Hybrid consultants
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c240 (Published 27 January 2010) Cite this as: BMJ 2010;340:c240
Abstract
Harish Madhava looks at an innovation in consultant roles
Hospital paediatrics in the NHS is undergoing a silent revolution. Over the past year, many trusts have created roles for consultants that are very different from the traditional consultant posts. These new consultants are called by different names—hybrid consultants, consultant paediatrician with resident on-call commitments, locum acute consultant paediatricians, or, as jokingly referred to in our trust, as “chameleon” consultants. These posts have come into existence because of various reasons. The most important of these are:
Deadlines for the implementation of the European Working Time Directive for junior doctors
Major shortage of middle grade doctors in paediatrics (enough has been written about the reasons behind this)
Low availability of paediatricians who have a certificate of completion of training
The need for change and an innovative approach to dealing with changing demand
The move towards consultant delivered care as opposed to consultant led care.
My role
I recently started as a hybrid consultant in general paediatrics at Surrey and Sussex NHS Trust. I completed my registrar training in general paediatrics and was awarded my certificate of completion of training in September 2009. I came across the role of hybrid consultant while I was applying for consultant posts and was initially very apprehensive about the role. Doctors within the NHS are institutionalised and find it very difficult to think outside the confines of the NHS and the traditional job descriptions, but I decided to approach the issue with an open mind. I did all the usual groundwork regarding the trust, met the senior members of the department, and gathered as much information as possible about the new roles. I applied for the post only after I was sufficiently convinced that I was the right person for the job and that the job was right for me. I interviewed successfully and was offered the post. I have been in the role for about six weeks now and I am loving it.
The job is split up into two sections. I function as the “traditional” consultant for four weeks, which includes being the consultant of the week for one week. I have my designated clinics, in general paediatrics and in my subspecialty interest (paediatric cardiology). For the next four weeks, I am on the middle grade rota, which includes seven nights and a weekend with adequate rest periods built in.
Pros and cons
Most trusts that have appointed hybrid consultants operate a similar job plan. From my short experience of working in this new role I have made some observations about its positive and negative aspects.
Pros
Consultant delivered care for patients
Fewer admissions and more efficient use of ambulatory services
More senior personnel available to take on activities such as writing and implementation of departmental guidelines
A gentle transition from being a registrar to being a consultant
Continued supervision and guidance
Remain very hands on and do not suffer from sudden withdrawal of the adrenaline that an acute paediatrics registrar gets addicted to
Adequate rest periods.
Cons
Deviation from the traditional role of a consultant
Continue to do unsocial and less flexible hours
Less time for clinics
Logistical difficulties associated with follow-up of patients
Too much hands on direct clinical care as opposed to the traditional supervisory and advisory role of a consultant
Difficulties fitting in management commitments around the on-call commitments
Uncertainty regarding the future of the roles
Difficulties associated with interpretation of consultant contract with the changing job description
Future of the role is uncertain and there is no pathway for career progression
Fear of creating a sub-consultant grade
Is it a cost efficient way to manage the workforce?
Possibility of high attrition rate and lack of commitment to the role.
Success depends on good vision
As with everything that is new, the hybrid consultant role is associated with uncertainties, insecurities, and the fear of the unknown. The roles were visualised and created mainly to achieve junior doctors’ compliance with the European Working Time Directive.
I believe that the success of these roles will entirely depend on the local arrangements. Senior management with good vision will be able to put to good use the extra workforce that has suddenly become available. Also important will be the recognition by senior management that the hybrid consultants are well trained professionals and if such individuals are not nurtured and looked after, there will be a very high attrition rate in this grade.
Also in this era of financial difficulties, how long will the funding for these roles last? If funding is not guaranteed for at least the foreseeable future, it will be very difficult for departments to plan any long term expansion and creation of newer services such as outreach clinics and ambulatory care.
These are some of the difficult questions that need to be answered and answered quickly if we are to make a success of this new and innovative concept of chameleon consultants in paediatrics.