1. Consultant resident on-call system: Salisbury

2. Salisbury DH  Rural  Relatively isolated – nearest unit 25 miles  Full obstetric and A&E service  Regional burns and plastics  Child pop. C 40 000  2500 deliveries p.a.  18 bedded children’s ward  Level 2b NICU

3. Paediatric dept.  10 consultants (8 on 11 PAs, 2 on 8 PAs)  4 middle grades  5 junior grades 4 GP trainees, 1 FY2 4 GP trainees, 1 FY2 Night on-call shared with 5 O&G SHOs Night on-call shared with 5 O&G SHOs

4. Resident consultant system  All 10 do resident on call: part-timers pro rata  Out-of-hours time divided between 4 MGs and 10 cons  Cons also do on call from home covering either MG or cons colleague  13 hour shifts same as juniors

5. Resident on call workload  Resident shifts about 1 night per 2 weeks and 1 weekend (3 shifts, days or nights) every 10 weeks  Always on with SHO  Day off afterwards  Contract: Daytime work: 6.5 PAs (including 2.5 SPAs) Daytime work: 6.5 PAs (including 2.5 SPAs) Resident shifts 3.5 Pas Resident shifts 3.5 Pas Other emergency work 1 PA Other emergency work 1 PA

6. Typical night shift  2100 – 2130: handover  2130- 2230: reviewing ward attenders and in- patients  2230- 0000: admin with interruptions  0000-0030: review patients  0030-0200: admin with interruptions  0200-0700: rest, with interruptions: Calls to ward, NICU, ED, Burns, labour ward Calls to ward, NICU, ED, Burns, labour ward  0700-0930: reviews and handover

7. Accommodation  Consultant flat, superior to juniors accommodation  About 100m from labour ward  Bedroom, bathroom, kitchen, lounge with TV and network computer

8. Accommodation

9. Bedroom

10. Kitchen

11. Lounge

12. Back up consultant  Resident cons always has back-up colleague on call from home for: 2 skilled people needed at once 2 skilled people needed at once Transfers Transfers Advice Advice

13. Advantages for service  Better out-of-hours care  Fewer unnecessary admissions  Better continuity  Better supervision of juniors & nurses

14. Advantages for individual  Financial  More day time off during week  More ‘hands-on’ work

15. Disadvantages for service  Fewer consultants around during the day  Less time for supporting activities  Cost

16. Disadvantages for individual  Tiredness  Less continuity for own patients  Less time for career development