The thought of integrating the responsibilities for MAU might send a lot
of A&E consultants to an early retirement. A proportion don't want to
look after an observation ward.

Andy Webster

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Cliff Reid
Sent: 10 September 2002 01:58
To: [log in to unmask]
Subject: Re: A vision - or am I just being paranoid?

Does sound a bit paranoid, but great to discuss.

As emergency care becomes more complex and other specialists
increasingly
demonstrate their lack of skill and interest in acute care we will have
a
greater, not smaller role to play. I haven't seen anyone 'creaming off'
the
acute stuff from the stacks of sick patients in our departments.

We have a responsibilty to demonstrate our indispensibility as
specialists
to the powers that be, with the long term goal of more NTNs and
consultants.

In the meantime, I acknowledge the staffing problem, which calls for
creative approaches. NCCGs are not the answer, since as you say, they're
just not out there. There is however a growing number of excellent
post-membership prospective emergency physicians who do not have an NTN
but
would like middle grade experience as a non-numbered registrar, whatever
you
want to call it ('fellow' is popular). There are also overseas doctors
who
would appreciate some UK experience and salary. There are medical
registars
and SHOs and PRHOs who might benefit from working under our direction in
our
departments if we were to integrate medical assessment units into our
EDs.

We shouldn't be left with social problems and out of hours GP work if we
agree what our core emergency work should be and demonstrate that we are
the
best at doing that and insist that is how our resources will be
deployed.

If we let other specialists do what we have trained to do, and allow
ourselves to be used as GPs, for which we haven't trained, then surely
we,
along with our Faculty and Association, should take responsibilty for
our
own passivity.

If your nightmare scenario does come true, I recommend www.qantas.com
for
good deals on one way flights.

Cliff Reid



>Have happily lurked for a while and wonder what the list thinks of the
>future of our Speciality outwith Teaching hospitals (which I have heard
>more than once in conversation with colleagues.)
>
>The New Consultant contract is rejected, and at some point a
>new-and-improved Contract is agreed (or enforced by the Gov).
>GP's will increasingly pull out of out of hours work.
>SHO training is drastically improved, by removing the service element
of
>their jobs as they pass through the two year General Training (European
>Working Time Directive making sure they don't stay up past bedtime.)
The
>gap between this and SpR post is as yet clear, but is likely to be some
>version of a speciality training.
>SpR Training will drop to three years and most of that centralised in
order
>to improve its quality (and conform with the EWTD.)
>Perpheral DGH's will rely on NCCG cover for service. There is a
shortage of
>Doctors willing to do this work at present, so many units will be short
>staffed.
>Central, teaching hospitals will be relatively well staffed as they
will
>have SpR's and NCCG staff, while DGH's will struggle to find staff.
>
>The result? DGH consultants will be required to do the work, a large
amount
>of it out of hours. Of course there will be less of it, as we will have
MAU
>and other speciality admission units that will cream off the Acute
stuff
>and MIU's for the minor stuff. This leaves us with the social problems
and
>less glamourous stuff, in addition to an increasing amount of out of
hours
>GP workload.
>
>I accept this is a rather extreme view, but I think we have an
interesting
>10 to 15 years ahead of us.
>
>
>
>




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