title: Service contribution and cost-effectiveness of specialist registrars in NHS trusts: a survey and costing analysis.
abstract: Since the introduction of the European Working Time Directive, specialist registrars arguably contribute less to clinical service. The purpose of this study was to broadly quantify the service contribution of specialist registrars across a range of specialties and their value to an NHS organisation. A questionnaire-based survey of the clinical activities of specialist registrars in a large NHS trust was undertaken. Simple costing analyses of this -clinical activity were performed. Responses from 66 specialist registrars in 24 specialties showed an average of 51% overall clinical autonomy. Trainees attended an average of 2.7 outpatient clinics per week and spent 3.5 sessions a week doing ward work. Medical trainees took more referrals and attended more clinics. An analysis of costings suggested that surgical trainees might have generated around £700,000 income per year for the trust. Overall, specialist registrars make a substantial contribution to NHS clinical service and are cost-effective.
authors.affiliation: Department of Radiology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Derfel Ap
authors.initials: DA
authors.lastname: Dafydd
authors.affiliation: Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Aroon
authors.initials: A
authors.lastname: Baskaradas
authors.affiliation: Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Bobdiwala
authors.affiliation: Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Muhammad Saleem
authors.initials: MS
authors.lastname: Anwar
authors.affiliation: Department of Postgraduate Medical Education, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Abrahams
authors.affiliation: Department of Renal Medicine, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Levy
authors.initials: L
authors.lastname: Jeremy
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008505:Medical Staff, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: European Working Time Directive; Training; clinical supervision; cost-effectiveness,; productivity; service provision