The role of the consultant paediatrician – case study
Dr Tracy Tinklin, consultant paediatrican and clinical lead for paediatric services at Derbyshire Children's Hospital, part of Derby Hospitals NHS Foundation Trust.
Derbyshire Children's Hospital is a large district general hospital with an associated graduate entry medical school, serving a population which includes 100,000 children and young people. It has an attendance rate of 24,000 per year in the emergency department and delivers around 5,500 babies per year, managing all medical pre term infants locally.
In 2002, the Trust examined the role of the paediatric consultant in the light of the lack of registrars.
The hospital has a level three neonatal unit, busy paediatric services and in effect, it provides an A&E for children who increasingly choose the hospital as their first point of assistance and care.
Paediatric consultant Dr Tinklin says the nature of the hospital and the services it provides prevented existing consultants from relinquishing some of their day time clinics and duties to be resident out of hours.
Instead, the trust recruited two residents on call consultants, 1.5 whole time equivalents. Their duties included on going responsibility of patient care for acute admissions and outpatient clinics, plus participating in the middle grade rota, allowing a senior decision maker out of hours.
The out of hours duties were always covered by two clinicians, either a resident consultant on call with a non resident consultant, third option or a registrar with non resident consultant.
Dr Tinklin says that although the senior presence out of hours had some benefits, possibly reducing admissions and length of stay, the hospital already had a ‘good length of stay’ record.
“But practically, because they were so busy, sometimes patients would be admitted before they could be seen by the consultant," she said.
Now the trust, which employs 9.6 whole time equivalent paediatric consultants, has decided that from May 2009 the resident consultant roles will be converted to ‘conventional posts’.
Dr Tinklin said:
"We anticipated when we appointed new or replacement consultants, the resident consultants may move into those posts, but this has not happened.
"The consultants' time available for daytime duties, particularly clinic duties and ongoing responsibility for patients, was reduced. Now both have become increasingly fatigued by the work intensity."
As part of the changes reverting the consultant roles to 'conventional' posts, the Trust has recruited a neonatal and general paediatric consultant and will appoint a further two neonatologists and an extra middle grade. Resident on call duties will be covered by registrars.
Dr Tinklin would also like to develop the role of the paediatric emergency medicine consultant, who is currently outside the conventional on call rota, working one evening per week and one weekend in four.
"If we recruited more people in this role, working more peak time shifts, they would reduce the intensity of the workload," said Dr Tinklin. "They are clinicians who have always worked shifts during their training and because they would not have responsibility for patients with long term care needs, they would offer a senior presence at the door and would help to move people through the patient pathway quickly."
