I do not see this as realistic, achievable or even always desirable. As an 'ANP' I do not want every 19 year old I see with chostochondritis or 12 month old with otitis media 'signed off' by a consultant - what form will this signing off take? Who will do it at 3am on a Sunday? I think the primary driver is more consultant staff whereas I am sure we could just make better use of and develop the expertise that we do have  - there is unfortunately a difference between what you want and what you get 
It is worth rememebering that there are going to be at least 7 other quality indicators as well so this should not be taken in isolation

Jim Bethel  

-----Original Message-----
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Subject: ACAD-AE-MED Digest - 6 Dec 2010 to 9 Dec 2010 (#2010-109)

There are 3 messages totaling 504 lines in this issue.

Topics of the day:

  1. Consultant Sign Off (3)

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Date:    Thu, 9 Dec 2010 19:09:37 +0000
From:    "McCormick Simon Dr, Consultant, A&E" <[log in to unmask]>
Subject: Consultant Sign Off

So, what are the list's thoughts on the CEM standard for consultant sign off?  A bold step to encourage safety and excellence in our specialty or another expectation heaped upon the already overworked consultant workforce?



I know they say it can be delegated on to a suitably qualified MG in our absence but haven't they seen what is happening across the country to that tier of doctors?  We are running with only half of the basic eight MGs required for 24 hour cover and like many have to prop up our rota with a succession of short/medium term locums, a significant number of whom wouldn't really fulfill the criteria they use for a suitable MG reviewer.



Clearly CEM continues to push for 24/7 consultant presence (a good thing) but is that achievable in the current climate or even in the near to middle future?  There does not appear to be a hoard of trainees hungry for DGH consultant jobs just about to pour over the hill to rescue those of us holding out at The Alamo ED.



Trainees appear to be turning their backs on EM and anecdotally it is because they see the conditions and workload of the consultants they train with.  The recent national recruitment for ST4s has 82 slots to fill and I understand has had only 26 applications to date.  Why are there so many ST4 gaps and why is nobody desperate to join in at this point?  Could it be those at the end of CT3 have decide that anaesthetics/critical care/acute medicine or even GP land offers a better working life for their skills?



Sorry but I do struggle to see any light at the end of this tunnel, particularly for those of us in understaffed DGHs.



Simon





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Date:    Thu, 9 Dec 2010 20:07:24 -0000
From:    [log in to unmask]
Subject: Re: Consultant Sign Off

I think it's part of a move towards a US style system of having every patient signed off by a fully trained doctor which is no bad thing. It would be difficult to achieve with current staffing, but if it becomes an accepted standard, it would drive consultant expansion. I do however have certain concerns about how we would fill these posts. I have just been sent an advert for a (presumably hard to fill) post in Brisbane: 8 consultants; 36 medical staff total; serving a population of 165,000; paying £217,000 a year. It is difficult for a UK hospital to compete directly with that offering an increasingly first on post; less job variety and a substantially lower salary, so it is not hard to see why trainees with an interest in Emergency Medicine are choosing to emigrate. I also have some concerns about the shift in the type of patient we will be seeing as consultant. While there is much to be said for having consultants reviewing all high risk patients prior to discharge from the patient's point of view, a move to a higher proportion of time being spent on this type of work will not be as attractive to everyone as (for example) dealing with critically  ill patients and the rewards are few: most of the patients who you decide are not fit for discharge will usually turn out eventually to have nothing wrong with them. The other issue I can see is that this is that rare thing: a move to increase rather than decrease the number of emergency admissions. I can see commissioners having a bit of a problem with the paradigm shift of having to think that avoiding admissions is not actually always a good thing.

 

Matt Dunn 

Warwick

 


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Date:    Thu, 9 Dec 2010 20:55:27 +0000
From:    Chris Kirke <[log in to unmask]>
Subject: Re: Consultant Sign Off

I agree with this standard as an aspirational aim. For far too long has the ED cohort of patients, including the sickest and most complex cases in medicine, been looked after primarily by doctors with woefully inadequate skills. I also believe that many middle grades are indeed not sufficiently experienced to look after high risk patients unaided.

The practical difficulties in achieving this aim should not prevent us from acknowledging and addressing the problem.

Best wishe
Chris Kirke


On Thu, Dec 9, 2010 at 8:07 PM,  <[log in to unmask]> wrote:
> I think it's part of a move towards a US style system of having every 
> patient signed off by a fully trained doctor which is no bad thing. It 
> would be difficult to achieve with current staffing, but if it becomes 
> an accepted standard, it would drive consultant expansion. I do 
> however have certain concerns about how we would fill these posts. I 
> have just been sent an advert for a (presumably hard to fill) post in 
> Brisbane: 8 consultants; 36 medical staff total; serving a population 
> of 165,000; paying £217,000 a year. It is difficult for a UK hospital 
> to compete directly with that offering an increasingly first on post; 
> less job variety and a substantially lower salary, so it is not hard 
> to see why trainees with an interest in Emergency Medicine are 
> choosing to emigrate. I also have some concerns about the shift in the 
> type of patient we will be seeing as consultant. While there is much 
> to be said for having consultants reviewing all high risk patients 
> prior to discharge from the patient's point of view, a move to a 
> higher proportion of time being spent on this type of work will not be 
> as attractive to everyone as (for example) dealing with critically  
> ill patients and the rewards are few: most of the patients who you 
> decide are not fit for discharge will usually turn out eventually to 
> have nothing wrong with them. The other issue I can see is that this 
> is that rare thing: a move to increase rather than decrease the number 
> of emergency admissions. I can see commissioners having a bit of a 
> problem with the paradigm shift of having to think that avoiding admissions is not actually always a good thing.
>
>
>
> Matt Dunn
>
> Warwick
>
>
>
> This email has been scanned for viruses; however we are unable to 
> accept responsibility for any damage caused by the contents. The 
> opinions expressed in this email represent the views of the sender, 
> not South Warwickshire NHS Foundation Trust nor NHS Warwickshire 
> unless explicitly stated. If you have received this email in error 
> please notify the sender. The information contained in this email may 
> be subject to public disclosure under the NHS Code of Openness or the 
> Freedom of Information Act 2000. Unless the information is legally 
> exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.
>

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