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Back to basics: medical staffing in general hospitals

BMJ 1994; 309 doi: (Published 29 October 1994) Cite this as: BMJ 1994;309:1166
  1. E R Williams,
  2. L P Harvey,
  3. G Ingrams,
  4. P E Robin,
  5. J G Temple

    There is a major crisis in medical staffing in hospitals in Britain and this is influencing other aspects of health care delivery. Before the new deal on junior doctors' hours the conventional pattern of staffing was the firm, usually of two consultants, a senior registrar or a registrar, a senior house officer, and one or two preregistration house officers. A one in two rota was often expected for resident junior staff. It was not unusual for registrars to be non-resident when on call, and even in major teaching hospitals the on call resident staff were sometimes surprisingly junior. Cross cover between firms was often unacceptable or discouraged.

    * “Overriding service needs have, therefore been met by the proliferation of unusual non-consultant posts.”

    The 1960s and early 1970s were characterised by this basic pattern of staffing spreading to all specialties with an enormous rise in senior house officer numbers but with a continued resistance to cross cover. As most of the senior house officers were destined for a career in general practice this did not always result in a high level of specialist junior skills. While junior doctors could be exploited by the service demands of a one in two rota, this was an effective way of providing 24 hour medical care and did result in continuity. It was, however, clearly socially and morally unacceptable and put service needs before training requirements. The statutory reduction in junior doctors' hours is a cogent factor in implementing profound change in the pattern of delivery of health care.

    Central and regional manpower committees tried to limit the uncontrolled growth of doctors in non-consultant grades but were faced with lack of funds and the expansion of senior house officers to meet service needs or …

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