Faced with growing pressures due to middle-grade rota gaps, many units have introduced resident consultant working out-of-hours.
In some units this has been successful, but in others newly appointed consultants have felt undervalued, resentful and disillusioned. In order to maintain a safe service, some resident consultant working will probably be necessary in most units.
The RCOG’s 2016 report Providing Quality Care for Women: Obstetrics and Gynaecology Workforce (PDF) set out recommendations to support resident consultant working as part of the solution to rota gaps.
For resident consultant roles to be successful, they must be professionally satisfying with opportunities and support equal to non-resident roles. An RCOG survey of resident consultants in 2015 highlighted the importance of a predictable work pattern, a defined case-load, opportunities for professional development and the sharing of clinical and managerial consultant responsibilities in the development of a successful resident post. A job plan allowing for improved work life balance was deemed essential. The requirement for all or most consultants to contribute in some way to resident out-of-hours work was also viewed positively; this did not need to be overnight, but could be out-of-hours work in the evenings or during the day at weekends.
In the past, recommendations have been made about the amount of resident consultant presence required for units with various numbers of deliveries. It is now accepted that these figures did not take into account all the necessary evidence. The emphasis should now be placed on providing safe care for women 24/7, and having the appropriate number of doctors with the appropriate skills available. Each individual unit should decide the best way for them to provide this care, based on their knowledge of their workload and case mix. However, in view of the significant rota gap issue it is likely that in many units this will involve some resident consultant working.