I agree about the difference in smaller v larger units. However, maybe it is only an "inevitable split" if we carry on a 'Hospital Department' approach rather moving to a 'Regional Emergency Service' way of thinking. I am not sure of the way forward, but it seems a very timely discussion. Tim. Coats. -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of McCormick Simon Dr, Consultant, A&E Sent: 28 September 2005 10:12 To: [log in to unmask] Subject: Re: A&E On - call Rota I'm afraid this thread is demonstrating the inevitable split that will occur between so called 'central/teaching' units and the 'peripheral/district' units. The bigger units can attract more senior staff on to better rotas which allow shop floor cover and a life outside medicine. They set a 'standard' of care/cover which is unachievable in smaller units who will struggle to attract trainees on to these rotas, unless they are the unusual few who want to do DGH Emergency Medicine! Simon McCormick Rotherham DGH nal Message----- From: Adrian Fogarty [mailto:[log in to unmask]] Sent: 28 September 2005 09:15 To: [log in to unmask] Subject: Re: A&E On - call Rota Absolutely not (to your last paragraph). I see consortium cover as a classic compromise, existing only because you don't have enough specialists in your own unit. There are some ridiculous examples of this around the country, where a consultant covers two, sometimes three, units at nights and weekends. The result? The consultant doesn't actually do any work, or does minimal work, in any of the units; he merely "covers from home" whatever that means. I suspect some specialists prefer this system because of its perceived "flexibility", which to my mind is just a euphemism for wanting a cushy rota. Surely it's about time our specialty provided decent levels of internal cover, and by that I mean resident shop-floor cover by day and increasingly at evenings and part-weekends, with dedicated single-unit cover at night, just as most other acute specialties do? AF ----- Original Message ----- From: "Coats Tim - Professor of Emergency Medicine" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, September 28, 2005 9:02 AM Subject: Re: A&E On - call Rota No experience of cross speciality cover. I don't think that an orthopod is able to practice emergency medicine (and an orthopod that thinks that they can just doesn't understand and so should certainly not be allowed to). I have some good experience of cross Department cover - very dependent on Geography (all of the hospitals in the East London A&E Consortium are a couple of miles apart). Even if long distances are involved, it might be better for an ED to have more distant cover from an emergency specialist rather than close cover from someone who is not a specialist in Emergency Medicine. Maybe an agreement from the local orthopods / surgeons that they would support the ED by coming in for major trauma (which they probably could cope with) might assist this system. To go one step further. My guess is that on-site late shifts followed by consortium on-call overnight (ie. one, or two, A&E consultant shared between several hospitals) will be a future pattern for emergency service provision. Closer integration with the pre-hospital care services would enable the night shift consortium consultants to focus their time in the right areas. Do we need to start taking a Regional rather than a Departmental view of the provision of nightime Emergency Care, to develop a more flexible system? (Puts on flame proof suit and hits send) Tim. Coats. -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of MICHAEL DUDLEY Sent: 27 September 2005 23:53 To: [log in to unmask] Subject: A&E On - call Rota Dear All Does anyone know of A&E Departments that have an on-call consultant cover arrangement shared with another specialty, e.g. Orthopaedic Consultants? I know it is suboptimal, but I am sure that many DGHs like us, have found that they would be unable to recruit new A&E Consultants with an on-call rota more onerous than 1 in 4. I would be very interested to hear of/from A&E Departments that run such an arrangement. Many thanks Mike Dudley Consultant in Emergency Medicine Airedale General Hospital This e-mail, including any attached files, may contain confidential and / or privileged information and is intended for the exclusive use of the addressee(s) printed above. 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