On Tuesday 1 November, United Lincolnshire Hospitals NHS Trust Board recommended Grantham A&E remains open from 9am to 6.30pm. This decision will need to be approved by NHS Improvement on 11 November and ULHT will review this decision monthly.
ULHT Board reviewed the temporary reduction in opening hours of Grantham A&E and considered the views of staff, stakeholders and the public in making this decision.
In August, ULHT made the difficult decision to change the opening hours at Grantham A&E due to severe shortage in emergency medicine doctors at Lincoln and Boston hospitals at a time when demand for services increased. With effect from Wednesday 17 August 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 along with other trusts, ULHT is seriously affected by this. Reducing the opening hours of Grantham A&E allowed us to support the provision of better patient care, shift by shift, in Lincoln – our busiest A&E – where they were most needed. Though not ideal, this was the safest option for the people of Lincolnshire including those who live in the Grantham and district area.
We have been working hard to recruit locums, agency staff and permanent staff. Since 17 August, we have received 16 applications for permanent jobs, and offered jobs to nine doctors. Due to the time it takes to recruit, none of these doctors have started work at ULHT yet, and the applications are in various stages of pre-employment checks. We have been successful in employing two more long term locum registrars to Lincoln A&E.
ULHT has the funding for 15 consultants and 28 registrars to cover rotas 24/7 in our three A&Es. Currently, we are now down to 14 consultants, of whom 10 are locums, and just 17.6 registrars. This is more than in August but two doctors are leaving the Trust in the next few weeks so the positon remains challenging.
This is well below the Royal College of Emergency Medicine’s recommended staffing levels of a minimum of 24 consultants and a minimum of 27 registrars and below the threshold of 21 registrars, which was agreed with NHS Improvement and South West Lincolnshire CCG as the minimum number of doctors needed to reopen Grantham.
Dr Suneil Kapadia, medical director at ULHT says: “Along with Grantham people, ULHT wants to reopen Grantham A&E. But we won’t do this until it is safe to do so.
“Since August we have employed two more long term locum registrars to Lincoln A&E and Grantham doctors are having a positive impact on Lincoln A&E. I’d like to thank the Grantham doctors who have supported Lincoln. They have been brilliant and have helped deliver safe patient care. They are providing up to 75 hours a week registrar and up to 8 hours a week consultant support at Lincoln. But the reality is the service remains fragile and sustaining staffing rotas in the three A&Es is difficult.
“We didn’t review the decision on our own. We consulted widely with neighbouring trusts, the ambulance service, commissioners and other agencies such as the police, and engaged our staff and the public. We recognise the closure is causing worry and stress to local people as a local service is important to the community.
“Our own data shows that the healthcare system is coping with the overnight closure of Grantham A&E and that on the whole, there has been minimal impact in the number of attendances and admissions at other A&Es.”
Our clinical management board (the committee made up of our most senior doctors), NHS Improvement and South West CCG and the Lincolnshire System Executive Team all feel that the A&E should remain closed until we recruit more doctors but to keep this under close review.
Dr Vindi Bhandal, GP and Chair of South West Lincolnshire CCG said: “The decision to close the A&E department overnight was made by ULHT as a result of concerns over the safety of A&Es across the whole county of Lincolnshire. South West Lincolnshire CCG understands the difficult decision the Trust was faced with making and is working with them and other NHS providers in Lincolnshire on the provision of urgent care services to our patients in Grantham.
“While the current situation is not ideal we will continue to work closely with the Trust as they work to address the staffing difficulties being experienced across Lincolnshire’s hospitals.
“I would like to reassure residents of the Grantham area that we remain committed to ensuring that our local NHS continues to provide high quality, appropriate care for our patients, their families and carers”.
There has been no significant increase in people attending at Lincoln or Pilgrim A&Es, although eight extra patients a day from the Grantham and district area (NG 31, 32, 33 and 34) are attending Lincoln and Pilgrim A&Es. There has been no increase in the numbers attending the GP out of hours service at Grantham hospital.
Two extra people a day are taken by ambulance to Lincoln via 999 but there has been negligible change in emergency admissions to the emergency departments at ULHT.
On average, one extra patient a day is being taken to Peterborough A&E by ambulance.
There has been no increase in the number of calls made to EMAS from Grantham and district patients. For double crewed ambulances, there has been no alteration to the length of time spent on scene or time taken to arrive although EMAS crews are reporting later finishing times since the closure.