This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies.Find out more here


To discuss how you and your organisation can get more involved with The Work Foundation, please contact us.

Call 020 7976 3575 or email


Dr Zofia Bajorek

The effect of excessive pressure on A&E staff

Authors: Dr Zofia Bajorek Dr Zofia Bajorek

08 October 2013

The headline on the health section of BBC online this morning (8 October), “A&E doctors say pressure is threat to patient safety”, paints a worrying picture of care provision in the NHS, and the health and wellbeing of Accident and Emergency Staff.

Concerns have been raised following a survey of 1,077 emergency medicine consultants by the College of Emergency Medicine. They found that 94% of staff regularly worked more than their contracted hours in an attempt to maintain ‘good quality’ levels of service, and 62% of emergency medicine doctors reported that their job is not sustainable in its current form. The work-life balance of A&E staff, the constant (and increasingly complex) workload, and continuing media criticisms of A&Es not reaching their four hour waiting time targets have also added to existing recruitment problems that have led to a crisis in A&Es.

In a recent longitudinal study discussing retention and turnover of NHS staff, reasons for leaving the workforce focused around what was wrong with the NHS rather than being attracted by alternative employers.  This may not be too surprising considering emergency medicine has been described as ‘the most challenging, high-pressured and stressful work environment, often with limited resources and gruelling workloads’.

The big question remains: what can be done to help A&E units in England cope with growing pressures, and to persuade more junior doctors to choose a career in emergency medicine? 

One solution currently in place extensively throughout the NHS is the use of temporary staff (both bank and agency) to cover short-term absence, or busy departments. However, concerns have been expressed regarding the use of temporary staff and their implications for patient safety and service quality. Temporary staff (particularly ad-hoc agency staff) unknown to the environment, may not have up-to-date training and are provided with limited, if any, feedback when on shift. 

Additionally, temporary staff may add to the workload and pressure of already over-worked permanent staff. This occurs because they require increased supervision, may not be able to undertake certain tasks, and may not receive an appropriate staff induction, especially if the A&E is already busy and understaffed.  If managers wish to continue using temporary staff to cover staffing cracks, then managers need to be aware of the importance of the employment contract, and maintaining a positive employment relationship with both temporary and permanent staff to improve patient outcomes and staff health and well-being.

The Department of Health has said that it has given an extra £500 million to help struggling A&Es. However, concerns have been raised by doctors stating that this cash injection only covers the cracks in the system, and will not benefit all departments, as funds are targeting Trusts who are under the most pressure and struggling to meet waiting time standards.  It may also be demoralising for Trusts who have performed well, consequently not benefiting from this gesture. 

It must be questioned what this money will be spent on?  Will it be used to recruit more permanent staff desperately needed in A&Es or will the money be used to hire agency staff as a short-term solution?  Or, will the money be used to invest in training and the development of managers to recognise the effects of stress and workload on staff, and to implement resources that can help to reduce absence of staff in the future?

Additionally, Health Education England has been tasked with developing plans to encourage more students to become A&E junior doctors in the future. However, questions remain regarding the current negative culture of A&Es and how this must change before emergency medicine becomes an attractive option.

If there are risks to patient outcomes and staff health and wellbeing with both understaffed departments and when temporary staff are used, effective management strategies to tackle the system currently in place need to be implemented, if any real change in outcome