Statutory role of the duty consultant

Dr Husain (Psychiatric Bulletin, August 2005, 29, 316) makes a very pertinent point in response to my proposal that duty consultants be replaced by telephone advice. Some jurisdictions (most notably England and Wales) may require a face-to-face interview with a senior psychiatrist before a person can be detained. However, the question remains whether or not such interviews contribute anything which could not have been achieved by other means. By making ourselves available 24 h a day, are we not, as a profession, effectively saying that we believe this to be clinically necessary? Legislators have responded to this perceived necessity but in doing so have paradoxically created the potential for the scenario described by Dr Husain, of urgent patient care being delayed. We have created a statutory demand for our services which is based on traditional working practices (prior to the revolutionary changes in telecommunications and mental health nursing), rather than on a rational appraisal of how best to utilise scarce resources and optimise patient care.