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In the context of great unhappiness among junior doctors, it is good to read that a return to aspects of the 'firm' is being discussed. This includes 'the ability to work with people for more than just a transient period'. The current shift system commonly produces the exact opposite, so that 'senior doctors identify juniors by their position and not their name', because they are seen as interchangeable. This is bad for morale and for training.
When implementing the New Deal in the 1990s, we organised the rotas so as to maximise the integrity of the firm, with only the minimum number of exceptions necessary to balance the hours for each level of staff. I understand that shifts are now generally planned by lay administrators, for whom the affiliation of juniors to their consultants is not a priority. Doctors need to take back responsibility for this important task to restore the working linkages between the various grades of staff on a unit. This is vital if the benefits of a firm system to be realised.
No competing interests
12 December 2016
David F L Watkin
Retired General Surgeon.
Formerly at Leicester Royal Infirmary. Past President, Association of Surgeons of Great Britain and Ireland