Casualty departments in Wales, UK are themselves becoming a casualty of an acute shortage of junior doctors. Working hours are being curtailed, affecting emergency patients.
General practitioners (GPs) could now be drafted in to run the department of a major hospital in Swansea because there are not enough junior doctors.
The Abertawe Bro Morgannwg University NHS Trust is considering transforming Singleton Hospital's casualty department in Swansea, into a daytime minor injuries unit.
The unit would be staffed by GPs and open between 8am and 6.30pm on weekdays only. During evenings and at weekends it would become the Swansea out-of-hours GP centre.
It is thought that the changes will affect up to 10 patients a night who use Singleton's casualty, but would instead be diverted to nearby Morriston Hospital.
The plans, which have yet to be approved but could be in place by the autumn, come as the casualty unit has been repeatedly forced to close at short notice because of a lack of junior doctor and locum cover (substitute), Western Mail reported.
The current service has been described as neither "safe nor sustainable."
Andy MacNab, an A&E consultant in Swansea, said: "Recruitment problems are not unique to Swansea or even to Wales.
"Emergency medicine is experiencing difficulties in recruiting middle-grade doctors, particularly non-training grade doctors.
"There are several reasons for this, which include the system for training junior doctors that was introduced last year UK-wide, making it harder to step up to registrar level from a non-training post.
"There has been difficulty recruiting appropriately skilled doctors to substantive posts at ingleton for some time, and the department has been increasingly dependent on locums, despite an increase in the amount of consultant input and support.
"Even the major locum agencies in the UK are struggling to find suitable candidates with plenty of advance notice. They report the locum pool for A&E has shrunk considerably.
"The intermittent, unpredictable closure of the Singleton service, which is happening increasingly often, is not in the best interest of patient safety.
"Patients have arrived expecting the department to be open and find it unable to deal with their condition.
"The senior A&E doctors in Swansea want a robust, predictable and safe service to be provided from the Singleton site."
Under the plans being considered by the newly-merged trust, some of the Singleton casualty staff would be transferred to Morriston Hospital's busy A&E unit to help deal with increased demand and meet the Assembly Government's tough four and eight-hour A&E targets.
Dr Ashock Rayani, a Swansea GP with 25 years experience, said: "The option to work more closely with GPs at Singleton has certainly got the support of the GP community in Swansea.
"While a well-equipped and resourced A&E service at Morriston is important for the city, there is also a necessity for patients who don't need that level of emergency care to have a safe and regular service available to them.
"There is an opportunity to provide medical expertise at Singleton using highly-qualified and experienced primary care doctors, who also have local knowledge of their patients.
"We already have a successful out-of-hours primary care service and there is the chance to develop and build on this good work."
Calum Campbell, the trust's assistant chief executive (west) said: "Through our discussions, and the feedback we've received from our clinical staff, it is clear that the current service is not safe and sustainable as it stands.
"We are regularly left with no choice but to close the unit at various times, particularly at night, because no doctor is available, and that situation cannot be allowed to continue indefinitely.
"The safety of our patients is the trust's first priority and we are working hard to determine the safest and most effective model of care for Singleton for the future.
"One option being looked at is working with the GPs to provide a safe, effective and regular service at Singleton. Nevertheless, nothing has been decided yet."
A spokesman for the Welsh Assembly Government said: "Hospitals across Wales and the UK, including Swansea, continue to have difficulties recruiting what are classed as middle- grade doctors in some specialities.
"That is why we are working hard with the Deanery and BMA to highlight the attractions of living and working in Wales to encourage more doctors to train and work here.
"Having more junior doctors in training in Wales should lead to more doctors taking forward their careers here and working in Wales in the future," he added.
"The recruitment round for any remaining junior doctor vacancies will begin in September."