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I agree with Mr Paterson Brown. Consultant surgeons in district
hospitals are going to be under increasing pressure to unite into a common
rota to enable delivery of services that comply with the difficult working
time directive. This, however, is not easy as it seems as the intensive
care and ambulance facilities are likely to hinder such moves. The impact
of this directive and its ramifications have not been fully assessed yet
but I fear, that trainee surgeons will have much to lose from deduction
of their night time 'work'. We have gone back to the old 24 hrs on call
with the SpR being made non resident after midnight to enable compliance.
This has come at a big cost with loss of team structure and a very
significant loss of continuity of care. This is not just an ode to the
past - but a statement of fact that the service rendered was perhaps
superior when we all worked in teams, knew all the patients' progress and
communicated with freely. Now, I can be working with juniors I hardly
know, whose competency I do not assess and whose performance I cannot
judge as I may see them just once over a 2 month rota cycle. Is this
progress in the right direction?