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The bottom line as I see it, is that EM as a speciality will have no credibility with other speciality groups until there is 24 hour middle grade or above cover in the department, as long as our juniors have to consult with another speciality after hours when they run into problems or cannot do something Emergency medicine wont be going anywhere in the UK. Unfortunately that means that staff grades and SpR's will have to work night shifts - thats ok for the SpR's because its finite till they finish their training (for the moment anyway - I think widespread consultant cover at night is a way off), but for the Staff grades it means a life time of night shifts - how these are compensated is going to be an interesting challenge. The other issue is the one raised by Derek, how to standardise the Staff grade - the huge variation in levels of practice is a real issue and a cause for concern - its unacceptable to have a spectrum which stretches from consultant level care to unsafe practice or to a deliberate narrow spectrum practice ie seeing only the minors. My personal view is that formalisation of a structured middle grade with an appropriate examination would certainly improve standards. That in itself has problems though with examinations being a common reason for heading into the staff grade to begin with and also the increased night shifts would effect a second major reason for becoming a staff grade - lifestyle. However there is a risk of being seen to be diluting and devaluing the SpR and consultant grades and offering the trusts a cheap (er) second best option - no offense to the staff grades (but taking the EM specialist as the gold standard). Why spend extra money on EM consultants if you have a well organised and trained middle grade ? One consultant leading a unit and 5-7 well trained staff grades doing the shop floor work ? The way of the future ? Craig CCH Secure Mail Server ******************************************************************************** This email or attachment(s) may contain confidential or legally privileged information intended for the sole use of the addressee(s). Any use, redistribution, disclosure, or reproduction of this message, except as intended, is prohibited. If you received this email in error, please notify the sender and remove all copies of the message, including any attachments. Any views or opinions expressed in this email (unless otherwise stated) may not represent those of Capital Coast Health Ltd. (AC_S001) [INFO] -- Virus Manager: No Viruses were detected in this message. ********************************************************************************