I'd agree with you..... I've added the "not" to your E mail as you meant.
Although in the short term sharing on-call for multiple trauma for
departments close to one another might be the only way of keeping "things"
going.

Then again what do we do about departments in rural areas Barrow is 47 miles
from Lancaster.... and we are in the same Trust.

The bottom line is we need many many more experienced A&E doctors to provide
a 24 hr service.

Ray McGlone
A&E Lancaster

----- Original Message -----
From: "Nick Jenkins" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, March 13, 2004 2:02 PM
Subject: Re: GPSI


Not the main thrust of the thread - but now that Jeremy has raised it...
Presumably before sorting out this night-time A&E cover we'd sort out the
evening etc. cover first - and all such cover would operate consistently?
That being the case I would far prefer to use Consultant A&E resources at my
disposal to be on my single A&E site providing an input into the vast
majority of A&E work - e.g.. the walking wounded etc. and dealing with the
majors once they come to A&E rather than being out in the community dealing
with only the big stuff. That way a greater proportion of A&E work gets
Consultant input - and I certainly would not envisage being able to provide
the
quality of A&E service that I'm happy with by spreading myself over even 2
sites (as I currently CD for anyway).
Just my opinion - each to their own.

Nick Jenkins
A&E Consultant
Abergavenny
http://www.ae-nevillhall.org.uk



-----Original Message-----
From: Jeremy Mayhew [mailto:[log in to unmask]]
Sent: 13 March 2004 13:24
To: [log in to unmask]
Subject: Re: GPSI


Remember that of a GPs total pay, say a well organised practice earning
80,000 each for a four and a half day week only 80% of it is usually
superannuable making a true NHS income of about 65,000 - the rest of
income comes from writing insurance reports, medicals, signing
certificates and so on.

The true salary therefore reflects an A&E consultant basic pay plus
earnings from say medicals and medicolegal reports.

Like all on call, out of hours is priced very badly - at 5-6% of total
income. The difference with primary care is they have restructured and
reorganised - instead of each GP earning 4-5,000 from doing a one in
four on call say, they have pooled all this money and run sessional out
of hours sessions so that typically at night a GP is on call for 30
practices.

The difference is working all night, taking telephone calls and visiting
whereas before you may face one unsociable hours call every other time
you were on call.

Pooling the resources mean a number of GPs can do short, manageable
intensive shifts paid extremely well. Resources are managed in line with
DH guidelines, ensuring that responses are limited to a response within
two hours for urgent calls.

I see no reason why A&E out of hours services cannot be organised in a
similar way.

In the County of Sussex for example, expert level A&E cover could be
satisfied for say midnight to 0800 by having two marked audi RS6's
driven by police or ambulance, fully equipped with emergency equipment
and a consultant for each side of the County - covering three A&Es each
and possibly helping out in the prehospital environment.

You would be in constant contact with all on call sites, be able to pop
in to all during the shift, and respond within 20 minutes to any request
for senior assistance at all hospitals - which should be sufficient with
pre-alerting, not to mention the fact that you would be listening into
the emergency communications all night.

I do not believe that major trauma hits the front doors of Sussex
Hospitals simultaneously very frequently.

Instead of being on call one in three, the consultants in Sussex could
do sessional 12 hour shifts (18 a week 1900-0700) and have to do one a
week, perhaps including senior SpRs on the rota too...

That may be fanciful, but is exactly what the GPs have done.

A GP dedicating him or herself to out of hours work will expect a
remuneration of around £150-200,000 at £60-100 pounds an hour, so I do
not feel the GPSIs pay is unreasonable.

A staff grades remuneration is not that bad really - equal to a salaried
partner of about 60k without on call or management responsibility, just
turning up, doing the job and going home again.


Best wishes

Jeremy


-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Simon McCormick
Sent: 13 March 2004 07:29
To: [log in to unmask]
Subject: Re: GPSI

Rowley and Danny,

I agree that the Staff Grades and Assosciate Specialists are under paid
and
am suitable chastised for forgeting about them. However, the principle
remains the same. You have senior staff who have been trained as
specialists or who have a long term commitment to a specialty and they
are
paid much, much less than someone else who is coming in to do a bit
extra
from another environment. I don't care how good they are as a GPSI, I'm
sure they're not worth that much more than the rest of us senior staff.
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