Do we really need a duty consultant?

Do consultant psychiatrists really need to provide a conventional out of hours service? How often does a clinical insight, resulting from a face-to-face, out-of-hours interview with the duty consultant psychiatrist, genuinely contribute to the management of a situation, in a way that could not have waited until the following day? Between 17.00 h and 09.00 h, could it not be replaced by telephone advice? A single consultant (working a reasonable shift of say 8 h) could provide advice to junior doctors, and others, for a large catchment of several million people, with a local consultant still available to review patients between 09.00 h and 17.00 h on weekends and public holidays.

There are two strong arguments for making such a change. First, the effort and expenditure invested by the National Health Service in ensuring the physical presence of a consultant psychiatrist at all times could be better spent on other service developments. Second, recruitment and retention are major challenges for the psychiatric profession (Storer, 2002) and we compete with other specialties for recruits. A significant attraction of psychiatry has traditionally been its ‘family friendly’ image (Eagles, 1996). The new general practitioner (GP) contract, with GPs no longer obliged to work out of hours, is likely to have significant effects on recruitment and retention in psychiatry. Psychiatry competes with general practice for recruits, and general practice has become much more attractive.