Hospital Dr News

Paediatricians lead way with consultant presence

Most paediatric units in the UK are operating some form of consultant delivered care which is delivering better outcomes for patients, says a new report.

Face-to-face consultant led care improves quality of care, ensures good handovers and improves communication with patients and their families, concludes the review by the Royal College of Paediatrics and Child Health.

The sixth month project included a survey of all paediatric inpatient and neonatal trusts in the UK and site visits to 10 paediatric units.

The term ‘consultant delivered care’ (CDC) is defined in the report as planned care, with consultants working resident shifts as against being called in or having to cover rota gaps.

Other benefits of the model were that it provides good quality training and access to teaching, is popular with nurses, improves team working, ensures continuity of care and can provide a good work/life balance.

The report also suggests that the consultant delivered care model could be used to address rota vacancies, reduce locum costs and ensure compliance with European Working time Regulations.

All the trusts visited had at least one medical handover in every 24 hours led by a paediatric consultant; all general paediatric units had an attending consultant system, nine out of ten trusts ensured a child was seen by a consultant within 24 hours of being admitted and more than eight out of ten trusts ensured a child was seen by a consultant within 24 hours of being admitted.

The RCPCH’s report follows publication earlier this year of a comprehensive review of consultant-delivered care by the Academy of Medical Royal Colleges which concluded that introducing consultant delivered care across all specialties would have demonstrable benefits. The review was led by Professor Terence Stephenson, Academy vice-chair and president of the RCPCH.

In the introduction to the RCPCH report Professor Stephenson says: “Paediatricians have led the way in 7/7 hospital working, which all acute services should aspire to – all patients deserve the same expertise and quality of care on Sunday as on Monday.”

The RCPCH’s workforce planning officer, Dr Carol Ewing, said: “We should always look at ways to improve our hospital services and I believe that by rolling out a model of consultant delivered care, or tailoring a variation of the model to a service’s busiest day or time of the week, our NHS will be a much better service.”

But not all consultants are happy about the prospect of moving towards a resident on call system. When NHS Medical Director Sir Bruce Keogh in an interview in the Telegraph called on consultants to consider weekend working to improve hospitals’ productivity there was a hostile backlash. A number of consultants commented on Hospital Dr that they already worked weekends but the financial recognition for going this extra mile was poor or non existent.

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5 Responses to “Paediatricians lead way with consultant presence”

  1. Nick Flatt says:

    Let’s face it, paediatricians have been “leading the way” for many years. Of course, a cynic like me might replace that phrase with “giving in to managerial pressure without a fight”.

    There seems little doubt that consultant delivered care is better. However, as a profession we must not acquiesce to emotional blackmail. If consultants are to deliver the care then they must be paid appropriately.

    Nearly forgot. Vote “Yes, Yes”!

  2. joshek says:

    fully consultant delivered care is “leading the way” into an early grave for the consultants delivering it. long hours, 24/7 shift patterns and a body clock out of sync is smthg a young(-ish) person can recover from after doing it for a decade or so. staying in that pattern PLUS bearing full responsibility for everything that happens in the department is suicidal.

  3. Malcolm Morrison says:

    “In my day” juniors did all the ‘OOH’ (out of hours) work and many consultants let it be know that they did not expect to be ‘called in’ at night or at weekends! But in those days the sort of emergency care that was available was pretty ‘basic’ – no cardiac stents or de-furring of carotids for strokes!

    Times have changed. The sort of emergency care has changed – even radilologists get called in nowadays! So, the involvement of ‘senior staff’ has become more commonplace. This has been exacerbated, and highlighted, by the imposition of the EWTR.

    Few would argue that the patient will receive better care form ‘trained’ staff rather than inexperienced ‘trainees’. But, of course, trainees must learn about the care of emergencies, so they must be available when they come in to hospital – often OOH.

    If we are to move from a ‘consultant led’ service to a ‘consultant based’ service, and consulatnts are to be ‘resident on call’ for OOH care, then, obviously, we shall need many more consultants – for they, too, are subject to the EWTRs. Thus, two 24hr ‘shifts’ and the week’s work is done! In other words, there will need to be a whole new approach to the concept of “what is a consultant?”; and this will involve a revolutionary approach to job plans and contracts.
    Retired Orthopod

  4. joshek says:

    malcolm – with everything interconnected, we need to be aware that we will not have the same calibre senior doctors any more. only juniors who experience real responsibility will become the seniors we all want. the “revolutionary” approach needed to jobs and contracts you mention means that, at long last, doctors shall have the same rights like everyone else. about time.

  5. Malcolm Morrison says:

    I agree, Joshek

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