I seem to be out of step with several others (Adrian, Matt, Nick - read on). Our little A&E department obviously enjoys very different working arrangements from the rest of the world. I agree this thread is rapidly drifting away from the list's intended use, so will contribute no more on this subject publicly after this. Very happy to entertain more discussion off list with any of you who feel strongly about the following. Apologies to Nick Jenkins for any perceived sleight in my email - none intended. I obviously misunderstood your email, but having just re-read it, I still get the strong impression you are questioning whether it is A&E's job to provide opportunistic tet vaccinations, much less Diphtheria too. I actually think you are quite right to question this and provoke searching questions about what jobs A&E should be involved in. I agree that providing routine immunization clinics is not a sensible use of A&E services, but I'm not sure that's what's being suggested. Matt Dunn feels that "not my job" is a part of good patient care. I'm sorry you feel that way, if only on the grounds that the patient or manager hearing this will hear "I could do it, but I'm not going to". The difference may be subtle but personally I find that "not my field of expertise" or "not something we're equipped to do" leads to much more fruitful negotiations with patients and managers alike. In article <003101c1fc64$c1af39e0$79a81e3e@AdrianFogarty>, Adrian Fogarty <[log in to unmask]> writes >A&E is clearly the dumping ground for just about everyone >these days You need to get out of London more, Adrian - we have a vacant post! You'll struggle to find anyone who says their A&E department is adequately resourced, but we're not alone in that. Ask any GP round here - they will read "GPs are the dumping ground....." in your above quote. That's precisely why the "not my job" argument (whether explicit or perceived) is unhelpful. The disastrous consequences of pitting social services against health should be ample supportive evidence. Post-exposure HIV prophylaxis and post-coital baby prophylaxis are examples of how this department has NOT just accepted "dumping" unquestioningly. Perhaps you think that our Department's goodwill is being hopelessly abused. All I can say is that if you look at the support we have from patients, in-patient teams and GPs locally then this approach has worked reasonably well for us. Having said all that, if we continue to be abused as a surrogate for adequate bed provision, I won't want to work here, or any other A&E Department for much longer (don't get me started on that one again!). Best wishes Gautam Dr G Ray A&E Sussex Reply to [log in to unmask]