A single-handed consultant cannot be present in the department all the time and so his or her responsibility is to organise the department so that it can cope in their absence. This involves much teaching and administration as described in the previous chapter. However where there is more than one consultant, they can spend much more time on clinical duties. In my own department 65 per cent of patients attend outside normal working hours and there has long been recognised the requirement for experienced doctors to be present 24 hours a day. In 1960 the Nuffield Report had said that the ideal casualty department ‘should have immediately available at any one time a medical man of consultant quality …’1 and the BOA in 1971 had also recognised the need for an experienced doctor on duty 24 hours per day.2 The possibility of consultants working shifts had been discussed following the Short Report in 1982 when there was much (but not total) opposition (see Chapter 5). It was, however, completely unrealistic with the number of consultants then available. The importance of 24-hour consultant cover (not just in A&E) was emphasised by the Royal College of Surgeons’ Report on patients with major injuries in 19883 and in 1990 BAEM stressed the importance of providing experienced 24-hour cover wherever possible.4


Consultant Paediatrician Minor Head Injury Junior Staff Experienced Doctor Casualty Department 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Nuffield Provincial Hospitals Trust. Casualty Services and their Setting (1960) Oxford University Press.Google Scholar
  2. 2.
    Durbin FC. Report of Accident Services Committee of the British Orthopaedic Association J Bone Jt Surg (Br) (1971) 53B: 765–6.Google Scholar
  3. 3.
    Commission on the Provision of Surgical Services Working Party. The Management of Patients with Major Injuries (1988) Royal College of Surgeons of England.Google Scholar
  4. 4.
    BAEM Ex. 12.7.90.Google Scholar
  5. 5.
    Information extracted from BAEM Directory 1996. BAEM, London.Google Scholar
  6. 6.
    Lowden TG. The casualty department: the work and the staff. Lancet (1956) 1: 955–6.CrossRefGoogle Scholar
  7. 7.
    Standing Medical Advisory Committee. Accident and Emergency Services (the Platt Report) (1962) HMSO.Google Scholar
  8. 8.
    Skinner D. Accident and emergency services. BMJ (1990) 301: 1292.CrossRefGoogle Scholar
  9. 9.
    Cooke MW, Kelly C, Khattab A, Lendrum K, Morrell R and Rubython EJ. Accident and emergency 24-hour senior cover — a necessity or a luxury. J Accid Emerg Med (1998) 15: 181–4.CrossRefGoogle Scholar
  10. 10.
    Wyatt JP, Henry J and Beard D. The association between the seniority of accident and emergency doctor and outcome following trauma. Injury (1999) 30: 165–8.Google Scholar
  11. 11.
    Binchy J. Accident and emergency medicine — the next 25 years. J Accid Emerg Med (1999) 16: 48–54.CrossRefGoogle Scholar
  12. 12.
    Nicholl J and Turner J. Effectiveness of a regional trauma system in reducing mortality from major trauma; before and after study. BMJ (1997) 315: 1349–54.CrossRefGoogle Scholar
  13. 13.
    Prescott M, personal communication.Google Scholar
  14. 14.
    Yates D. Regional trauma systems. BMJ (1997) 315: 1321–2.CrossRefGoogle Scholar
  15. 15.
    Miles S, personal communication.Google Scholar
  16. 16.
    McCabe S, personal communication.Google Scholar
  17. 17.
    Cooke M, personal communication.Google Scholar
  18. 18.
    BAEM AGM. 29.3.96.Google Scholar
  19. 19.
    BAEM and FAEM. Workforce planning in A&E Medicine 2001–2010 (2001).Google Scholar
  20. 20.
    Social Services Committee. Medical Education. Vol. 1 (Short Report) (1981) HMSO.Google Scholar
  21. 21.
    Working Party. SHO Training: Tackling the Issues, Raising the Standards (1995) Committee of Postgraduate Medical Deans (COPMED) and UK Conference of Postgraduate Deans.Google Scholar
