Guidance on safe medical staffing

This guidance is currently under review. We are working with resident doctors in training to develop updated guidance.

The RCP has updated its position on physician associates (PAs) since the 2018 publication of this guidance. In 2024, we published interim guidance on the scope, supervision and employment of PAs working in the medical specialties (also known as the physician specialties). The UK government has established an independent review of the PA and anaesthesia associate (AA) professions (the Leng review) which will report in spring 2025. 

Key points

• The results of the RCP Medical Registrar Survey (Appendix 2) and feedback from RCP members and fellows suggest that the out-of-hours workload of the medical registrar on-call is inappropriately onerous, with implications for patient safety.
• The practice of a single medical registrar both leading the medical intake and providing on-call medical cover for the hospital is unlikely to be successful and contributes to the heavy out-of-hours workload of the medical registrar on-call.
• It is essential that as much patient care as possible is delivered during the normal working day, rather than out of hours. We think that this is a key issue for patient safety, and the daytime staffing of wards should be such as to minimise ‘legacy’ work.
• Service must always support training and we have concerns that the significant increase in consultant-delivered care may limit the opportunities for resident doctors to acquire experience in decision making. We urge trusts to recognise residents’ educational needs when implementing consultant-delivered services.
• There must always be sufficient time available to speak with patients and their families and carers to ensure that all the relevant issues are known to the medical team who are caring for that patient. This is particularly important when a patient is unable to represent themselves adequately.

This report represents the start of an ongoing process to help hospitals ensure that they have sufficient medical staff to meet the needs of their patients and deliver safe patient care. The RCP will work with the NHS to refine the method in different hospitals.

Contact

If you have any questions or would like to find out more about the report, please email the RCP policy team on policy@rcp.ac.uk.