> Family life is important, isn't it.  We use
> five SHOs per 24 hours (staggered shifts, only one from 2am),
> so with 16 people, all of whom need six weeks hols, two weeks
> of stat days and two weeks of study leave - that still means
> about one-in-three weekends.  Not very good, is it?
> Maybe twenty is more realistic.

With consultants, things can be run a bit differently: you can be resident
and indeed on the shop floor apart from meal breaks but not working all the
time (functioning a bit like the head waiter in a restaurant), so shifts of
12 hours and over are workable (depending partly on how often you do them).
Also, you don't need overlap- handover time is sufficient (and some days
there won't be a lot to hand over). So you could run a weekend between 2
consultants without too much trouble as long as consultants are providing
advice and care for the sickest patients rather than the main service
committment of the department. Maybe nearer 1:6 weekends. Certainly
tolerable if appropriate time off midweek. Obviously if it's low intensity
(critically ill patients only) you can manage with much fewer consultants
and 3 day weekends. To decide what is acceptable you really need to know
what the workload will be.

I'd look at departments that have tried to achieve 24/ 7 consultant cover
before. It has been tried with an approximation to 8 consultants (Including
2 SRs) but various locums, and not every consultant an A and E consultant,
so it was established that the consultants were for trauma alerts and
cardiac arrests only. This did mean that for most A and E patients there was
often no consultant cover at all- and certainly not one available to come in
and deal with waiting times (maybe no bad thing). There was a bit of a
problem in that 'time off' was often taken up by meetings (there's still a
feeling by some people in the NHS that you have duties to the NHS during
office hours regardless of what you do out of hours). They were unable to
fill all posts (and had a fair amount of sick leave) so I think its fairly
clear that 8 is considerably insufficient (although I believe Oxford has
been working with resident orthopaedic consultants with fairly low numbers
pretty successfully- maybe they are resident but have low out of hours
intensity. I'd be pleased to hear comments from someone who actually knows
something about it).

> Current Situation
>
> Consultants 31
> Departments 38
> Registrars 104
> SHO 168

This looks like in 5 years (assuming consultant retirement at the rate of
20% every 5 years) you'll have 130 consultants for 99 posts with registrars
coming through the system. This is going to make recruitment to these posts
easier even assuming you have no new registrars appointed (and judging by
your numbers (am I in the right area with an estimate of 1- 1.2 million A
and E attendances for the country as a whole), registrars probably have a
major service committment so there will be opposition to reducing their
numbers.
Being cynical, the cheap way of providing 24/ 7 consultant cover is not to
make these jobs family friendly but to train enough consultants that its
going to be a choice between taking whatever job you can get, leaving the
country (not always an option depending on family committments etc) or being
unemployed. Staff grades already work large proportions of weekends (and in
some cases, nights). May be that consultants are being pushed in the same
direction.

Is it just me or can this thread segue neatly into the telepresence thread-
why have 9 consultants per department rather than just having them at one
central point and nurses at the others.

Matt Dunn
Warwick


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