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Consultant resident on-call system: Salisbury

Consultant resident on-call system: Salisbury. Salisbury DH. Rural Relatively isolated – nearest unit 25 miles Full obstetric and A&E service Regional burns and plastics Child pop. C 40 000 2500 deliveries p.a. 18 bedded children’s ward Level 2b NICU. Paediatric dept.

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Consultant resident on-call system: Salisbury

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  1. Consultant resident on-call system: Salisbury

  2. Salisbury DH • Rural • Relatively isolated – nearest unit 25 miles • Full obstetric and A&E service • Regional burns and plastics • Child pop. C 40 000 • 2500 deliveries p.a. • 18 bedded children’s ward • Level 2b NICU

  3. Paediatric dept. • 10 consultants (8 on 11 PAs, 2 on 8 PAs) • 4 middle grades • 5 junior grades • 4 GP trainees, 1 FY2 • Night on-call shared with 5 O&G SHOs

  4. Resident consultant system • All 10 do resident on call: part-timers pro rata • Out-of-hours time divided between 4 MGs and 10 cons • Cons also do on call from home covering either MG or cons colleague • 13 hour shifts same as juniors

  5. Resident on call workload • Resident shifts about 1 night per 2 weeks and 1 weekend (3 shifts, days or nights) every 10 weeks • Always on with SHO • Day off afterwards • Contract: • Daytime work: 6.5 PAs (including 2.5 SPAs) • Resident shifts 3.5 Pas • Other emergency work 1 PA

  6. Typical night shift • 2100 – 2130: handover • 2130- 2230: reviewing ward attenders and in-patients • 2230- 0000: admin with interruptions • 0000-0030: review patients • 0030-0200: admin with interruptions • 0200-0700: rest, with interruptions: • Calls to ward, NICU, ED, Burns, labour ward • 0700-0930: reviews and handover

  7. Accommodation • Consultant flat, superior to juniors accommodation • About 100m from labour ward • Bedroom, bathroom, kitchen, lounge with TV and network computer

  8. Accommodation

  9. Bedroom

  10. Kitchen

  11. Lounge

  12. Back up consultant • Resident cons always has back-up colleague on call from home for: • 2 skilled people needed at once • Transfers • Advice

  13. Advantages for service • Better out-of-hours care • Fewer unnecessary admissions • Better continuity • Better supervision of juniors & nurses

  14. Advantages for individual • Financial • More day time off during week • More ‘hands-on’ work

  15. Disadvantages for service • Fewer consultants around during the day • Less time for supporting activities • Cost

  16. Disadvantages for individual • Tiredness • Less continuity for own patients • Less time for career development

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