  22. 22.
    Department of Health. The NHS Plan (2000) Department of Health.Google Scholar
  23. 23.
    Yates DW. Accident and emergency services. BMJ (1991) 302: 111.CrossRefGoogle Scholar
  24. 24.
    Lecky F, Woodford M and Yates DW. Trends in trauma care England and Wales 1989–97. Lancet (2000) 355: 1771–5.CrossRefGoogle Scholar
  25. 25.
    Heyworth J. Medical staffing in A&E in Coffey T and Mythen M (eds) NHS Frontline — Visions for 2010 (2000) The New Health Network, London.Google Scholar
  26. 26.
    Anonymous. OME survey confirms consultants’ commitment to NHS. BMJ (1990) 300: 471–2.Google Scholar
  27. 27.
    Brown R. Activities of accident and emergency consultants — a time and motion study. J Accid Emerg Med (2000): 17122–5.Google Scholar
  28. 28.
    BAEM and FAEM. Report of Joint Meeting on extension of role of A&E consultant 29.6.99.Google Scholar
  29. 29.
    Report of the Working party on the Management of Head Injuries. (1999) Royal College of Surgeons of England.Google Scholar
  30. 30.
    Jackson RH. Children in accident and emergency departments. BMJ (1985) 291: 991–2.CrossRefGoogle Scholar
  31. 31.
    Mason MA. Children in accident and emergency departments. BMJ (1985) 291: 1353.CrossRefGoogle Scholar
  32. 32.
    CSA Ex. 8.10.87.Google Scholar
  33. 33.
    British Paediatric Association, British Association of Paediatric Surgeons and Casualty Surgeons Association. Joint Statement on Children’s Attendances at Accident and Emergency Departments (1988) British Paediatric Association.Google Scholar
  34. 34.
    Multidisciplinary Working Party. Accident and Emergency Service for Children (1999) Royal College of Paediatrics and Child Health.Google Scholar
  35. 35.
    Marsden A, personal communication.Google Scholar
  36. 36.
    Walker A and Brenchley J. Survey of the use of rapid sequence induction in the accident and emergency department. J Accid Emerg Med (2000) 17: 95–7.CrossRefGoogle Scholar
  37. 37.
    Nee P, personal communication.Google Scholar
  38. 38.
    Baird RN, Noble J and McLean D. Initial intensive care in an accident and emergency department. BMJ (1972) 4: 90–2.CrossRefGoogle Scholar
  39. 39.
    Bache JB. The work of an A&E department: a new look at the figures. A&E News (1982) March 4–5.Google Scholar
  40. 40.
    Shalley MJ and Cross AB. Which patients are likely to die in an accident and emergency department? BMJ (1984) 289: 419–21.CrossRefGoogle Scholar
  41. 41.
    Anonymous. Rising emergency admissions. BMJ (1995) 310: 207–8.Google Scholar
  42. 42.
    Anonymous. The continuing rise in emergency admissions. BMJ (1996) 312: 991–2.Google Scholar
  43. 43.
    Volans A. Trends in emergency admissions. BMJ (1999) 319: 1201.CrossRefGoogle Scholar
  44. 44.
    Penny WJ. Improving door-to-needle times for thrombolysis in acute myocardial infarction. J Roy Coll Phys Lond (1999) 33: 6–7.Google Scholar
  45. 45.
    Working Party of the Federation of Medical Royal Colleges. Acute Medicine: The Physician’s Role (2000) Royal Colleges of Physicians.Google Scholar
  46. 46.
    Quin G. Chest pain evaluation units J Accid Emerg Med (2000) 17: 237–40.CrossRefGoogle Scholar
  47. 47.
    Mather HM and Connor H. Coping with pressures in acute medicine — the second RCP consultant questionnaire survey. J Roy Coll Phys Lond (2000) 34: 371–3.Google Scholar
  48. 48.
    Schiller KFR. Specialists should not be expected to practise general medicine. BMJ (1999) 318: 1759.CrossRefGoogle Scholar
  49. 49.
    Working Party. Acute medicine: making it work for patients. A blueprint for organisation and training (2004) Royal College of Physicians, London.Google Scholar

Copyright information

© Henry Guly 2005

Authors and Affiliations

  • Henry Guly
    • 1
  1. 1.Derriford HospitalPlymouthUK

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