Journal of the Royal Society of Medicine
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There is much ambiguity about consultant leave allowances and arrangements for cover in the National Health Service. We analysed job descriptions for 47 consultant posts advertised in mid-2000. 35 defined a duty rota but only 3 mentioned specific available leave (all different). ⋯ This arrangement is particularly hazardous in surgical specialties. If elective surgery is to continue when the consultant is absent, arrangements for leave and cover need to be more clearly defined.
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A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. ⋯ Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest.
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There are numerous standards currently available that relate to accident and emergency medicine. Some of these relate to organizational structure; others are clinical and relate either to the process of care or to outcomes. Few, if any, deal explicitly with the dimensions of quality mentioned in recent white papers about the NHS. It is suggested, to maximize the effect standards have on care, that they should be developed for existing technologies not just for novel ones, rigorously developed and effectively disseminated and implemented, formally evaluated after their introduction and mutually compatible.
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This paper examines some of the misapprehensions that have often underpinned the planning of accident and emergency services in the UK. Accident and emergency (A&E) is not a homogenous group of activities and the different components that make up the service should be planned separately. This planning needs to be accompanied by some significant redesign to meet growing patient expectations. In particular, there is a major challenge for services to offer local access in an environment in which acute care is increasingly centralized.