The role of the consultant paediatrician – case study
Dr Phil Wylie, clinical director for family services directorate,
Dorset County Hospital NHS Foundation Trust
Dorset County Hospital is a district general hospital in Dorchester, serving a population of 220,000. It operates a combined paediatric/neonatal rota and delivers around 2,300 babies each year.
In 2001, prompted by a visit from representatives of the Royal College of Paediatrics and Child Health, the family services directorate examined the role of the paediatric consultant.
After considering the alternative options of moving to a consultant led services model or employing more staff grades, the hospital chose the former, becoming the first unit in the country to adopt this model.
Dr Phil Wylie, clinical director for family services, explains how the service now operates, how any challenges were overcome and what the benefits are for staff and patients.
"We wanted to go down the consultant led route and our chief executive was very supportive," he says. "It has proved popular with both staff and patients."
The consultants agreed to reduce their working week to four days and accept 16 hours of resident on call duties. The recruitment of first one and then a second additional consultant has enabled the model to succeed.
Now six consultants work a 9am to 5pm day, to include a 15 to 30 minute 'handover' at 4.30pm. The on call consultant is then non resident until 9.30pm when he or she becomes resident until 9.30am next day.
The following day the consultant resumes normal duties, aiming not to have a heavy clinical workload because consultants are not routinely off after a resident night on call but instead have a set day off.
The consultants each act as consultant of the week every sixth week, in which they do not hold clinics but still work on the wards. The responsibility includes a 48 hour weekend on call, 24 hours of which is resident.
At the same time SHOs operate a shift system, either working 9am to 5pm or, if on call, either 9am to 10pm or 9.30pm to 9.30am. A culture shift was needed to remove any traditional apprehension around calling a consultant out of bed.
Registrars either work a 9am to 5pm shift or the same 9am to 10pm if on call, but normally only work night shifts on Sundays and to provide consultant holiday cover.
Dr Wylie says the new model is popular with consultants, enabling them to enjoy a better work/life balance and popular with nursing staff who feel well supported with senior input.
The model has reduced admission rates, provides a good quality of care for patients and helps to maintain the practical skills of the consultant. It removes the need to constantly find good quality staff grades and there has been no problem recruiting to consultant posts.
The consultant of the week role improves continuity with both the consultant supervision of care and the training of juniors.
Dr Wylie says he believes the model works best in the right sized unit, a district general hospital serving a population of 400,000 maximum would be ideal. He acknowledges that older, more senior consultants may not want resident on call duties indefinitely as a heavy workload can inevitably mean a tiring next day.
Although consultant time is expensive, Dr Wylie believes this model may be less costly than the realistic alternative.
"The key element is that when a child is brought to hospital, their parent or carer wants to see an experienced doctor," he says. "We have the experience not to over investigate and to send the child home when it is appropriate."
