I have had experience of all of these - from a 1:1 cover for 7 years, to 1:4
with Orthopaedics and then to a cross-department cover.
The first is unsustainable, the second - Orthopaedic consultants do not
practice Emergency Medicine and should not cover anything other than
Orthopaedics - simple governance issue. My experience was just that - they
did not respond to the department.
I found that the Orthopaedic surgeons were very unhappy and got out asap.
 We now have a system in Shropshire where the 2 departments are covered by
the consultants in both departments (2 in each) on 1:4 - when we cover our
base department and also cover an Associate Specialist looking after the
other. This has worked well for some time. I resent the implication that we
do no work when covering - perhaps the author would like to come and try it.
We lead the trauma response and can be in for other matters as well. It
certainly is not a cushy number from where I come from with the Shropshire
and Welsh road systems generating business.
Mark P

> -----Original Message-----
> From:	Adrian Fogarty [SMTP:[log in to unmask]]
> Sent:	28 September 2005 09:15
> To:	[log in to unmask]
> Subject:	Re: A&E On - call Rota
> 
> Absolutely not (to your last paragraph). I see consortium cover as a
> classic 
> compromise, existing only because you don't have enough specialists in
> your 
> own unit. There are some ridiculous examples of this around the country, 
> where a consultant covers two, sometimes three, units at nights and 
> weekends. The result? The consultant doesn't actually do any work, or does
> 
> minimal work, in any of the units; he merely "covers from home" whatever 
> that means. I suspect some specialists prefer this system because of its 
> perceived "flexibility", which to my mind is just a euphemism for wanting
> a 
> cushy rota.
> 
> Surely it's about time our specialty provided decent levels of internal 
> cover, and by that I mean resident shop-floor cover by day and
> increasingly 
> at evenings and part-weekends, with dedicated single-unit cover at night, 
> just as most other acute specialties do?
> 
> AF
> 
> ----- Original Message ----- 
> From: "Coats Tim - Professor of Emergency Medicine" 
> <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, September 28, 2005 9:02 AM
> Subject: Re: A&E On - call Rota
> 
> No experience of cross speciality cover. I don't think that an orthopod is
> 
> able to practice emergency medicine (and an orthopod that thinks that they
> 
> can just doesn't understand and so should certainly not be allowed to).
> 
> I have some good experience of cross Department cover - very dependent on 
> Geography (all of the hospitals in the East London A&E Consortium are a 
> couple of miles apart).
> 
> Even if long distances are involved, it might be better for an ED to have 
> more distant cover from an emergency specialist rather than close cover
> from 
> someone who is not a specialist in Emergency Medicine. Maybe an agreement 
> from the local orthopods / surgeons that they would support the ED by
> coming 
> in for major trauma (which they probably could cope with) might assist
> this 
> system.
> 
> To go one step further. My guess is that on-site late shifts followed by 
> consortium on-call overnight (ie. one, or two, A&E consultant shared
> between 
> several hospitals) will be a future pattern for emergency service
> provision. 
> Closer integration with the pre-hospital care services would enable the 
> night shift consortium consultants to focus their time in the right areas.
> 
> Do we need to start taking a Regional rather than a Departmental view of
> the 
> provision of nightime Emergency Care, to develop a more flexible system?
> 
> (Puts on flame proof suit and hits send)
> 
> Tim. Coats.
> 
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of MICHAEL DUDLEY
> Sent: 27 September 2005 23:53
> To: [log in to unmask]
> Subject: A&E On - call Rota
> 
> Dear All
> 
> Does anyone know of A&E Departments that have an on-call consultant cover
> arrangement shared with another specialty, e.g. Orthopaedic Consultants?
> 
> I know it is suboptimal, but I am sure that many DGHs like us, have found
> that they would be unable to recruit new A&E Consultants with an on-call
> rota more onerous than 1 in 4.
> 
> I would be very interested to hear of/from A&E Departments that run such
> an
> arrangement.
> 
> Many thanks
> Mike Dudley
> Consultant in Emergency Medicine
> Airedale General Hospital
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