Medicopolitical Digest

Consultants must not be compulsorily resident

BMJ 1995; 310 doi: (Published 24 June 1995) Cite this as: BMJ 1995;310:1676
  1. Douglas Carnall,
  2. Linda Beecham,
  3. Jane Smith

    The conference agreed overwhelmingly that consultants should never be compulsorily resident on call, but it backed away from agreeing that limits should be set on the total number of hours that they could work.

    Dr Bob Buckland, a consultant anaesthetist in Winchester, argued that trainees' problems should not be passed on to consultants, though trusts were increasingly using this option as a short term solution when juniors were on holiday or sick leave. He called on the conference to produce guidance for consultants' behaviour in such circumstances, saying that it would often involve cancelling routine work.

    Being resident on call “undermined the status of consultants,” said Mr William Lamb, a consultant in oral and maxillofacial surgery in Cambridge, and “made the job less attractive,” though he admitted that such arrangements did have advantages for both juniors and patients. He argued for the negotiating committee to agree a financial value for such work.


    Mr Lamb was likewise against the formalisation of on call arrangements, arguing that it would compromise the next generation, though hepersonally could remember the pleasure of being continually on call as a junior. In his opinion, the introduction of payment for on call work had started a downward spiral which continued to the present day.

    The conference defeated the motion, while also voting against a motion which sought to limit the number of hours that a consultant could be on call. Proposing this, Dr Richard Ackroyd pointed out that consultants could be working for longer than their juniors. One in two rotas were common when consultants were covering absent colleagues, which meant that consultants could often be working 80 to 100 hours a week alongside juniors who were working only 72. The problem related to the way consultants were paid. “We are on an open contract, which is now leading to exploitation—we are cheap labour, and if forcing us to work additional hours is cheaper, we will be used.” Dr Ackroyd's solution was to work to a defined contract, with a job plan and agreed control on hours and on call periods. “We must stop consultants from becoming yesterday's SHOs working yesterday's SHOs' hours.”

    Dr Ann Blyth, a consultant anaesthetist in Glasgow, said that the reason why this motion was being debated was because junior doctors' hours had come down without an expansion in consultant numbers.

    The conference agreed that consultant numbers had to expand to implement the Calman report, and passed a motion deploring the lack of central direction necessary to increase consultant numbers.

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