What is our message? I think we all know what the 
'symptoms are, can probably guess at the causes but I 
haven't heard a convincing treatment package proposed.  I 
think the GPs are wresting the initiative away from us on 
this. The politicians must be glad for summer and hope 
that this problem goes away for at least six months

Symptoms
Increasing input (but not by very much) Full departments 
offering patchy chaotic care and poor performance against 
the 4 hour target. Poor recruitment at HST and Consultant 
level.

Causes
Decreased bed capacity within hospitals, decreased social 
care beds for the very elderly, increasingly complex 
discharge paperwork. Long waits to outpatient clinics for 
sub acute emergencies. Fragmented and inconsistent OOH 
care that confuses the public. Risk averse triage 
algorithms such as 111.
Relatively unattractive rotas and renumeration compared to 
just about any other doctor in training.

Treatment package
(Other than a stiff double)  System wide reform for all 
unscheduled care. Simplify choice, and improve equity of 
access to GPs across the clock. Invest in social care 
beds. Offer retention bonuses to middle grade / HST 
doctors. Push for 50% of FY2s / GP VTS doctors to undergo 
a ED post. Facilitate transfer of surgeons and physicians 
at ST3 level across into HST if they have a change of 
heart.

Ah well, nice thinking about it

Adrian


On Sun, 2 Jun 2013 14:29:17 +0000
  Doc Holiday <[log in to unmask]> wrote:
> There are two aspects here:1. The state of EM & EDs in 
>the NHS and associated problems2. The potentially 
>negative effects EM work and of number 1 above on any one 
>of us and/or colleagues
> Some of the contributors on this thread have lamented 
>point 1; others have noticed that point 2 applies to 
>themselves; yet others appreciate BOTH aspects in the 
>view they expressed.
> NOT everyone has a number 2 issue. Some are merely 
>worried about number 1.
> Your solution is for number 2 only - part-timig is 
>completely "right" if it's what you feel is right for 
>yourself. It IS professionally responsibe. But in itself, 
>even if also chosen by many others, will likely not 
>resolve point 1 above, which is, I think, what the Radio 
>4 Programme was about.
> 
> Date: Sun, 2 Jun 2013 14:45:48 +0100
>From: [log in to unmask]
> Subject: Re: In case you missed the Radio 4 Program
> To: [log in to unmask]
> 
> 
>  
>    
>  
>  
>    Have you guys and gals checked your collective BP 
>recently?
> 
>    
> 
>    Mine's fine.
> 
>    Here's why.
> 
>    
> 
>    I can't fix any of the problems you raise.
> 
>    I'm not sure anyone can - we are no longer prosperous 
>enough to
>    afford the solutions.
> 
>    
> 
>    I can manage the mismatch between my personal 
>resources and
>    the demands placed on them.
> 
>    I've gone part-time.
> 
>    Call it running away if you like. Some of my 
>colleagues do, sotto
>      voce.
> 
>    I prefer to think of it as accepting limits - my own 
>and the system
>    -  and working to them.
> 
>    It's like a strike really, but I still get paid 
>something and it's
>    more professionally responsible, just.
> 
>    
> 
>    Now when I go to work, I can deliver my slim-line job 
>as effectively
>    as the system will allow me to.
> 
>    I'm not perfect. Nor are you.
> 
>    When things go wrong, I still reflect honestly on my 
>own
>    imperfections and the systemic failures, aired so 
>eloquently on the
>    list.
> 
>    Those twin banana skins will always be there for me 
>and my patients.
> 
>    Assiduous attention to CPD minimizes risk from the 
>former, and
>    alerting safety managers when appropriate is all I 
>can do to address
>    the latter.
> 
>    But at least now I am not impaired by fatigue or 
>stress and I don't
>    go home and metaphorically beat up the wife and kids 
>any more.
> 
>    As a small cog, that's all I can do.
> 
>    
> 
>    This winter nearly finished me off, professionally 
>speaking.
> 
>    What about you?
> 
>    And I live and work in an easier place to function 
>than you do,
>    probably.
> 
>    I am additionally fortunate in supportive and 
>sympathetic
>    colleagues.
> 
>    
> 
>    So, I am cash-poorer, but feel enriched.
> 
>    I'm genuinely sorry if you really can't afford the 
>option.
> 
>    Some nurses I work with really can't afford to go 
>part-time.
>    And yet they have, or left. Why?
> 
>    Perhaps they can't afford not to.
> 
>    Perhaps potential ED trainees think the same.
> 
>    Perhaps they're brighter than we give them credit 
>for.
> 
>    Perhaps they're brighter than me. After all,  it took 
>me years to
>    work it out.
> 
>    
> 
>    Fix what you can fix and look after your BP.
> 
>    
> 
>    Goat
>