are working with UK and international recruitment agencies to ensure we recruit enough doctors. We will review the opening hours in 3 months, at our Board meeting in May.