I wonder if you heard the 1p coin drop... My wife is doing a
flexible-training-DIY-self-construct-inflicted stint. The post grad deanery
as well as the JCGPT are NOT happy that for money and banding reasons these
post should not have any after-hours commitments as "THE SHO SHOULD BE PUT
IN DECISION MAKING SITUATIONS (I.E. THE ONE OCCURING DURING THE NIGHT BEING
ALONE)". I come from a well known, hounted part of the world, until recently
hard to find behind a certain iron curtain, but this kind of baby sitting
for the training grades never happed and never will. Something somewhere
went very wrong...

tudor

Dr. Tudor Codreanu Msc(Med)
Staff Grade Physician
Accident and Emergency Dept.
Dr. Gray's Hospital
Elgin
tel: 01343 543131 ext 67360
dir: 01343 567360
fax: 01343 552612
e-mail: [log in to unmask]

> -----Original Message-----
> From: Adrian Fogarty [SMTP:[log in to unmask]]
> Sent: 17 January 2003 15:33
> To:   [log in to unmask]
> Subject:      Re: SHO supervision at night
>
> That's fascinating Tudor. But the colleges seem to be obsessed with this
> idea that somehow an SHO is no longer "training" if they don't have a
> registrar or consultant by their side at all times. I think this is utter
> nonsense. Whatever happened to "adult learning" in all of this? As long as
> your SHOs are vaguely sensible, they have been induced and received some
> training, they've got guidelines and protocols to fall back on, and
> they've
> got some access to senior support by a mixture of in-house teams and
> telephone advice from home, then it seems to me that this must be
> considered
> "a reasonable level of safety" bearing in mind our current resources and
> service configuration. In fact I would go one step further and argue that
> no
> doctor will ever learn the art of decision making without working
> independently for part of the time while they are "training".
>
> OK, I admit this may be suboptimal for certain cases, but as the thread
> detailed below reveals, many units only manage to survive by reliance on
> the
> use of lone SHOs at night. We should not as a specialty expect all units
> to
> provide a 24-hour middle grade presence with our current level of
> resources.
> To do so might cause more problems than it solves. We should of course
> maintain pressure for these resources to be put in place, and this will
> take
> time as well as money. In the meantime our health authority are "whipping"
> us like some sort of recalcitrant factory workforce, hoping to improve our
> productivity. It drives me mad...
>
> Adrian Fogarty
>
> ----- Original Message -----
> From: "Tudor Codreanu" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, January 17, 2003 2:40 PM
> Subject: Re: SHO supervision at night
>
>
> > Three years ago the College came to visit us. Everything was commended,
> from
> > the teaching, to the hands-on experience for the SHO's etc etc. However,
> > they decided that the night-worth-of-time-spent-in-A&E would not
> consitute
> > good training, as there is no middle/senior cover, exceptr of course
> from
> > in-house the specialties. Therefore, A&E staff went home at midnight,
> but
> > the dept remained open for business ment by other sho's on call that
> night.
> > It was the nurse's in charge job to decide which specilaty the newly
> came
> > patient would most likely belong to and he/she would it then be bleeped.
> The
> > result was a complete disaster and nightmare to run. Orthopods are
> covering
> > for surgery and vice-versa, and if they were in theatre the next to be
> > called, as per the "cascade" would be the medics... Now, one would
> certainly
> > ask what would the medical consultant position (and responsibility) for
> a
> > patient who was referred to his team in the middle of the night for a
> > non-medical problem. Conversely, the surgeons argued that their job
> would
> > not entail expertise in saving the life of somebody with aheart attack
> in
> > resus in A&E while the medics were busy in a cardiac arrest somewhere
> else.
> > There were various permutations on the same tune, of course.
> > However, we were revisited and "re-evaluated" by the same College,
> which,
> > when confronted with the facts supported by figures and near misses,
> just
> > said: you need to be open 24 hours a day, and we'll approve an extra SHO
> > post...
> > Closing an A&E dept at night is the potential end to an entire hospital.
> > This means that no ambulance stops at your door, therefore to the bin
> goes
> > peds, surgery, O&G etc.
> >
> > Also, I suspect that the public of an area threatened by the closure of
> > their A&E dept will not swallow it at all.
> >
> > Tudor
> >
> > Dr. Tudor Codreanu MSc(Med)
> > Staff Grade Physician
> > Accident and Emergency Dept.
> > Dr. Gray's Hospital
> > Elgin
> > tel: 01343 543131 ext 67360
> > dir: 01343 567360
> > fax: 01343 552612
> > e-mail: [log in to unmask]
> >
> > > -----Original Message-----
> > > From: Steve Meek [SMTP:[log in to unmask]]
> > > Sent: 07 January 2003 12:43
> > > To:   [log in to unmask]
> > > Subject:      Re: SHO supervision at night
> > >
> > > I reckon too that the college will back off. I have
> > > heard these threats used before and are used to exert
> > > pressure, often with the support of the ED Consultant.
> > >
> > > The problem is things will have to change, and lone
> > > SHOs at night will have to stop as it is dangerous,
> > > but not having an ED for 30 miles is also dangerous.
> > > Getting middle grades is so hard isnt it, the staff
> > > grade post needs reinventing on a decent salary for a
> > > start. A government which recognises this problem
> > > would tackle middle grade recruitment - I'm sure BAEM
> > > have told them this.
> > > Abergervenny is such a lovely area...if they funded
> > > more consultants would you not get some quality
> > > applicants? Not the whole solution I know.
> > >
> > > Steve
> > >
> > > --- Nick Jenkins <[log in to unmask]>
> > > wrote:
> > > > ...answering on Danny's post because he's been so
> > > > nice to me!
