A few thoughts
Firstly to answer Bruce's original Q. My 'wrath is not
inspired' and I think this a legitimate and useful
topic to discuss. There are topics on the list I don't
like but live and let live.....
Frenchay has had 24h 'on site' middle grade cover 24/7
since 1993 I think, when I started there as a reg, and
full shift 'shop floor'cover for 2 years I think.  BRI
does also.
Bath was the first in the Southwest to get 24h 'shop
floor'reg cover in 1999.
on site cover is world away from shop floor or full
shift cover.
This is an important distinction. As a reg, I would be
brought x rays to my 'on call' room regarding minor
injuries but only find out about the ruptured spleen
in the morning.
The change in Bath to 24h full shift, shop floor cover
made emergency care registrar based 24 hours a day
rather than SHO based. There is still a huge aversion
to calling one's senior in UK medicine so the
'seniors' have to be there 24/7. Bath has neatly
managed to integrate the sick medical take patient
into this as I have bore dthe list with many times!
The problem with UK EDs is that one size does not fit
all - some smaller but geographically isolated depts
may never get the 7 middle grades required to provide
on site cover - and maybe don't have the casemix to
justify it. In other cases, Bath being one, the
casemix is such that the idea of returning to the old
'on call' registrar system is totally unacceptable.
Our experience in Bath of setting this up was that
there is indeed a difficulty getting quality middle
grades but there are people around: BMJ ads were
virtually useless but local word of mouth and positive
talk is useful and advertising in Australia once led
to a stream of excellent registrars for several years.
Admittedtly not everywhere has the international
'tourist' draw of Bath but Frenchay and BRI have also
been successful in antipodean recruitment.

Steve Meek
Consultant at Frenchay from Monday

>
> >  ----- Original Message -----
> >  From: Bruce Finlayson
> >  To: [log in to unmask]
> >  Sent: Tuesday, July 23, 2002 4:00 PM
> >  Subject: 24 Hour 'Senior' Cover
> >
> >
> >  At the risk of inspiring the wrath of the
> academic purists on the >list....
>
> >
> >  Who has 24 hour middle grade or consultant
> on-site cover?
> >
> >  Answers privately please if you don't want to
> clutter up the list....
> >
> >  Thanks
> >
> >  Bruce Finlayson
> >
> >
> >
> >


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