Consultants of the future

Abstract

Few people disagree that the work of British consultants is changing rapidly. The questions revolve around how consultants should organise their work to meet a set of apparently conflicting demands on their time. Over the past four weeks we have invited contributors to discuss these issues,1 2 3 4 and last week the BMA's consultants' committee hosted a meeting at BMA House to think about the future role of consultants. Consultants clearly believe that they have been dancing to others' tunes for too long and that, in the words of Jim Johnson, the consultants' chairman, it's time to take charge of their own destiny. Change is needed because of reductions in junior doctors' hours; the proposed change to shorter, more structured training for juniors5; demands from purchasers that more work is done by fully trained specialists; and the requirements of the new NHS: audit, contracting, and managing. Scientific advances3 and changes in the pace and place of care4 also make change essential. The net effect is that heavier workloads leave consultants with little time to reflect on how they can best use their time. Teamwork is one solution. If fewer juniors are available for service work, more of that work will have to be done by consultants. Although consultants work more efficiently than juniors, the large amount of emergency and night work presently done by juniors remains a problem. Bigger teams make this more manageable. In the United States, for example, senior doctors in a …