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Out-of-hours cover for consultants who do not perform major gynaecological surgery (Safety Alert No. 1)

Published: 09/08/2011

The College receives many enquiries from Fellows and Members seeking guidance on out-of-hours cover for consultants who do not perform gynaecological surgery. This has been discussed by the Safety and Quality Committee which regards this as an important patient safety issue.

Other than the document on the Responsibility of Consultant On-Call, the College does not have a standard policy or recommendation for the provision of out-of-hours cover as it is clear that there is unlikely to be one arrangement that will suit all hospitals.

This is because there is such an enormous variation in the arrangements at different trusts; smaller hospitals may have one consultant to cover obstetrics and gynaecology, while others will have separate obstetric and gynaecology rotas and some even separate obstetric and gynaecology and gynaecological oncology rotas.

There are certainly many consultants who do not perform major gynaecology surgery who are on-call for gynaecology. Local arrangements are obviously necessary for the additional support needed in the rare event of major surgery being needed out of hours, or massive obstetric haemorrhage.

We recommend that a second consultant should be called in if it seems likely that peripartum hysterectomy may be necessary. It is strongly recommended that you read the Healthcare Commission’s report into the maternal deaths at Northwick Park to guide you as to whether you have satisfactory arrangements in place for women with massive obstetric haemorrhage. It makes salutary reading.

We therefore advise Fellows and Members to discuss their local arrangements within their own clinical directorates.