I am indeed. Working through the night becomes harder with increasing age. There is some evidence from North America to support the 4am handover: it appears that a very late finish or very early start may be less disruptive to normal diurnal rhythms and therefore more sustainable. The ED may also be reasonably quiet (as much as it ever is these days), facilitating a swift and efficient handover between two consultant colleagues.


Best regards,




From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Andrew Webster
Sent: 19 March 2012 22:31
To: [log in to unmask]
Subject: Re: Consultant 24/7 working




Are you suggesting a split night shift one finishing at 4am and the next starting at 4 am?



On 19 Mar 2012, at 21:36, Jonathan Benger <[log in to unmask]> wrote:

Dear James,


In addition to the joint workforce document already mentioned the College of Emergency Medicine is currently considering this issue. Further guidance will follow, but in the meantime there are a few areas that you may wish to consider:


1.      It is becoming increasingly recognised that for a career in EM to be sustainable work patterns will need to change over time as an individual ages. I would suggest a three-phase approach by which individuals take on a reducing amount of night/out-of-hours work as they increase in seniority. This has implications for the number and distribution of individuals taking part in the roster.

2.      Under the 2003 consultant contract rostered work after 7pm and at weekends is voluntary and attracts a 3 hour PA. There was no provision in the 2003 contract for overnight working, but a growing consensus suggests that overnight working should attract a 2 hour PA along with suitable protected rest time before and afterwards.

3.      24 wte sounds like a large number until you start devising rosters (particularly with overnight 2 hour PAs, which have some interesting effects). Depending on the size of your ED and the expected duties you may actually need more staff than this. It is essential that early adopters do so in a sustainable fashion.

4.      Because so few EDs are currently providing 24/7 consultant working there are ideal opportunities for evaluation and research. I am particularly interested in the 4am handover to reduce the stress of overnight working and other strategies to ensure sustainability over decades.


I hope these comments are helpful.


Best regards,


Jonathan Benger.


From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of James McFetrich
Sent: 19 March 2012 14:07
To: [log in to unmask]
Subject: Consultant 24/7 working


I am part of a group looking at 24/7 EM consultant working in our Trust. This will probably be with 24(ish) of us.


I am guessing this is fairly unique, and there are a whole host of questions that we need to work through. So far I have filled 3 sides of A4 brainstorming it before I can even get to understanding what the rota looks like.


I would be really interested to hear the forums thoughts on this, especially anyone with experience or contemplating anything similar.


Although we are nervous about what this may bring, if we are to go down this line I am sure many others will follow over the next decade and our negotiations will be really important to getting the right package to do this so it is acceptable to us and to future consultants.


All advice gratefully received. Cross-posted on DNUK.