1. Changes in working practices The consultant physician perspective

2. RCP Workforce Unit

3. Role of the College To improve the quality of patient care by continually raising medical standards Key areas pertinent to today: Monitoring physician numbers Setting standards for acute care including handover Reviewing impact of EWTD

4. Consultant delivered service

5. Specific issues: EWTD Consultant and registrar expansion Patient/doctor ratios Quality of training

6. EWTD on patient care and training Much better BetterNo changeWorse Much worse Has EWTD changed the quality of your training? 0.9%5.1%44.8%37.8%11.4% Has EWTD changed the amount of specialty training you undertake? 0.6%4.5%42.9%41.0%11.0% Has EWTD changed the amount of GIM training you undertake? 0.7%6.7%52.8%30.0%9.8% Has EWTD changed the quality of patient care? 0.7%4.6%36.5%42.0%16.2% Has EWTD changed the quality of patient care relating to continuity of care? 0.6%2.3%25.5%32.6%39.0% Has EWTD changed your quality of life at work? 0.9%10.5%39.7%40.1%8.8% Has EWTD changed your quality of life at home? 4.2%23.8%47.5%16.8%7.7%

7. Have you had problems implementing EWTD? 68% said yes “Multiple. Junior presence on the wards is fewer, patient care has been compromised. Occasionally Consultant has cancelled elective activity to cover juniors’ jobs.” “Cannot find any external locums.” “If there is even a single person off sick or on unexpected leave there are insufficient junior staff hours to adequately cover all the requirements for the functioning of the firm as a whole.” “Major problems, need to beg/force internal locums to help at short notice causing unhappiness.” “Yes – shift pattern very disruptive to training.”

8. How often do you use locums?

9. Strongly agree AgreeNeutralDisagree Strongly disagree Internal locum cover is easy to organise 1.6%6.3%12.7%46.0%33.3% External locum cover is easy to organise 1.6%4.8%6.5%30.6%56.5% Internal locums are usually reliable 25.8%71.0%3.2%0% External locums are usually reliable 1.6%19.4%45.2%30.6%3.2% Internal locums are usually high quality 23.8%57.1%17.5%1.6%0% External locums are usually high quality 0%9.7%41.9%40.3%8.1% Patient care is usually worse when internal locums are employed 1.6%3.2%9.5%66.7%19.0% Patient care is usually worse when external locums are employed 9.7%33.9%43.5%12.9%0%

10. Sickness rates

11. How to we solve EWTD and H@N?

12. Increasing the number of consultants Benefits – Shorter patient stay – Reduced mortality – Improved patient safety – More trainers – Less restrictions within EWTD – Low sickness rates Drawbacks – ?Increased readmission rate – Cost

13. Early discharge and consultants on AMU McNeill et al, Clin Med 2009

16. Cardiology trainee’s future

17. Since 2001: Registrar numbers have increased by 66.3% Consultant numbers have increased by 25.9%

18. My team – April-June 2009

19. Summary EWTD has stretched the profession Night-time care is currently maintained but under threat in the future Consultant expansion is needed There is a large emerging workforce which could be used