QUEEN Margaret Hospital will have the only full-time accident and emergency service in Fife from today (Monday).

From now until January, all "out of hours" medical emergencies in the Kingdom will be dealt with in Dunfermline.

The A&E department at the Victoria Hospital in Kirkcaldy will operate as normal during the day but will become a minor injuries unit (MIU) from 5pm to 8am.

At that point, if someone attends at Kirkcaldy and their condition is more serious, they will be transferred to QMH.

Dr Gordon Birnie, medical director of the operational division, said, "This is an important step in the reconfiguration of our services as we prepare for the move of acute services into Victoria Hospital and the establishment of the diagnostic and treatment centre at QMH in early 2012.

"By basing out-of-hours emergency medicine at QMH from the end of February until the new wing opens, we can ensure the stability of services and allow new patterns of working to develop prior to the moves next year." Patient safety has forced the change with the health board highlighting the difficulty of staffing two A&E departments with unexpected absences, problems obtaining locum cover and reductions in the hours staff are allowed to work.

NHS Fife has stated most patients will be able to be treated at a minor injuries unit and reiterated, "At no time will the emergency departments at the Victoria Hospital 'close'." The roles will be reversed next year � the provisional date is 11th January 2012 � when the new wing at the Vic will open and the A&E in Dunfermline will close for good. From that date onwards, as part of Right for Fife, the QMH will have a diagnostic and treatment centre instead and patients will face being driven past their local hospital to get to the Victoria.

There are fears that patients will be confused about which hospital to go to and the extra travelling time in life-or-death situations.

Speaking to the Press earlier this month, Dr Robert Cargill, clinical director for emergency care, said, "It's a valid concern and something we've put a fair bit of thought into as well.

"The Kirkcaldy site was chosen to be the most central geographically and population-wise within Fife.

"It does mean that for the next few months there will be cases of ambulances taking patients past Kirkcaldy to Dunfermline.

"Subsequently there will be patients being brought from Dunfermline past their hospital to Kirkcaldy." The decision to move out-of-hours emergency medicine was taken in January and NHS Fife said it will provide consistency for the public and staff.

This followed a chaotic summer in 2010 when the contingency plan was implemented on numerous occasions, often at only a few days' notice, with QMH having to cope with all major cases from 5pm to 8am.

John Winton, of Local Health Concern and a board member at NHS Fife, said, "This is not an ideal situation and it will put extra pressure on the beds at QMH but, out of the choices on offer, it was the obvious one to take.

"I suppose in one sense Kirkcaldy is being used as the guinea pig so they can see how it works before the big change in Dunfermline in January.

"The biggest worry is still people attending at Kirkcaldy in the middle of the night, they then find out it's not something that can be dealt with there so they have to transfer them and wait for an ambulance.

"That's the risk and that's why it's so important they get the information out there about what a minor injuries unit can and cannot do."