> > > >
> > > > The bit I didn't say was that their stipulation was
> > > > not for the whole of the
> > > > post but for an unstipulated time when the chaps are
> > > > new in their post and
> > > > vunerable.  The aims are laudable although smack of
> > > > the hand-holding that
> > > > juniors these days need.  My point however is to ask
> > > > should the RCS  dictate
> > > > to our Specialty how we should staff and run our
> > > > Departments - is that not
> > > > for us (?BAEM) to decide?  Also,  as  noted by
> > > > Andrew,  any requirement
> > > > should be consistent amongst all Departments.
> > > >
> > > > It would be really good for improving quality of
> > > > patient care if we could
> > > > all provide this level of cover - the practical
> > > > problem is of course how do
> > > > we all do it (and do we,  as suggested, lose our
> > > > good smaller Departments if
> > > > we can't?).  I'm lucky in that I've got excellent
> > > > Staff Grades who share my
> > > > committment to the Department and to the provision
> > > > of high quality care.
> > > > They however are in the job they love for the rest
> > > > of their working life
> > > > and,  as they move into middle age and beyond  they
> > > > will not be in a
> > > > position to work night shifts.  They would probably
> > > > reluctantly leave if I
> > > > forced them into it and obtain less enjoyable work
> > > > where their hours were
> > > > controllable.   So what about the SpRs?  Certainly
> > > > with only one at present
> > > > that could not be my answer for total cover - yet I
> > > > could do it for the
> > > > first week of this "vunerable"period.  I'd be
> > > > reluctant as this strikes me
> > > > as SpR abuse - and sooner or later we'll be holding
> > > > their hands too!
> > > >
> > > > Guess I'll have to clone myself!
> > > >
> > > > So I'll talk to the Staff and some way or other
> > > > we'll cover the vunerable
> > > > period.  Like all these things I simply must exract
> > > > every inch of good out
> > > > of it and use it to get more funding/staff/whatever.
> > > >  But thanks for the
> > > > food-for-thought from those who've replied so far,
> > > > which has been very
> > > > useful.  If anyone else has any comments I'll be
> > > > most interested.
> > > >
> > > > Thanks again,
> > > > Nick Jenkins
> > > > A&E Consultant
> > > > Abergavenny
> > > > http://www.ae-nevillhall.org.uk
> > > >
> > > >
> > > >
> > > >
> > > > -----Original Message-----
> > > > From: Danny McGeehan
> > > > [mailto:[log in to unmask]]
> > > > Sent: 06 January 2003 20:58
> > > > To: [log in to unmask]
> > > > Subject: Re: SHO supervision at night
> > > >
> > > >
> > > > > Where does the list think we stand on this one and
> > > > if it comes to arguing
> > > > it
> > > > > out would it be best done with Faculty,  BAEM,
> > > > local STA or who?
> > > > > Thanks,
> > > > > Nick Jenkins
> > > > > A&E Consultant
> > > > > Abergavenny
> > > >
> > > > I share your concern, it will kill off a lot of
> > > > departments.  The first
> > > > group that did it were the aneasthetists about 20
> > > > years ago. Closed a third
> > > > of hospitals within 18 months.  I share your
> > > > concern.  Middle grade cover is
> > > > difficult to recruit.  Many in our area are leaving
> > > > to go into GP land and I
> > > > don't blame them.  They earn at least an extra 20k
> > > > and less hassle.
> > > > Generous tax allowances and no hassle with HR.  Many
> > > > PCT's are desperate to
> > > > recruit.  What with NHS Direct telling their
> > > > patients to rock up to A & E.
> > > >
> > > > Anyway the writing is on the wall and I suspect the
> > > > hidden agenda may be to
> > > > close off the smaller DGH's.  The modernisation
> > > > agency will be rubbing their
> > > > hands in glee.  Just think of the number of project
> > > > managers and data input
> > > > clerks they can employ and sack a few A & E
> > > > consultants.  They can even say
> > > > that they are improving the service and get a few
> > > > exploding pie charts to
> > > > prove it.
> > > >
> > > > I used to work with a very eminent Professor in a
> > > > so-called Trauma Centre
> > > > not too far away from where I live who was
> > > > advocating this very policy only
> > > > 5 years ago.  He was recommending the closure of at
> > > > least a third of all A &
> > > > E depts.  He didn't get a lot of opposition from the
> > > > powers that be in the
> > > > speciality.  I often publically spoke out against
> > > > him hence my move 16 miles
> > > > to the South.
> > > >
> > > > I don't think there will be much support with the
> > > > vested interests out
> > > > there.  What they will forget is that you Nick have
> > > > provided a first rate
> > > > service to the people of Abergervenny.  I suspect we
> > > > may have the same
> > > > problems in Stafford.  There is no way that we have
> > > > the funding or could
> > > > recruit sufficient middle grade cover to provide a
> > > > 24 hour service.  I
> > > > suspect that units like ours will go to a 18 hour
> > > > service.  Close at 10 o'
> > > > clock at night and just take medical admissions.  I
> > > > could then go and get a
> > > > job driving taxis or in B & Q.
> > > >
> > > > You will probably have to move down to Newport for a
> > > > night a week.  The spin
> > > > merchants from the various unelected agencies who
> > > > purport to represent the
> > > > speciality that we all know too well will say how
> > > > the service to the
> > > > patients has improved out of all recognition.
> > > >
> > > > Don't forget the whole philiosophy of SHO training
> > > > is about to change next
> > > > year with the foundation year.  They will no longer
> > > > be the workforce of the
> > > > NHS but will have to be facilitated
> > > >
> > > > If the worst comes to the worst you can always stand
> > > > for parliament or even
> > > > President of the Faculty or Royal College.  Could do
> > > > with some different
> > > > people on it for a change.
> > > >
> > > > Danny McGeehan