Making hospitals safer - RCP sets out safe staffing levels to protect patients

Guidance on safe medical staffing has assessed in detail the time needed to diagnose, treat and manage patients in a variety of hospital settings. The working party report divides clinicians into three clear tiers based on levels of knowledge, experience and responsibility, and calculates how much time is needed from clinicians in each tier. The three tiers are:

• Tier 1: Competent clinical decision makers – clinicians who are capable of making an initial assessment of a patient. This includes foundation year doctors, and doctors in the early stages of training such as core medical training and the GP vocational training scheme, physician associates and advanced nurse practitioners
• Tier 2: Senior clinical decision makers – the ‘medical registrars’ – clinicians who are capable of making a prompt clinical diagnosis and deciding the need for specific investigations and treatment. This includes specialty registrars in higher medical training programmes, SAS doctors and trust doctors, or sometimes more experienced core medical trainees who are at the end of core medical training
• Tier 3: Expert clinical decision makers – clinicians who have overall responsibility for patient care. This includes consultants and associate specialists.

The report then applies the tier model to the following hospital care settings:

• medical assessment and admission team
• medical ward team
• weekend medical ward team
• medical team on-call (providing out-of-hours cover for inpatients with medical problems).

The report makes specific recommendations for the amount of hours needed from each tier of clinician in each setting adding that hospitals need effective mechanisms in place to continuously monitor for surges in activity that compromise safe patient care. 

RCP president Professor Dame Jane Dacre said:

This report results from a detailed analysis, completed by physicians experienced in delivering care for acutely ill patients. It provides a tool which can be used to calculate a safe level of medical staffing. We hope to work with NHS colleagues to refine the method in different hospitals, so that it can help ensure that patients are not put at risk by medical workforce shortages.

RCP registrar and president-elect Dr Andrew Goddard adds:

The variation in the numbers of doctors per bed in the UK is staggering. At last we have a way we can benchmark medical staffing levels to ensure that patients will know if the wards they are on have safe staffing levels.

Dr Kathy Mclean, executive medical director at NHS Improvement, said:

Having the right medical staff with the right skills in the right place and at the right time is vital for providing patients with high-quality, responsive care. This report is a useful addition to the ongoing research into how the NHS can achieve safe and sustainable staffing across all its health settings. We will now work with the RCP on the issues raised by this report.