I think the new contract guidance says most of it: most places are going to
a 1:4 (with cover for leave) or less frequent. Certainly anything more
frequent would deter applicants (even if you hardly ever get called in, the
restrictions on what you can do might not go down too well- particularly if
the applicant's partner works some weekends as well). As to out of hours
sessions, probably depends on how much call ins you get. We currently get 2
PAs for call ins (keep it low by not coming in for waiting times). I think
at that level, adding in regular unsocial hours sessions won't go down too
well with prospective applicants (or with family). Also if we were coming in
for waits instead of sick patients it would be a bit boring and I think we'd
need to cut the amount of call ins. Again, the 2 PAs worth of call ins is
the maximum recommended in the new contract.
Andy Webster's point about offering special interests is an important one.
Offer these sessions and you can get more free work out of the consultant
and make the job more attractive to the better applicants.
With regard to banding, there have been some strange interpretations. The
word in the contract is "typically". Some trusts have tried to interpret
this as "the majority" i.e. if you get one call on a typical night and come
in for that, it's Band A; if you get 10 calls and come in for 4 of them it's
Band B. Usually, though, if you need to come in at 20 minutes' notice (i.e.
if you're on call for sick patients not just for waits) with any degree of
frequency, it's Band A. Major Incidents were mentioned. They're specifically
covered: you can be on Band B even if you come in for them.
With a single consultant, I had a friend (in another speciality) who was in
this situation a few years back. The BMA advised him (and his trust accepted
this) that single handed consultants have a lot of admin work, so maximum 5
fixed sessions and no on call. Sadly this was slightly after my own spell of
being single handed.
Matt Dunn
Warwick
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