Education And Debate

Rethinking Consultants: Alternative models of organisation are needed

BMJ 1995; 310 doi: (Published 08 April 1995) Cite this as: BMJ 1995;310:925
  1. Fiona Moss, consultant respiratory physiciana,
  2. Martin McNicol, chairmana
  1. a Central Middlesex Hospital NHS Trust, London NW10 7NS

    Anyone considering a fundamental rethink of the role of consultants risks exposing tensions in the medical profession that have characterised the development of medical practice since the 18th century. That tense story was one of beds and money, power and domination. Rethinking the role of consultants must now take into account the relationship between consultants and their specialist colleagues and general practitioners; examine the distribution of work between consultants and junior doctors; and relate the contribution of the consultant as specialist to that of other health professionals. After half a century of a national health service characterised by equity of access to care, we urgently need to debate the roles of those who work in it and in doing so to focus primarily on the needs of patients.

    Consultants are the senior doctors in the hospital and community services of the NHS. We discuss here their role in clinical specialties in the hospital service. All patients seen in hospital are nominally looked after by a consultant. This is a consultant's primary role, but there are others. While training, all doctors work for a consultant. In theory, most consultants are trainers and educational supervisors. In the hospital a consultant often has organisational responsibilities ranging from that of managing a clinical firm to that of medical director. Many consultants—not just those with academic appointments—take part in research and teach undergraduates. Consultants have allegiances outwith their hospitals to royal colleges or specialty associations, and some have considerable responsibilities to these groups.

    So rethinking the role of the consultant means unravelling the complex package that makes up a consultant's job. The central consideration in any change should be the needs of patients for the clinical services provided—and therefore the needs of the employing organisation. Here we consider only those parts of consultants' roles that …

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