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24 March 2015, 05:00
The body which represents A&E doctors has launched a campaign aimed at improving the quality and safety of emergency care in Scotland's NHS.
The Royal College of Emergency Medicine's (RCEM) Step campaign sets out a series of measures to address the problems facing A&E departments across the country.
It comes as many NHS boards continue to struggle to meet national A&E waiting-time targets.
The campaign calls for "safe and sustainable" staffing levels and "fair and effective" terms and conditions and funding.
It also calls for "exit blocking" and overcrowding to be tackled by locating primary care NHS services alongside emergency departments.
The RCEM said that while the number of A&E consultants in Scotland has increased, it is still short of the target of 230 whole-time equivalent agreed with the Scottish Government in 2012.
It warned that trainee doctors are exiting the speciality in "significant numbers" while more doctors and consultants are emigrating to work abroad.
It has called for the "life-career fit" of emergency doctors to be addressed by reviewing terms and working conditions, and for more to be done to retain and value trainees.
Over-reliance on more costly locum doctors is also inhibiting the development of a sustainable service and this money could be allocated to improve the working conditions of emergency doctors, the RCEM said.
It has also urged the Government and health boards to undertake an evaluation of funding for A&E.
Meanwhile, exit blocking - when patients cannot be transferred from emergency departments and admitted into a hospital bed - must also be addressed, the RCEM said.
It believes the issue should be dealt with by co-locating primary care facilities with A&E units to make transfers faster and more safe.
Dr Martin McKechnie, vice president (Scotland) of RCEM, said: "This campaign is essential for providing immediate support to, as well as ensuring the future of, Scotland's emergency departments.
"The college welcomes the support the Scottish Government has given to increasing staffing and tackling crowding in our emergency departments.
"We now need real action to be taken to champion our talented emergency medicine workforce, otherwise we will continue to lose staff to emigration and to other specialities.
"We must recognise and value the importance of emergency medicine to NHS Scotland."
The campaign has been welcomed by the Royal College of Physicians of Edinburgh (RCPE) but the Royal College of Nursing (RCN) Scotland warned against an isolated approach.
RCPE president Professor Derek Bell said: "The Step campaign highlights issues that are also being considered by the Scottish Government's unscheduled care review and it is important that both these initiatives are supported and driven by all professions associated with health and social care, and that a whole system approach is planned and adopted."
RCN Scotland director Theresa Fyffe said: "Focusing on A&Es in isolation is an oversimplification of the problem.
"So, instead of taking a piecemeal approach - via individual taskforces such as on delayed discharges, out-of-hours services, seven-day services and unscheduled care - we think the Scottish Government should put in place a sustainable approach to the whole health and social care system."