Intended for healthcare professionals


Consultant led and delivered services

BMJ 2012; 344 doi: (Published 10 May 2012) Cite this as: BMJ 2012;344:e3229
  1. Nigel Edwards, senior fellow
  1. 1King’s Fund, London W1G 0AN, UK
  1. n.edwards{at}

Increasing patient access to specialists is important, but new ways to do this need to be found

Recent reports published by the Academy of Medical Royal Colleges and the Royal College of Paediatrics and Child Health add to a growing call for consultant led care in the United Kingdom.1 2 At first sight, adoption of this model seems to be simply a matter of increasing the number of consultants and changing to shift work, while keeping the current model of healthcare provision. But in fact it would require major investment that might not be feasible. Just increasing consultant numbers may not be the right answer. In addition, the reports may have important implications for where care is provided and how it is organised.

Patients undoubtedly benefit from seeing an appropriately trained doctor who has a high level of expertise as early in their care as possible. Since the inception of the NHS, however, the sickest patients have tended to see the most junior doctors, and access to a senior opinion has depended more on the time of day or day of the week than the needs of the patient.3 The academy’s report presents evidence that patients have increased morbidity and mortality when the involvement of specialists is delayed, particularly in acute surgery, emergency medicine, …

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