JRSM >
Volume 96, Number 2 >
Pp. 102
62 Stoke Road, Guildford, Surrey GU1 4HR, UK
E-mail: jnkevin{at}aol.com
Mr Ramchandani and his colleagues report the attitudes of hospital consultants, general practitioners and patients to pooled waiting lists for cataract surgery (December 2002 JRSM1). I think that this strategy could improve efficiency in my own specialty, gynaecology.
In the UK patients are traditionally admitted to gynaecology units under a named consultant. In essence, this means that NHS consultants ‘work together in isolation’. By contrast, in Continental Europe referrals to gynaecology units tend to be ‘generic’. Patients are the responsibility of the whole department, headed by a chief of staff. They are looked after by teams with an appropriate special interest, and the most suitable surgeon is internally allocated to each patient. This achieves uniformity of practice and equality of patient care. The patient turn-over is quick and there are no waiting lists for investigations.
This arrangement has other benefits. It should reduce the disparities that arise when inexperienced specialist registrars enter the system. In the European units I have visited, groups of consultants work together in the operating theatre or the clinic. This provides clinicians with the opportunity to monitor each other's performance, update techniques, and expand repertoires and to reciprocate teaching opportunities. This arrangement also facilitates audit and learning, and enhances patient safety. It truly is lifelong learning.
One of the arguments against the European structure is that UK consultants would not want to sacrifice their clinical autonomy and work under a ‘chief of staff’. This argument is becoming less tenable. We are directly accountable to the clinical or medical director through appraisal and revalidation as part of our jobs plans. Besides, if our management is evidence based and ‘best practice’ it should be consistent with that of our colleagues. Therefore, I do not see loss of traditional autonomy as an important issue.
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