ACCIDENT and emergency consultants have today issued a call for action to address a "crisis" in frontline hospital care.
In an unusual move, the College of Emergency Medicine Scotland issued a list of 10 priorities which they say need attention.
These include measures to attract enough doctors to the field and changes to prevent patients being rushed into hospitals unnecessarily.
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The document says last year more than £14.4 million was spent on emergency medicine locums by health boards, and suggests relying on such staff to plug vacancies puts services at risk.
The call has been published despite repeated reassurances from the Scottish Government that their unscheduled care action plan and £50m investment package are reducing delays in A&E.
Serious concerns about the pressure on hospitals emerged in the winter of 2012-13 when hundreds of emergency cases had to wait for more than 12 hours on trolleys in A&Es because of shortages of ward beds.
The Herald revealed that the College of Emergency Medicine Scotland (CEM Scotland) had written to ministers months earlier warning that 21 out of 24 A&Es in the country were regularly unsafe.
The newspaper has been campaigning ever since for a review of capacity in the NHS and social care sectors to project the resources required to cope with the growing frail elderly population.
Last night Dr Jason Long, chair of CEM Scotland, said: "Certain areas of Scotland are still under quite a lot of pressure. There are good days and bad days. It is better than it was a few winters ago when there were a lot of people waiting over 12 hours. There is a lot of emphasis now at both health board level and government level on this.
"We have to move forward from what is going on to how more we can fix it. That is what we are having to impress on."
The priorities for action outlined include enabling patients to move swiftly out of A&Es, as crowding increases mortality. They want night and weekend duties of emergency doctors - often cited as a reason for shortages of trainees interested in the speciality - to be recognised in their contracts.
They are seeking better alternative services to help people avoid a trip to A&E. The document says: "A&E cannot mean 'Anything and Everything', no other healthcare system works in this way."
Dr Clifford Mann, president of the College of Emergency Medicine, said: "The college has been warning for some time now about extreme pressure in the unscheduled healthcare system. These are most evident in the A&E departments and create sometimes overwhelming challenges for those working in these departments."
Five of the 10 priorities for action issued are areas where the college is taking steps themselves, but the other five require action from the Scottish Government and NHS managers.
Alex Neil, Health Secretary, said: "CEM Scotland's continued support for the Scottish Government's investment in, and commitment to, the specialty of Emergency Medicine and the work of Emergency and Medical and Surgical Assessment Departments in Scotland is helping us to make good progress."