> But there is not a consultant expansion. I have been working
> single handed for 3 years and was previously in a dept with 2
> consultants. A dept just to the North of here will be done
> to 2 consultants and at one stage there were 6.
Yes, a few departments have lost consultants since 1994 (mainly due to
failure to fill posts)- although I believe the department to the North of
you still has the anaesthetists on the rota so has lost 2 rather than 4
consultants. By my reckoning, in 1994 there were 20 consultants in post in
the West Mids, whereas now there are 50. I'd reckon from the expansion in
higher specialist training posts over the period there would be a pretty big
expansion, so even if my figures are a bit off they're probably close to the
truth. I'd guess that over the period 1994- 2001 consultant numbers have at
least doubled in the UK (although some individual departments may have had
no increase). Does anyone actually have the figures?
Basically I don't think the argument that consultant numbers have not
increased holds water.
Equally, as to the argument that maybe the trauma is coming in more after
midnight- possibly true, but I'd consider the main advantage of consultant
expansion to be that with a less frequent on call rota you can afford to
come in from home for all the sick or seriously ill patients 24/7 (possibly
with the day off after a night on call)- otherwise what are you doing?
I'd note that the paper from the West Mids alluded to by Adrian refers to
total A and E attendances. What is interesting is critically ill patients.
There may be a lot of variation between departments but in my own department
they are spread evenly throughout the 24 hour period
On major trauma, it comes to us more in the late than early evening (I
suppose in London, by 19:30 there's still plenty of traffic around but it's
not at a standstill. It's late evening by the time they've made their way up
the M40). Morning RTAs tend to be less serious. But major trauma makes up
only a small proportion of our call ins.
Matt Dunn
Warwick
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