Consultant resident on-call Consultant resident on-call system: Salisburysystem: Salisbury

Salisbury DHSalisbury DH

RuralRural Relatively isolated – nearest unit 25 milesRelatively isolated – nearest unit 25 miles Full obstetric and A&E serviceFull obstetric and A&E service Regional burns and plasticsRegional burns and plastics Child pop. C 40 000Child pop. C 40 000 2500 deliveries p.a.2500 deliveries p.a. 18 bedded children’s ward18 bedded children’s ward Level 2b NICULevel 2b NICU

Paediatric dept.Paediatric dept.

10 consultants (8 on 11 PAs, 2 on 8 PAs)10 consultants (8 on 11 PAs, 2 on 8 PAs) 4 middle grades4 middle grades 5 junior grades5 junior grades

4 GP trainees, 1 FY24 GP trainees, 1 FY2 Night on-call shared with 5 O&G SHOsNight on-call shared with 5 O&G SHOs

Resident consultant systemResident consultant system

All 10 do resident on call: part-timers pro All 10 do resident on call: part-timers pro ratarata

Out-of-hours time divided between 4 MGs Out-of-hours time divided between 4 MGs and 10 consand 10 cons

Cons also do on call from home covering Cons also do on call from home covering either MG or cons colleagueeither MG or cons colleague

13 hour shifts same as juniors13 hour shifts same as juniors

Resident on call workloadResident on call workload

Resident shifts about 1 night per 2 weeks Resident shifts about 1 night per 2 weeks and 1 weekend (3 shifts, days or nights) and 1 weekend (3 shifts, days or nights) every 10 weeksevery 10 weeks

Always on with SHOAlways on with SHO Day off afterwardsDay off afterwards Contract:Contract:

Daytime work: 6.5 PAs (including 2.5 SPAs)Daytime work: 6.5 PAs (including 2.5 SPAs) Resident shifts 3.5 PasResident shifts 3.5 Pas Other emergency work 1 PAOther emergency work 1 PA

Typical night shiftTypical night shift

2100 – 2130: handover2100 – 2130: handover 2130- 2230: reviewing ward attenders and in-2130- 2230: reviewing ward attenders and in-

patientspatients 2230- 0000: admin with interruptions2230- 0000: admin with interruptions 0000-0030: review patients0000-0030: review patients 0030-0200: admin with interruptions0030-0200: admin with interruptions 0200-0700: rest, with interruptions:0200-0700: rest, with interruptions:

Calls to ward, NICU, ED, Burns, labour wardCalls to ward, NICU, ED, Burns, labour ward

0700-0930: reviews and handover0700-0930: reviews and handover

AccommodationAccommodation

Consultant flat, superior to juniors Consultant flat, superior to juniors accommodationaccommodation

About 100m from labour wardAbout 100m from labour ward Bedroom, bathroom, kitchen, lounge with Bedroom, bathroom, kitchen, lounge with

TV and network computerTV and network computer

AccommodationAccommodation

BedroomBedroom

KitchenKitchen

LoungeLounge

Back up consultantBack up consultant

Resident cons always has back-up Resident cons always has back-up colleague on call from home for:colleague on call from home for: 2 skilled people needed at once2 skilled people needed at once TransfersTransfers AdviceAdvice

Advantages for serviceAdvantages for service

Better out-of-hours careBetter out-of-hours care Fewer unnecessary admissionsFewer unnecessary admissions Better continuityBetter continuity Better supervision of juniors & nursesBetter supervision of juniors & nurses

Advantages for individualAdvantages for individual

FinancialFinancial More day time off during weekMore day time off during week More ‘hands-on’ workMore ‘hands-on’ work

Disadvantages for serviceDisadvantages for service

Fewer consultants around during the dayFewer consultants around during the day Less time for supporting activitiesLess time for supporting activities CostCost

Disadvantages for individualDisadvantages for individual

TirednessTiredness Less continuity for own patientsLess continuity for own patients Less time for career developmentLess time for career development