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Views And Reviews Provocations

The consultant on-call system is an extravagant waste of money

BMJ 2018; 361 doi: (Published 08 May 2018) Cite this as: BMJ 2018;361:k2000
  1. Louella Vaughan
  1. louella.vaughan{at}

Consultants make less of a difference out of hours than is generally thought

That “consultants do it better” has become an accepted truism in the NHS, with 24/7 consultant cover of services now seen as a cornerstone of safe and effective patient care.1 And for overnight on-call services this seems to come at a bargain basement price. Consultants receive the princely sum of around £7.50 an hour for trekking into the hospital in the dark of night (box 1). Paying consultants a set percentage of their base salary (from 1% to 8%, depending on frequency and intensity of work) seems like an excellent deal for the NHS.2

The truth, however, is that the current consultant on-call system is an extravagant waste of money. The problem lies with successive policy initiatives designed to reduce clinicians’ fatigue and improve patient outcomes. The near uniform responses of the royal colleges to the European Working Time Directive,3 which limits the time any doctor can spend either working or on call, and to the moves to a seven day a week consultant delivered service4 have been to call for the expansion of the consultant workforce. So where once a moderately busy service needed only four …

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