I
think your point is fair Adrian, but I think Doc is speaking a lot of
sense. I believe we are too quick to undervalue ourselves in an attempt to
be helpful and forward thinking as a specialty. Locally
we already provide far more shop floor cover than is recommended by BAEM
for our numbers and I frequently find myself walking the hospital corridors
during hours when the physicians are sitting at home whilst there is a four hour
wait for their juniors to clerk medical referrals. I do believe we
should be providing a consultant led service, and I also think we can show other
specialties the way but personally I am reluctant to sacrifice my personal life
to achieve an artificial ' target' in the vain hope it will convince others that
they should do more work out of hours.
Out of interest, how does it affect our specialty
when ED consultants (me included) do agree to work beyond the level of
cover recommended by our specialty?
Are we being helpful, realistic or selling ourselves
short?
Simon
I'm not sure I would agree with this "I don't think consultants should
queue bash even 9-5". OK, I don't like to routinely queue bash, but given the
sometimes wide fluctuation in our workload, I don't think we can escape
occasional queue bashing. Sure, other levels of staffing can do this, I agree,
but I don't agree that ED consultants should be somehow "above" this type of
work. After all, other consultants frequently do routine jobs, whether a
consultant in OPD, an anaesthetist on a routine day list, or a
radiologist/pathologist on routine reporting etc.
>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.