Coping with pressures in acute medicine - the second RCP consultant questionnaire survey

The second questionnaire survey of consultant physicians involved in acute unselected takes in 1999 achieved a 76% response rate, and the results have been compared with those from the first survey of 1997. The proportion of consultants whose trainees worked partial shifts had increased from 42% to 61%, although these patterns of duty were adjudged to have detrimental effe cts on the quality and continuity of care, and on junior staff education an d training. The benefits of ward-based systems were counterbalanced by thei r disadvantages, but introductions of admission wards and assessment units were considered a resounding success. The number of hospitals with 'physici an of the week' schemes had increased from 12 to 23, hut opinion of their v alue was sharply divided. The provision and competence of all grades of loc ums was identified as an increasing problem. Seventy per cent of respondent s stated that they would never participate in 'hands-on' emergency care, al though 86% thought that future consultants might have to do so. Seventy-nin e per cent reported increases in the pressures of their posts and in their working hours, and the tensions between general and specialist duties were highlighted. Most consultants considered that the only long-term solution t o the staffing crisis was a marked expansion in the numbers of all grades o f medical staff.