Staying organised and overcoming challenges as a new NHS Consultant: A view from two paedipods

By Adelle Fishlock^a and John Davies^a
a Consultant Paediatric Orthopaedic Surgeon at Leeds Children's Hospital

Perspective of Adelle Fishlock:

As a senior trainee I always thought there was an amazing person in the background making sure that everything ran to plan; kit was ordered, physios were kept up dated, clinics were adjusted as required and theatre lists were planned efficiently. However, during my first few weeks as a consultant I soon realised that ‘amazing’ person was in fact meant to be me! It quickly became clear that I needed to be much more organised to deal with the barrage of emails, requests and meetings that were required of me.

I had always considered myself to be an organised person, but I was going to have to up my game. This is how I am now able to manage my time more efficiently and ensure I keep up to date with my emails (most of the time!!)

Have a set time where you answer the majority of your emails. I have an admin session on a Monday morning and I will spend this time uninterrupted answering all my emails. I try to check my emails once per day and only answer anything urgent immediately, everything else can wait and have my full attention on Monday morning.

Ask your secretary to send you one email per day with all non-urgent messages. This is much easier to manage than receiving lots of ‘little’ messages or tasks throughout the day. I also ask that I am called about anything urgent, this means I can often deal with the issue there and then, rather than a multitude of emails to and fro.

Delegate appropriate roles. Now this is the one that I found most difficult in my first 12-18 months as a consultant, but it is vital. Organisation of theatre lists and kit is an important skill for trainees to develop, this is part of their training. When appropriate I delegate this to my trainee, with my support. This empowers then to think about planning and ensures that patients and theatre staff are appropriately prepared for upcoming cases.

On a personal note, if you have any significant others in your life ensure you have a joint calendar, where everything is updated in real time. You don’t want the dreaded call at 15.30, saying that no one has arrived to pick the children up (we have all been there), when you are half way though a difficult operation or clinic.

Lastly, and probably most importantly, ask for help. If you are struggling seek out a colleague who can help and guide you. The transition to consultant can be a really challenging time, but also a really exciting time. Surround yourself with a supportive team and never be afraid to ask for help.

I have found that these simple adjustments and modifications have worked for me, but everyone is different. Find what works for you, but most importantly do ask for help during the challenging times and remember, no one really likes a one-man-band.

Perspective of John Davies:

Becoming a new consultant in the NHS is more demanding than ever. I started as a consultant in Hull Teaching Hospitals in 2018 and then moved to Leeds in 2020 just before the COVID-19 pandemic struck. Mentorship is the most important thing to emphasise to anyone starting consultant practice; and I was extremely fortunate to have amazing mentors in Verne Johnson and Sally Hobson who were both in Hull when I first joined. Much of their advice, practices and valuable life lessons I still use to this day. I recall when I had my first job planning meeting with the Clinical Lead and Business Manager in Hull, Verne was also in the room, and whilst I sat in almost complete silence oblivious to how Programmed Activities (PAs) equated to my actual timetable, Verne negotiated on my behalf to ensure all my activities and sessions were fairly recognised.

Clinical practice varies considerably depending upon the setup of a particular department and whether you are LTFT or have other additional roles and responsibilities. The ethos and culture of a department impacts on your own working practices and how you organise your time. As a group of paediatric orthopaedic consultants in Leeds, we are a small clique with our own separate business meetings, as well as audit and governance. This means we have a greater voice amongst ourselves to dictate what happens and respond to mistakes and adverse events. In comparison, being an individual consultant in a large department there can be a tendency for certain opinions to monopolise the discourse and you feel like a face in the crowd. There are also down sides to this separate existence such as our 1:6 rota, which is far more onerous compared to the 1:16 on-call I previously did in Hull. One important factor in team working is office arrangements and who we sit with (Figure 1). Working more closely together means that dealing with referrals, handovers and planning complex dual consultant cases are often easier to arrange.

Figure 1: LGI Paediatric Orthopaedic Office. Desk setup for A Fishlock and J Davies (also not shown Mr Sabouni and Ms Laura Deriu’s desks occupying same office). Whilst four in an office is busy, clinical advice is easily accessible from colleagues.

Outside of clinical work, admin and email correspondence contributes to much of how our time is spent and the first rule is to know thyself and how you deal with enquiries. Scheduling time every week or daily works best to minimise the consequences of this on your personal life. Some colleagues can completely relax during their annual leave and remain unphased to come back to an inbox of several hundred unopened emails. A tip from a friendly arthroplasty consultant is to plan an extra day of leave to deal with tasks, rather than going straight back into a normal workday. Most trust email accounts use Microsoft outlook, and it’s worth considering whether you prefer the web-based version or the actual outlook application itself which has more customisable options. One advantage of being in a unit with an Honorary Lectureship at a University as part of your NHS contract is that you can access Edurom wifi which is often more reliable; and it also entitles you to University facilities such as their Microsoft office licence rather than having to purchase a separate home licence. If using a Mac as a personal computer at home is supported by your Trust IT systems, it is a worthwhile investment to reduce eye strain (Figure 2).

Figure 2: Most Trust PCs due to budgetary constraints utilise conventional displays with lower pixel density. Patient Pathway Manager (PPM+) is a web based EHR accessible outside of the Trust and is supported on Macs with a Retina display and higher pixel density.

Overall teamwork and help from your colleagues can make the crucial difference between being overloaded and thriving in the midst of a challenging environment. A senior neurosurgeon in Leeds Mr Atul Tiyagi operating in the theatre next door made an astute recommendation for difficult brain surgery cases “if you have the opportunity to operate with another consultant doing a case, always take that opportunity it makes your life so much easier” and I completely agree with this.