THERE was an advertisement feature in the Observer (August 31) about a consultant who said he lived in Eastbourne but mainly worked at the Conquest in Hastings.
Normally this would not be allowed as consultants are contractually required, under the Terms and Conditions of Service, to live within 10 miles or 30 minutes drive of their base hospital.
There are good reasons for this. It has always been thought to be a reasonable arrangement for consultants who are on-call from home. This is especially the case for those consultants who work in acute specialties such as the Medical Assessment Unit.
Sometimes the 10/30 rule is waived for those consultants who are prepared to make agreed closer accommodation arrangements during their time on-call or are resident on-call and never on-call from home or for those consultants where call out is less urgent or infrequent.
In some acute specialties, there are far stricter rules. The CNST (Clinical Negligence Scheme for Trusts) mandates a 30-minute period from the time of the telephone call for assistance to the appearance on the ward in the case of consultant obstetricians, consultant anaesthetists and consultant paediatricians.
There is a similar 30-minute call to appearance time for consultants in emergency medicine. In such typical scenarios as inability to deliver the head at Caesarean section, failed anaesthetic intubation at Caesarean section or the resuscitation of a very sick neonate, the middle grade resident doctor needs the consultant presence as soon as possible and ideally within minutes to salvage a life-threatening disaster.
Note this is not the drive time; it is call to appearance time. In reality, this means that most consultants need to live within five miles/15 minutes drive time to achieve a 30-minute call to appearance time.
There is no doubt that Medical Assessment Unit is an acute specialty. The resident middle grade doctor may well need consultant presence within 30 minutes from call. Such a case would be a young person with life-threatening asthma. It is, therefore, highly unusual and rather dangerous for an acute consultant at the Conquest to be allowed to live in Eastbourne but we again stress that we are making no comments about any individual consultant.
This has major implications for reconfiguration. The 10/30 rule is likely to apply and the CNST 30-minute appearance rule is mandatory. Therefore all consultants in acute specialties will have to move house if they are not within these limits. This will be unpopular and costly. The alternative would be for local accommodation arrangements when on-call.
We would, of course, challenge anyone who says that they can drive between Eastbourne DGH and the Conquest in 30 minutes at any time of the day and it is obviously impossible to achieve a 30-minute call to appearance time.
It would clearly be totally unacceptable, under the proposed reconfiguration, to allow acute consultants to live in Eastbourne when on-call for the Conquest or vice versa. This would be a serious and dangerous deterioration in consultant availability under single site arrangements which would far negate any benefits of single siting.
Chairman, Hands Off the Conquest
Chairman, Save the DGH Campaign