A former NHS consultant has raised concerns about the erosion of the traditional consultant-led team structure within hospitals, warning that its decline threatens patient care and efficiency. Dr. Mark Durling, who has over four decades of medical experience, highlighted how changes introduced to limit junior doctors’ working hours have inadvertently disrupted continuity of care.

Under the previous "firm" system, a consultant would work consistently with a small group of junior doctors who followed patients throughout their hospital stay, from admission to discharge. This arrangement allowed the medical team to maintain a thorough understanding of each patient’s history, examination findings, and ongoing progress. It also provided junior doctors with the opportunity to learn directly from senior colleagues over time.

However, the introduction of reduced working hours for junior doctors—aimed at preventing fatigue-related errors—has led to increased fragmentation within hospital teams. Patients are now often seen by multiple doctors and shifted between different consultant teams, especially in acute medical services. Each new team must restart the process of gathering histories and performing examinations, which can cause delays in decision-making and raise the risk of missing crucial clinical details, despite the diligence of medical staff.

Dr. Durling also noted a growing reliance on standard investigative protocols rather than prioritizing individualized clinical judgment based on detailed history and physical assessment. He argued that such procedural approaches, while systematic, might undermine medical decision-making that relies on nuanced patient understanding.

While acknowledging the importance of protecting doctors from excessive workloads, Dr. Durling urged the NHS to find a way to preserve the benefits of continuity offered by stable, consultant-led teams. He suggested that maintaining established medical teams who are familiar with their patients could improve both care quality and operational efficiency within hospitals.

The concerns raised underscore ongoing challenges in balancing the demands of modern working-hour regulations with maintaining cohesive patient management in the NHS. Efforts to enhance continuity of care may require structural adjustments to hospital staffing and workflows to better support both patient outcomes and medical education.