Discussion will continue on this but I feel that is why our speciality is so
attractive.
I believe that we all share a common vision of direct senior involvement in
Emergency Medicine during all hours. If we did not have this then we would
not have made our career choice in Emergency Medicine?? (or am I naive).
Sadly practicalities intervene and some of us struggle against the problems
of maintaining standards of care in our departments with not enough numbers
of consultants to make working shop-floor shifts OOHs practical.
Some would argue that in those circumstances the work of the department
should be limited, or even that departments should close (Kidderminster!!)
This may be right but I caution against a knee-jerk response.
There are some departments that are geographically important yet they are
small and must be supported to provide a service. (This is not always the
view of managers)
In these circumstances we get down to "horses for courses" and provide what
is practical in the circumstances - as has been my experience.
In doing so I believe that we should not lose sight of our aspiration of
quality service for all.
Where patients can be focussed on one unit (eg Major Trauma) or arrangements
for cross cover agreed, then provided that the ground rules of cover and
standards of care are also developed, then as a speciality we should at
least study these systems and recognise that Emergency Care comes in many
guises

"life outside medicine" is another debate!!!
Mark P


> -----Original Message-----
> From:	Coats Tim - Professor of Emergency Medicine
> [SMTP:[log in to unmask]]
> Sent:	28 September 2005 11:18
> To:	[log in to unmask]
> Subject:	Re: A&E On - call Rota
> 
> I agree about the difference in smaller v larger units. However, maybe it
> is only an "inevitable split" if we carry on a 'Hospital Department'
> approach rather moving to a 'Regional Emergency Service' way of thinking.
> 
> I am not sure of the way forward, but it seems a very timely discussion.
> 
> Tim. Coats.
> 
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of McCormick Simon Dr,
> Consultant, A&E
> Sent: 28 September 2005 10:12
> To: [log in to unmask]
> Subject: Re: A&E On - call Rota
> 
> 
> I'm afraid this thread is demonstrating the inevitable split that will
> occur between so called 'central/teaching' units and the
> 'peripheral/district' units.  The bigger units can attract more senior
> staff on to better rotas which allow shop floor cover and a life outside
> medicine.  They set a 'standard' of care/cover which is unachievable in
> smaller units who will struggle to attract trainees on to these rotas,
> unless they are the unusual few who want to do DGH Emergency Medicine!
> 
> Simon McCormick
> 
> Rotherham DGH
> 
> nal Message-----
> From: Adrian Fogarty [mailto:[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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