title: A review of the job satisfaction and current practice of consultant diabetologists in England--barriers and successes.
abstract: OBJECTIVE
  The project aimed to describe the perceptions of consultant diabetologists about their work, explore models of care, identify problem areas, consider potential solutions, and outline strategic issues for retention and recruitment.
  
  
  METHODS
  The study was based on semistructured qualitative interviews with 92 consultant diabetologists, recruited via a purposive sample. Interviews were recorded, transcribed and anonymized, and analysed by the project team, assisted by QSR Nvivo software.
  
  
  RESULTS
  The consultant diabetologist role encompasses a diversity of skills/expertise, with differing emphases between individuals. Integration with general medicine is seen by some as crucial to maintaining proficiency in diabetes, and by others as hindering fulfilment of other roles. Successful team working across organizational boundaries is recognized as essential to effective services, but often impeded by the continuous reorganization and competitive culture of the National Health Service. Significant differences between consultant diabetologist perspectives of primary care colleagues and of primary care trusts emerged. Some consultants have adopted innovative working approaches, adapting national guidance to local environments, but there is general resistance to adopting centrally imposed solutions. Training programmes are not sufficiently explicit about the core skills/attributes required of consultant diabetologists.
  
  
  CONCLUSIONS
  The skills of specialist teams are not fully exploited. Competing calls on time could be addressed by encouraging multifaceted consultant teams, allowing individuals to concentrate in specific areas. Clear definition of core skills required by consultant diabetologists underpins training programme development. Collaboration in cross-boundary services reflecting local needs is impeded by competition between sectors. Protected time is necessary for cultivating multidisciplinary teams, cross-boundary partnerships and effective, relevant education programmes. Specialist training must reflect the changing role of consultant diabetologists, and include role-specific programmes.
authors.affiliation: Royal Devon and Exeter NHS Foundation Hospital, Exeter, UK. kenneth.macleod@pms.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Macleod
authors.forename: M
authors.initials: M
authors.lastname: Carter
authors.forename: A
authors.initials: A
authors.lastname: Asprey
authors.forename: N
authors.initials: N
authors.lastname: Britten
authors.forename: J
authors.initials: J
authors.lastname: Dean
authors.forename: R
authors.initials: R
authors.lastname: Hillson
authors.forename: A
authors.initials: A
authors.lastname: Mackie
authors.forename: N
authors.initials: N
authors.lastname: Morrish
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003253:Consultants; D003920:Diabetes Mellitus / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D013222:State Medicine / Q000592:standards