A Changing Specialty

Abstract

A single-handed consultant cannot be present in the department all the time and so his or her responsibility is to organise the department so that it can cope in their absence. This involves much teaching and administration as described in the previous chapter. However where there is more than one consultant, they can spend much more time on clinical duties. In my own department 65 per cent of patients attend outside normal working hours and there has long been recognised the requirement for experienced doctors to be present 24 hours a day. In 1960 the Nuffield Report had said that the ideal casualty department ‘should have immediately available at any one time a medical man of consultant quality …’¹ and the BOA in 1971 had also recognised the need for an experienced doctor on duty 24 hours per day.² The possibility of consultants working shifts had been discussed following the Short Report in 1982 when there was much (but not total) opposition (see Chapter 5). It was, however, completely unrealistic with the number of consultants then available. The importance of 24-hour consultant cover (not just in A&E) was emphasised by the Royal College of Surgeons’ Report on patients with major injuries in 1988³ and in 1990 BAEM stressed the importance of providing experienced 24-hour cover wherever possible.⁴