LEADERSHIPAND MANAGEMENT
Consulting the evidence
Evidence shows that consultant-delivered care provides significant benefits to patients and trainee doctors. Professor Terence Stephenson, president of the Royal College of Paediatrics & Child Health, chaired the steering group examining consultant-led care for the AoMRC, and discussed the findings with NHE.
T
o dispel the dangerous idea that it is acceptable, even in the face of huge
financial pressures, for patients’ care to be led mainly by junior doctors, the Academy of Medical Royal Colleges (AoMRC) has recently published a major report called ‘The benefits of consultant delivered care’.
The report gathers evidence from case studies around the world, as well as a collection of professional opinion on the topic. Professor Terence Stephenson, who chaired the steering group that produced the report, said this evidence should be considered when future decisions are made concerning the medical workforce.
The AoMRC does not think that consult- ants alone can handle patient care, of course – they need the essential support of other health professionals. Prof Stephen- son told us: “They can only function as part of a team.”
The report considers consultants as part of a team of workers, who will offer added value compared to a team where junior doctors are in the majority.
The training debate
“There seemed to be a debate around whether you could get away with partial
26 | national health executive Mar/Apr 12
training,” Prof Stephenson suggested, which would move away from the question of partially trained versus fully trained, and on to the more narrow definition of a doctor trained to fulfil particular tasks.
He said: “We wanted to engage with that and find out what the evidence is that the fully trained ‘complete doctor’ might give better care than someone trained in certain procedures or only certain illnesses or parts of a disease.”
This has implications for specialisation, as although doctors can gain recognition for further training and particular expertise, Prof Stephenson argued that the NHS needs “all-round, fully-trained consultants, not someone who’s just trained in some small part of patient care”.
The UK health service is heavily dependent on both junior doctors and those from overseas, something that Prof Stephenson would like to see changed. He said: “The UK should aim to be self-sufficient in the number of consultants it provides. The number of consultants per capita in the UK is quite low compared to some other countries.”
He argued that the service should predominantly be led by consultants, with
the trainees “there to be trained”. While the AoMRC was clear that this would not mean students taught purely through lectures, it would see trainee doctors as part of a system where consultants treating patients was the norm.
7/7 services
Moving towards a seven days out of seven system of working is a current topic of discussion around the NHS, with hard research having confirmed long-held anecdotal suspicions that patients are more likely to die in hospital at weekends.
Prof Stephenson said: “Most people in the health service now think that the care you get should be the same on a Sunday as a Tuesday. We firmly believe that.”
He cautioned that this would not be necessary for all services, as elective operations or scans could be rearranged throughout the week, and the real need for seven-day care is in terms of emergencies.
The biggest obstacle to implementing such a structural change is probably due to the number of consultants available, Prof Stephenson said, something that is further limited by the European Working Time Directive.
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