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Sir, I would like to address a few of the points raised by Miss Kanoun in her recent letter (BDJ 2018; 224: 665) regarding the effect of the new junior doctors' contract and hospital at night system on dental core trainees (DCTs).
Having worked in two rather different maxillofacial units, both with no out-of-hours (OOH) DCT cover, I've found that the current system actually works rather well. On one occasion I worked a night shift, I was contacted only once at 3 am regarding a patient who could 'feel his nasogastric tube in his throat' and 'can you request a chest X-ray'. Suffice to say this wasn't a sensible or welcome call and demonstrates that many units actually have very little OOH OMFS activity. These units have adopted daily urgent clinics in order to address the lack of OOH DCT cover. Properly used and implemented, these can be highly effective ways of providing non-emergency care within the competence of a DCT.1
The cover by consultants and second on-call middle grades remains unchanged. The latter being available to call for advice by the night doctor and both being appropriately reimbursed for this. If the night doctors are properly inducted into OMFS and assured they will not be ridiculed or made to feel a burden by calling the second on-call, there is no reason that inappropriate admissions or hospital transfers should occur. In fact most night doctors I've encountered feel completely the opposite and refuse to mistakenly assume the correct management, when they know an off-site second on-call is being paid for that exact role.
Having DCTs overnight in all but the busiest centres is neither financially prudent nor educationally beneficial. The rota must either take DCTs from daytime theatres and clinics, where learning and training is supervised and highly efficient, or recruit even more DCTs (which would require lowering the entry standards), thus taking even more dentists from the underfunded primary care sector. All this in order to plug a costly part of the rota with low efficiency, unsupervised 'training' at greater cost to the NHS.
Long gone are the days of the 84-hour-week OMFS SHO on the 1-in-2 rota, and I would say this is a welcome change. Many are quite happy and secure with our career choices without having to experience 'life as a proper doctor'. DCT training is already sufficiently disruptive to personal lives in terms of yearly reapplication, OOH work, and the implications of moving post every 6-12 months; without also working nights which are shown to be nothing but harmful to the health of doctors2 and patients.3 I suspect many would much rather have our sacred EWTD (European Working Time Directive) 48 hours per week spent in theatre or clinic, experiencing one-to-one, hands-on teaching, rather than coming to the ward at 3 am to reassure both patient and nurse that their NG tube is meant to be in their throat and doesn't possess the sentience to perform intra-oesophageal somersaults and tracheal abseiling.
References
Abou-Foul A K, Shah N P, Mirza J, Anand P . Cross-cover of oral and maxillofacial surgery out-of-hours: an audit of a new adult treatment clinic. Br J Oral Maxillofac Surg 2016; 54: 868–871.
Harrington J M . Health effects of shift work and extended hours of work. Occup Environ Med 2001; 58: 68–72.
Postgraduate Medical Education and Training Board. National Training Surveys 2008-2009, Key findings. 2008. Available online at https://www.gmc-uk.org/-/media/documents/National_Training_Surveys_2008_09_20090929.pdf_30512348.pdf (accessed 9 July 2018).
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White, J. Working patterns: Out of hours provision. Br Dent J 225, 93–94 (2018). https://doi.org/10.1038/sj.bdj.2018.594
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DOI: https://doi.org/10.1038/sj.bdj.2018.594
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