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We've gone up to a 1:4 from 1:3 and less on call is always appreciated! Much easier to squeeze in 2-3 weeks of holiday between weekends on-call as well. We cover 9-9 four days a week but not doing weekends until we have 5. Managed to get double time for our 5pm-9pm PA (helped achieve the target and was beyond recommended cover) and intend to try and keep that principle for weekends. Band A for on-call as first on-call but not very frequent calls except when we were being phoned about 2 hour waits by the management!! The banding was part of a Trust wide agreement. It is interesting to see how many departments are offering more cover than is recommended by BAEM with the number of staff employed. In any case, Andy, with only one consultant you can do little more than be around managing the department from your office with a few dedicated clinical sessions to maintain your skills. Agree to 1:4 weekends on-call and then it is up to the Trust to sort out the cover beyond that. It is sad that many smaller departments are coming to this, perhaps BAEM should produce guidance or a document for smaller departments suffering from just this sort of staffing crisis, its not going to be uncommon in the next few years. Interestingly, there was a lot of help for Leicester when they got in to big trouble but many smaller departments are expected to muddle through. Why? Simon McCormick -----Original Message----- From: Duncan Peacock [mailto:[log in to unmask]] Sent: 17 October 2005 15:45 To: [log in to unmask] Subject: Re: Consultant Rota's Adrian, Very good appreciation of rota psychology whether 1-in-3 0r 1-in-4. We have just gone to 1-in-4 from 1-in-3 by bringing an associate specialist into the rota, and the difference it makes to your life is marked : once a month is so much better. There are 3 of us and a AS on the rota, Consultant cover on the shop floor from 8 -5pm and 8 -1pm weekends. We get around 2 calls a week and occasionally go in. Daily review clinic in outpatients. We get band B, hopefully under review, what on call band are others on?. Duncan ----- Original Message ----- From: Adrian Fogarty <mailto:[log in to unmask]> To: [log in to unmask] Sent: 16 October 2005 23:33 Subject: Re: Consultant Rota's Interesting subject Andy. Although many on the list know me as perhaps-too-shopfloor-out-of-hours for their liking, I'd like to think that I still have a handle on what is acceptable for my juniors and what is a "bridge too far" for them or for my consultant colleagues. The bottom line is, when it comes to the long haul - and by that I mean registrar level and above - then you shouldn't aim for anything worse than a 1-in-4 weekend rota. There's something magical about that "watershed" of 1-in-4. Sure, longer rotas are better, but you can live with 1-in-4 if there are other perks (like a day off per week) but it's dammed difficult to do 1-in-3 or worse for anything other than short term. There's a subtle psychological barrier about a 1-in-2 or a 1-in-3 where your weekend off is always just before or just after a weekend on call. 1-in-4, however, is basically one weekend per month, so you have almost a month before your next weekend on call and you can enjoy 3 clear weekends off (and we don't do on-call from home during those 3 weekends). It's also one weekday night on-call per week (Mon to Thur making it 4). That's my view of on-call in a nutshell. Am happy to do one weekday per week and one weekend per month on call (both of which are partial resident) and I can sustain that in the medium-to-long term but I don't like to do anything more than that and I don't expect my juniors (apart from the SHOs who are like grunts on the front line for a defined "tour of duty") to do any more than that either. In saying that, it can be difficult organising leave as we often end up swapping weekends in order to take a two-week holiday. As I said at the beginning, many of my acquaintances probably think I'm mad for the amount of resident on call that I, and my colleagues, do. AF ----- Original Message ----- From: < [log in to unmask]> To: < [log in to unmask]> Sent: Sunday, October 16, 2005 9:34 PM Subject: Consultant Rota's Given my abject failure to attract senior staff to my department what is the list's view of the maximum on-call frequency for a DGH with 40,000 new cases per year. There is middle grade presence 9am to 1am, the current consultants do shop floor at the weekend from 9-2ish on both days then go away on-call. there is a consultant led trauma team with some input to the rota from surgery, orthopaedics and anaesthesia. I have been working a 1:3 weekends and had hoped to reach 1:4 i had hoped given the excellent life style of a small coastal town with reasonable access to the larger northern towns and 3 hours to London by train that we would get some interest for those who wanted hands on care, could hack 1:3-4 weekends and not many calls at night. What are you guys and gals wanting? i need this data since the guy due to join in january has just pulled out for vague reasons and my senior partner retires in december leaving me solo with an Associate Specialist. The Trust are going to come to me asking how to make us attractive, or, more likely how to keep me in place, I suspect. I am NOT going to do 1:1! So what floats your boats? What is everyone doing out there? round here 1:4 to 1:5 seems to be the target. Does that include presence on the shop floor at weekends?