Freeman Hospital, Newcastle
One of the key distinctions between the models is whether non-medical practitioners are integrated into the junior doctor medical rota or have their own separate rota. The latter arrangement was more common across the case study sites, but at the Freeman Hospital in Newcastle the junior doctor medical rota for cardiothoracic surgery comprises ten surgical nurse practitioners and two core trainees. As a small specialty, cardiothoracic surgery will always find it difficult to staff an acute out-of-hours rota 24/7 with junior doctors. The hospital had responded by employing nurse practitioners to fill 10 of the 12 slots on the on-call rota. The two doctors in core training who fill the other two slots are effectively supernumerary, other than their on-call commitments, which amount to 14 shifts on the ward during a 4-month rotation. This was designed to ensure that doctors in core training gained exposure to ward management tasks, while at the same time increasing their opportunity to attend theatre and clinics.
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