----- Original Message -----
From: "Fiona Wallace"
Subject: Re: Primary care in A&E
> When you say 'middle grade', Adrian, do I hear the echo 'staff grade'?
> Certainly seems that the registrars are less and less likely to have any
> commitment beyond 5, or at best, 10pm.
No, I mean middle grades. The clinical fellows (read that "staff grades") in
our unit will have the same rota as the SpRs - when we finally appoint them
next week! Despite the New Deal and the EWTD, SpRs are still capable of
covering out-of-hours, you'll be glad to hear.
> Don't forget these staff grades will, if foolish enough to stick around
> under current conditions, reach their 40s and 50s and be no more willing
to
> commit to this 24 hour cover than you are. I don't need to point out that
> A&E with a 90% plus clinical commitment is hard, hard yards. It isn't
> sustainable simply to shove the lion's share onto a small group of people
> indefinitely. A 50:50 commitment is far more realistic, be it teaching,
> research or one of the many other channels available.
I'm well aware, Fiona, as my consultant colleagues and I do the same
out-of-hours as the SpRs in this unit; actually more, 'cause we cover their
on-call as well! Returning to my new clinical fellows, they will have the
same "privileges" as the SpRs, be that teaching, research, study leave etc,
as you mention. They will only lose out on regional SpR teaching (unless
we're hosting) and they will have slightly less study leave (in terms of
days) but the same funding. But they will have the same day-to-day support
and guidance from the four consultants. And if we happen to get one who
becomes a "permanent fixture", naturally we will aim to give them more
freedom with respect to non-clinical duties, subject to their interests and
aptitudes, and we will of course consider a move towards associate
specialist status in the fullness of time (or its equivalent following
"NCCG" negotiations).
> It is very easy in
> A&E to lose perspective; I rarely go home feeling I have achieved
anything,
> and I suspect this is true for a significant proportion of middle graders,
> and it fuels their egress from the specialty.
This is where some student teaching, for example, or some form of
"management", can be helpful, to place things in perspective, and to give
one a sense of belonging, and a sense of worth or value within a unit.
> I enjoyed the tale of the radiologist - today I had to ask a surcical SHO1
> to arrange an IVP for a man with renal colic, as radiology won't accept
the
> form if signed by me.
Sorry, but this suggests weak consultant leadership, Fiona. (I don't know
where you work, Fiona, so I imagine I've upset someone!) If you can't order
an IVP for renal colic, then your department's got major problems! Or
rather, your radiologists have major problems - but that's not so unusual,
is it!
Adrian Fogarty
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