The role of the consultant paediatrician – case study
Dr Vivienne van Someren, consultant paediatrician and clinical director for Women’s and Children’s services, Royal Free Hampstead NHS Trust.
The Royal Free Hampstead NHS Trust is a large teaching hospital which treats 700,000 patients each year, with general paediatrics and a level one neo natal unit (NNU). There are 3,400 deliveries a year.
The hospital introduced 24 hour paediatric consultant cover, assisted by SHOs, physician assistants and specialist nurses, in response to the lack of middle grades in the sector.
Now 15 consultants, whose hours are annualised, contribute to a rota compiled in six monthly time periods. "A consultant is available every day, every night and in every clinic," says Dr van Someren.
Before the major change was made, the department examined all its working practices, including the organisation of clinics, with particular regard to waiting time targets, says Dr van Someren.
Some consultants who did not agree with the new system left, but an active recruitment campaign was successful in attracting people to the new role, increasing the number of consultants in the department. Team building days, which included the clarification of roles and responsibilities and special interest clinics, were followed by mentoring.
"What we try to emphasise is not the change itself, but that our consultants now provide 24 hour care," she says. "They are not just doing the job previously done by others, but doing it in a better way."
Dr van Someren says the obvious main benefit is the presence of a senior clinician in the service 24 hours a day. The increased number of consultants in turn increased the amount of time for other consultant responsibilities including teaching, training and service development. It also led to more people in leadership positions.
Another impact is that fewer children are admitted through A&E after being assessed by a consultant. Also, consultants can make a decision in the evening to allow a child to go home early next day, so reducing length of stay.
Dr Someren advises that if trusts are considering such a change, it must be acknowledged as a whole system change.
"I would say it's essential to make it a big change and to pay attention to involving the whole team," she says. “I believe that if some of the old ways are retained, you can be trapped between what used to happen and the new way of working."
