The Pleasures and Pitfalls of Life as a New Consultant – an Anecdotal Review Part 2

My first 18 months

Following my appointment, I began to work for my new Trust in January 2016. My initial job plan was split between our main unit at Queen's Medical Centre, Nottingham and re-establishing a satellite service at Kingsmill Hospital in Mansfield. At our main unit, I could learn how the hospital worked from my consultant colleague who has worked there for many years. In hindsight, this allowed me to concentrate on setting up our peripheral unit in good time, whilst slowly easing into the consultant role at Queen's. Despite mentioning on more than one occasion that I was left-handed, this appeared to come as a shock to the management when I arrived. As part of my arrangement to begin work at the Trust, I negotiated some new essential equipment and images and orthodontic planning software to be installed, and for a new dental chair and unit (Figures 1 and 2).

The first two items of my list were reasonably easy to source and obtain as long as I was organized and chased things up. Installation of a new chair, however, was a different matter. It took far longer than expected (over 6 months!) to get all the necessary checks and balances completed in the NHS. It also required a 4-week shutdown of the department. I write this in an effort to suggest to future budding hospital consultants that, if you intend major work or renovation on your unit, you really need to overestimate the time it should take. The plethora of departments that need to be involved when undertaking work of this nature was immense. Estates, building surveyors, tendering department, health and safely, infection control, cleaning to name just a few. My new unit should now, hopefully, see me through my career, although I do wonder how we will deal with the other three units when they need replacement. My advice, in the event of a complete service shutdown, is to do as much as possible in one go to prevent future disruption.

Restarting a previously closed unit provided its own challenges. I was fortunate to find myself with an effective and motivated pair of dental nurses who were keen to rebuild the service. At this unit, I was met by patients who had previously not completed treatment for a multitude of reasons. I am not ashamed to say I didn't have all the answers for every case of this nature. I enlisted senior consultants for advice and contacted my defence union to ensure that I was handling these transfer cases appropriately, keeping the patients' best interests at the heart of any decision made.

As a younger consultant, I was keen to provide some teaching in the local area and ensure that our unit has a reputation for providing good quality care. I made some contact with the local deanery and dental groups early, offering to provide some additional training at FD and GDP level. To date, I have run three courses this year which have, hopefully, raised the profile of the unit for the coming years (Figure 3).

I also managed to get a website for our department up and online, to provide some patient and referrer information to interested parties. Again, this took longer than expected and I anticipate to update and the website in the coming years. However, at least our department has a digital footprint to promote our work and allow patients to review department information online before attending for consultation (Figure 4).

When I started at the unit, I spent time assessing the throughput of patients. When I initially started, we had a number of patients waiting for assessment and some lists were overloaded with patients in treatment. This was causing some patients to complain, and some members of staff to become demotivated. I therefore approached my clinical lead and consultant colleague and we put a plan in place to train orthodontic therapists. A business case was constructed to show how the costs of training would be recouped and how diversification of the workforce would have benefits in the longer term. It was hoped that, by incorporating these new members into our team, we would cut new patient waiting lists and improve the throughput of patients in treatment. Consultant time could be freed up for complex work or treatment planning whilst routine procedures could be carried out by the therapists. It required a lot of extra hours at the computer, endless emails and meetings, but we managed to obtain funding for two orthodontic therapists. Diane and Mehreen are currently training via the Leeds Orthodontic Therapy programme, but their practical skills will be taught in house (Figure 5) There is a lot of water to go under the bridge before we can show this idea has borne fruit but, 3 months in, things are looking promising and I feel our new team members have reinvigorated the department.

The final project I set for myself was to sell orthodontic oral hygiene products. (Figure 6). This required me to present another business case to the management. Throughout my training, the units I worked at had this system in place but it was not established at Nottingham. ‘Selling’ of any product in the NHS must go through management, finance and diversional leadership teams before approval. Money handling is also something the NHS is sensitive about. For example, a previous unit I worked at delayed the rolling out of oral hygiene sales due to a reluctance of staff to handle money?! Treating patients is OK, but money … out of the question!

Building upon this previous experience, I assessed what systems were already in place. Our radiology department has a card machine for payments and cash payments can be taken, a little further away at a general office. Ideally, I wanted our reception area to have a card reader, but this would have cost additional funds to run and would have required training members of staff. In this case, I went with the path of least resistance, in terms of payments, to obtain approval for the purchasing of stock. If sales take off, the card reader can then be argued as a way of making a good idea work more efficiently for patients and its costs will already be covered. The revenue is ring-fenced within the department to order more stock and clinically necessary equipment in the future as money grows in the account.

These projects highlighted are my personal achievements, and part of my 5-year plan I set myself when I arrived. By setting yourself targets, and checking on them regularly, you will give yourself the chance of achieving the goals you set. They are in addition to the role I have in providing advice and treatment for complex orthodontic problems. The learning curve is steep in the early months. The ISFE exam occasionally looks like paradise compared to real life. Transfers, complaints, surgery dates, endless emails, they all take time to answer … sometimes when you don't initially know the right answer.

The opinion of others

Apart from providing my own meandering insight in the first 18 months as a consultant, I thought it appropriate for readers to hear the viewpoints of other newly appointed consultants. I recently asked my consultant cohort to comment freely on their first years as the big boss. In order to give you a full flavour of the pros and cons of their experience, their place of work and names have been redacted. Here is a selection of their pros and cons of the job….