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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

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