Lack of trainee paediatricians could impact on out of hours care

SOUTHERN Scotland’s health boards, including NHS Borders, have revealed that with a lack of trainee doctors, paediatric staffing levels in the region are expected to be below the required minimum for out of hours care.

Paediatric and maternity services currently provided at the Borders General Hospital could be impacted on by the drop in numbers and with NHS Lothian and NHS Fife also experiencing a shortfall, services at the Royal Hospital for Sick Children and the Simpson Centre for Reproductive Health in Edinburgh, St John’s Hospital, Livingston, and the Victoria Hospital also stand to be affected.

Paediatric trainee doctors currently play a key role in providing out-of-hours cover for paediatric and neonatal services at these sites.

A total of 47 senior trainee doctors are needed to provide out-of-hours cover across the region but current projections for February are that there will only be 34 trainees available to cover these services.

A joint statement issued by the South East and Tayside Planning Group earlier this week read: “The paediatric workforce is managed on a regional basis to ensure safe and sustainable services across the region.

“NHS Lothian, NHS Fife, NHS Borders and NHS Education for Scotland’s South East Region (also part of SEAT), are working together and in partnership with stakeholders, to decide how best to deploy the workforce to provide safe and sustainable care for children and babies across south east Scotland, now and in the future.

“A paper detailing options for the future provision of children’s and maternity services across the region will be presented to the NHS Lothian Board at its November 28 meeting, to the NHS Borders Board on December 6 and to the NHS Fife Board on December 18.

“The public should be reassured that any decision will be taken in the best interests of patient safety and that there will be full engagement with all stakeholders.”

Since 2008, there have been growing challenges in medical paediatric staffing across Scotland and the UK as a result of: a reduction in the number of hours trainee doctors can work (European Working Time Directive); unprecedented levels of maternity leave and an increase in trainees working less than full time; the loss of very experienced trainees taking up other opportunities elsewhere to gain further specialist experience; and the lack of available and suitably experienced locum doctors to fill gaps, due to changes in UK Immigration rules.

All three affected health boards have been working closely to try and address the predicted shortfall in staff.

NHS Borders has been preparing for a change to the service model which would see out-of-hours cover for children’s and maternity services provided by advanced nurse practitioners rather than trainee doctors and has made a significant investment in training and development for these roles.

A review of paediatric training in the south east of Scotland was carried out by the Royal College of Paediatrics and Child Health earlier this year.

Although this review recognised the training programme was of a very high standard, it recommended that trainees should not work out-of-hours at St John’s Hospital and possibly Borders General Hospital as the small number of cases and limited case mix does not provide sufficient training experience.