>But I'm surprised you get any rate at all for bank holidays. Aren't these 
>part of every consultant's contract, in the same way weekend cover is? 
>(Except you can take a day in lieu obviously.)

--> I am not aware of them being part of contracts except as described in 
one's job description. And the latter, of course, is individualised.

I think it is important to achieve a standard in one's department and then, 
such a standard, should cover 24 hours a day, 365 days a year. Consultants 
on the shop floor should eventually be one such standard, but, as we all 
know, there are not "enough" consultants about for this. Not that they do 
not exist, exactly. Each department has its own cover hours, some longer 
than others even with similar consultant numbers. It is logical to say that 
there are enough consultants in the UK for SOME departments, although 
nowhere near a significant quantity, to have 24-hour shop-floor working 
presence. In theory, for example, department X and its trust elected to have 
this cover and decided it required Y consultants, they could recruit that 
many. But they would have to find those who wanted to do this, knowing that 
the majority in the country do not. Some consultants will refuse to do it 
completely and this is understandable, as it was probably something they did 
not "sign up for" when they chose the career. For those others who would 
agree, a suitable remuneration system would be required and it is THIS 
(remuneration) that trusts don't have enough of, or don't wish to allocate 
enough to. Hence, business-wise, there will always be the drive to try to 
get the most they can for the buck they won't invest.

With this in mind, one must check one's job description not only for the 
hours of work, but also for the typr of work one is expected to do.

I don't think consultants should "queue bash" even 9-5. If they do that, 
then, by definition, you are using your most expensive asset for a job 
others can do and more of these others should be paid to be around - this 
makes financial sense if we accept that these others CAN do the job.

My previous point on this item, to expand, means that for ED consultants in 
this way are expected in when a certain size queue or waiting time is 
present, i.e. a numerical criterion. The parallel criterion would be for a 
number of simple, but urgent, orthopaedic and surgical cases which will 
require the trust to call in surgical consultants to "queue bash" with their 
SpRs in theatre, alongside with the relevant support from anaesthetists and 
other staff and theatre facilities - i.e. a 24-hours NHS. We'll need 
radiologists to be paid to come in outside hours to reduce the queue of 
unreported X-rays in trusts where they have more than a "next day" target 
for this (assuming "next day" is good enough. There should not be a waiting 
list for most things if everyone was paid enough to come in at weird hours 
and sacrifice their family time, etc.

There is not the money allocated for this. In some countries, to various 
degrees, in some specialties, there is and, of course EM will probably be 
front of the queue for it! I am looking forward to when EM consultants are 
paid enough to make all these anti-social shifts worthwhile. I am NOT 
against a 24-hour service. I am against a 24-hours service with 
discriminatory under-payment for those who provide it.