GWENT'S newest hospital - the £172 million pound Ysbyty Ystrad Fawr - may be forced to close its emergency unit at nights and weekends from February next year.

The removal of some junior doctors from out-of-hours on-call work at the hospital - demanded by the Wales Deanery, which oversees doctors' education and training in Wales - has already forced Aneurin Bevan University Health Board into an expensive reorganisation of staff rotas.

The Deanery now also intends to withdraw remaining junior doctors from out-of-hours work at Ysbyty Ystrad Fawr from next February, a move a health board report warns will make running it during the night "totally unsustainable."

That would result, states the report, "in the hospital only being able to assess and admit patients between the hours of 8am and 8pm Monday to Friday, with the Medical Assessment Unit and the minor injuries unit (ie the Local Emergency Centre) having to close outside those hours.

The health board will discuss the issue at its board meeting on Wednesday, is seeking urgent talks with the Deanery, and will ask it to reconsider its decision.

A health watchdog has meanwhile warned that the Deanery's proposals could put patients at risk, and threaten the viability of the area's Clinical Futures programme of health service modernisation.

The Deanery, which is yet to comment on the matter, made its first intervention earlier this year, ordering that Core Medical Training (CMT) doctors undertake their out-of-hours on-call training at a busier hospital, in this case the Royal Gwent in Newport.

There were, and remain, concerns too that junior doctors have difficulty accessing teaching and do not get enough on-the-job consultant support.

The health board has implemented plans to increase middle grade doctor and consultant cover at the hospital, in response to the initial Deanery proposal, a move that will cost an extra £227,000 this year and a similar amount next year.

It had also begun to plan a medium-long term increase in consultants there, to enhance patient care and maintain junior doctors' training needs.

Now the health board will develop a business case by the end of November for extra consultant posts, though the timescale is tight and recruitment conditions difficult.

For a flagship hospital open for less than three years, and of which the 24/7 Local Emergency Centre is a major part, night and weekend closure of the medical assessment and minor injuries units would be a significant blow.

More than 16,000 patients have been through the medical assessment unit since the hospital opened, while 27,500 patients a year attend its minor injuries unit, which since April has averaged 2,574 patients a month.

Cathy O'Sullivan, chief officer with Aneurin Bevan Community Health Council, Gwent's independent health watchdog, said the health board had offered a form of junior doctor rotation designed to provide a broad scope of training support.

"The Deanery must work very hard to resolve this with the health board because this hospital is a lynchpin of the Clinical Futures programme and the South Wales Programme (of key services reorganisation) and without these services everything will fall down," she said.

She added that Ysbyty Ystrad Fawr has a key role, based on being a viable "local hospital for local people" and supporting the wider Gwent hospital network.

"I would urge the Deanery not to take any drastic measures. Otherwise it may put patients and services at risk," she said.