We are experiencing increasing difficulties in staffing our minor injury units (MIUs) and have to take the difficult decision to restrict the opening hours of some units when we cannot run them safely.
MIUs that have been affected in recent weeks are those at Burnham-on-Sea, Minehead and Shepton Mallet community hospitals. All the other MIUs at Bridgwater, Chard, Frome, and West Mendip community hospitals have been open as normal.
We know that it is a disappointment and concern to local communities when we need to restrict opening hours on safety grounds and we are doing all we can to keep our normal opening times unaltered. This includes working very hard to attract permanent staff and seek short term bank and agency staff to cover shifts. Many of our colleagues are also volunteering to work extra shifts, or working in a clinical role, to keep services open.
When we do need to restrict the opening hours of some units, we notify our NHS partners so that patients who seek advice are given up to date information, post information on our website and on our social media accounts. The minor injury service is one of a number that provide care. Anyone who is not sure where to go should ring NHS 111 for help and advice, this is accessible 24/7.”
What is causing the restricted hours in some units?
Our MIUs are led by Emergency Nurse Practitioners (ENPs) who are highly qualified sought after members of the NHS team. ENPs are senior registered nurses specialising in emergency and urgent care, who have additional diagnostic clinical skills and are registered as independent prescribers. They are able to interpret x-rays and are qualified to a higher level in the resuscitation of both adults and children. Regrettably there is a shortage of ENPs nationally, Somerset is no exception.
Since March 2018, the equivalent of nearly ten full time ENPs have left their roles in the west of Somerset due to a combination of maternity leave, staff sickness, resignations, retirements and taking up jobs elsewhere in the NHS or overseas and we currently have five ENP vacancies across Somerset. This picture is constantly changing.
Our staff work across a number of units in order to provide as much resilience as possible but, with the current level of vacancies, we have had to restrict the hours of some units when we cannot run them safely.
Our MIU in Minehead is the only unit that is open overnight and it is staffed by paramedics from 9pm until 7.30am. In recent weeks we have also carried vacancies for paramedics, which has resulted in us having to close overnight on some occasions.
What are we doing to solve the problem?
We are working hard to recruit permanent colleagues. Since 2018 we have had 8 ENP adverts out but, due to the shortage of suitably qualified candidates, we were only able to offer roles to a small number of individuals, not all of whom accepted. We currently have adverts out for ENPs.
We work with universities to train our own ENPs. Our programme is well-recognised and respected and training places are highly competitive. It takes an average of two years to train a registered nurse to become an ENP.
We are thinking as imaginatively as possible to see if we can employ colleagues with sought after skills to work across two organisations, enabling them to gain experience in different sectors. We are also exploring whether minor injury services can be provided differently, for example with physiotherapists working with ENPs in our minor injury unit at Bridgwater.
We work with a range of agencies to help us ensure that we have skilled colleagues in place to care for patients and we are working with a number of agencies to find ENPs and paramedics to cover shifts. Again, this is difficult because demand for ENPs currently outstrips supply and the same is true of paramedics.
Like all NHS organisations we use agencies that are on the national framework and provide staff as close to capped rates as possible but must sometimes seek staff from non-framework agencies where there is an urgent need. We are currently working with nine agencies to identify ENPs to cover shifts in our MIUs, two of which are off framework. Once the agency identifies someone who is suitable to work for us, we check their qualifications and eligibility to work in-line with NHS Employers standards.
Our colleagues are doing their best to maintain our normal opening hours with many of them volunteering to work extra shifts or working in a clinical role.
About the Minor Injuries service
The minor injury service in Somerset is one of a number of services that provide urgent care. If you are not sure where to go, ring NHS 111 for help and advice and for emergencies, call 999.
We provide a minor injury service from 7 sites across Somerset, caring for approximately 100,000 people a year. Our MIUs are situated in community hospitals in Chard, Bridgwater, Burnham-on-Sea, Frome, Glastonbury, Minehead and Shepton Mallet. They are run by Emergency Nurse Practitioners (ENPs) supported by staff nurses, paramedics and health care assistants.
The service is accessible and open to all, patients can ‘walk-in’, be referred by NHS111, the ambulance service, or referred by their general practitioners.
The service is intended for patients with non-life threatening conditions. Patients with heart attacks, stroke, major injuries or other time critical conditions need to be seen and treated in emergency departments.
Our team of emergency nurse practitioners see, assess, diagnose and treat a wide range of non-life threatening minor illnesses and injuries. Common examples include:
- Chest infections
- Throat infections
- Eye injuries and infections
- Urinary infections
- Minor head injuries
- Sprains and strains
- Broken bones
- Assorted wounds
Average annual attendances at our units are:
Shepton Mallet, 12,000