Cementing a strategy for the future of the emergency care workforce

A new report recommends extra investment in advanced clinical practitioners to help address the significant pressures in emergency departments.

A new report recommends extra investment in advanced clinical practitioners (ACPs) to help plug the gaps in staffing and address the significant pressures in emergency departments (EDs).

For the first time in its history, the Royal College of Emergency Medicine (RCEM) has come together with NHS England, NHS Improvement and Health Education England to draw up a vision for clinical workforce planning in EDs.

Picture: Alamy

Shared vision

Setting out a comprehensive package of proposals, the plan, launched last month, will create the opportunity 'to provide a step change in ensuring that the present workforce challenges can be met in the medium term'. It also promises a 'proper shared vision' to address future demand.

Securing the Future Workforce of Emergency Departments in England focuses on three areas to support local organisations trying to address their workforce challenges. These include: growing a multiprofessional workforce, reducing attrition in emergency medicine training and improving the retention of staff working in EDs.

23 million

patients seen at emergency departments in England over the past year

Among the practical steps proposed is the development and funding of an ACP fast-track programme, which will see 42 ACPs begin work in 14 trusts this year, rising to 84 ACPs next year. In addition, a new national ACP framework will be published this month setting out a clear definition of the role, and the level of practice and capabilities needed. This will help to ensure a more consistent approach to the training, deployment and outcomes for ACPs, says the report.

Chair of the RCN Emergency Care Association Janet Youd broadly supports this expansion. 'While the number doesn’t sound very many, each will cost around £10,000 in university fees, so this is not an insignificant investment,' she says.

'ACPs will form part of the permanent workforce of the future in emergency departments, providing a valuable, knowledgeable and stable workforce.

'The challenge is educating the number we need,' says Ms Youd.

'We’re at risk of depleting an existing workforce that is already stretched. We know that we have a workforce shortage in emergency nursing, particularly at band 6 and 7 levels in many places. If you look at the RCN’s emergency nursing curriculum, there’s a clear pathway to ACPs, but we need succession planning to backfill those posts. But of course, we also need to be mindful that nursing isn’t the only profession ACPs can come from.'

Physicians associates (PAs) are also set to increase considerably over the next two years. Annual graduate numbers are projected to exceed 900 by 2019, bringing the total number of qualified UK PAs to more than 3,200 from a current level of about 360, with one third of those working in emergency care.

'This will provide significant additional clinical resource for emergency departments,' says the plan. 


growth in the registered nursing workforce in emergency departments between 2012 and 2017 – from 12,491 to 14,613 whole-time equivalent


On recruitment and retention, next year 20 trusts with the most pressing problems will be given dedicated HR support to develop their own bespoke plans to address workforce issues. This support will test initiatives such as enhancing professional development, training, research time and study leave allowance for ED staff; putting in place more options for those nearing retirement or aged over 55, including pastoral or teaching opportunities; and funding for psychological support for those who have experienced traumatic events.

The RCEM and NHS Improvement will also publish a best-practice guide that trusts will be expected to use to lead improvements in their own EDs.

'There is a clear link between employers who have good staff engagement strategies and plans, high levels of staff health and well-being, and improved patient care,' says the plan. It also suggests that looking at work-life balance, career development and staff engagement may all help to counter staff stress and burnout.

'Staff who work in emergency care tell us that they are attracted to the specialty because of its fast pace, the regular and direct contact with large numbers of patients, and the variety and interesting nature of the work,' the report says.


number of advanced clinical practitioners, including nurses, from 14 trusts being funded on a fast-track training programme this year

'However, the reasons that staff are attracted to the specialty can also be the very reasons they want to leave.'


To drive the plan’s implementation, a steering group will be established, with representatives of all four organisations, plus the RCN and others who will meet quarterly, reviewing progress against a range of indicators. These include vacancy rates, spending on locums and staff satisfaction surveys. 

Although the plan focuses primarily on the emergency medicine workforce, there is an acknowledgement in the report of the 'significant challenges' faced by ED nursing. 'These will be considered as part of further work on the broader urgent and emergency care workforce over the coming months,' it says.

Who are advanced clinical practitioners?

Advanced clinical practitioners (ACPs) play an increasing role in emergency departments, says the Royal College of Emergency Medicine (RCEM) report, although their use varies widely across the country.

As well as those drawn from nursing, ACPs may come from a variety of different backgrounds including pharmacy, occupational therapy, physiotherapy and paramedic practice.

The report says: 'There is significant scope to grow this workforce group in a more systematic way, which will bring significant benefits.'

These include:

  • Increasing the breadth of cover and skills.
  • Offering further career development for senior nurses.
  • Improving staff retention.
  • Reducing reliance on locums.
  • Increasing the stability of rotas.

The RCEM is piloting a credentialing process for ACPs, while earlier this year the RCN launched its own credentialing scheme for advanced nurse practitioners following a successful pilot. The RCN fee-based scheme is open to nurses who can demonstrate they are working at an advanced level of practice, with those who are successful included on a register.


The RCN is already working with NHS Improvement on the nursing stream, says Ms Youd, although nothing has yet been published.

'I hope the work feeds into this multiprofessional workforce planning,' says Ms Youd. 'You can’t be prescriptive around specific professions anymore, because departments have such different staff mixes.'

Last year, the RCEM and the RCN held a crisis summit on the pressures facing EDs, which led to a report titled The Medicine Needed for the Emergency Care Service, published in August 2016. Among the recommendations was 'an effective and realistic workforce planning strategy'.

Read the full RCEM report

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