Letter: Consultants at the coal-face

Sir: Dr Southern (letter, 21 March) is correct in stating that consultants spend more time on administration, and that the reduction in junior doctors' hours is another potential difficulty for maintaining a first-class level of continuity of care for acutely sick patients. He is, however, incorrect to say that consultants have too little time to see sick patients, especially when they are admitted.

We are a busy two-site campus with a large casualty department. When each consultant was on the rota every fifth day with his team for emergency admissions, the difficulty was to fit an unpredictable workload into an already crowded schedule and the system often worked badly, yet it is the way most hospital admission teams work - often the consultant only has time to be shown the sickest people and may not return until the next routine ward round.

My directorate runs a physician-of-the-week (POW) system, with one consultant available 24 hours a day for seven days on a rota system. His routine work is cancelled for that week. There are two ward rounds, at 8am and 5.30pm, teaching sessions for students and house staff, and ample time to follow up the admissions of previous days. Continuity of care has been transformed, especially at weekends.

Far from consultants being kept from the bedside, the week is enjoyable, different and there is time to do a proper job. It has optimised the timetables of busy physicians who have a lot to contribute to the care of the acutely ill.

Dr STEPHEN G SPIRO

Clinical Director of Medicine

University College London Hospital Trust

London W1