Medical staffing in paediatric departments in district general hospitals.

In 1978 the Manpower Economic Review established by the Doctors and Dentists Review Body identified paediatricians as one of the hardest working groups of consultants with the highest rate of recall back to hospital out of hours. Now, nine years later, the situation has deteriorated considerably because the workload within many paediatric departments has continued to increase without any significant improvement in medical staff levels. This increase in workload includes inpatient admissions, the increasing intensity of neonatal care, and the greater recognition of physical and sexual abuse of children. Figures published by Her Majesty's Stationery Office show that deaths and discharges for paediatric units in England and Wales increased by 42-5% during the 11 years, 1974-1984.1 During the same period the increases for general medicine and for general surgery were 21% and 2-7%, respectively. There has been no significant change in birth rate over recent years but the intensity of care provided by neonatal departments is continuing to increase at a tremendous rate. For example, in the Northern Region during 1978, 50 newborn infants received assisted ventilation. By 1985 the number had increased to 375, an increase of 650%. Hospital inpatient paediatrics and neonatal care is undoubtedly an acute specialty. It should therefore have adequate levels of consultants and experienced junior medical staff to provide an adequate and safe service. In many districts this is clearly not so. For example, within the Northern Region eight out of 16 health districts have no established registrar posts within their paediatric department. Junior medical staff cover is therefore almost totally provided by senior house officers who have no previous postgraduate experience of paediatrics and particularly of neonatology. Many of these doctors are training for careers in general practice where experience in hospital neonatal care is largely irrelevant. Within these same districts comparison with other specialties can show dramatic differences. For example, within my own district, Gateshead, the paediatric department has an established medical staff of 2-7 consultants and three senior house officers, all with no previous postgraduate paediatric experience. The combined general and geriatric medical unit has six consultants, four registrars, and 10 experienced senior house officers, and the general surgical unit has four consultants, three registrars, and four senior house officers who have had previous surgical experience. The paediatric unit is the only clinical and non-clinical unit in the district that has no established registrar cover.