INTRODUCTIONThe management of an efficient acute surgical service with conflicting pressures of managing elective and emergency work, compounded by waiting list targets and the maximum 4-h wait for patients in accident and emergency poses a significant challenge. We assess the impact of appointing a dedicated emergency surgeon on the delivery of our emergency surgery service. There was a significant increase in daytime operating from 57% in 2004 to 74% in 2005 (P < 0.001) and a significant increase in consultant-supervised operations from 14% to 52% (P < 0.001), with a consequent fall in out-of-hours operating (43% to 26%; P < 0.001). In addition, there was a significant increase in early (within 48 h) discharges from 41% to 53% (P < 0.001). The salary of the new appointment is more than offset by the quantifiable savings of approximately £90,000 per annum based on the increased proportion of earlier discharges alone as well as the improved quality of care provided.CONCLUSIONS The appointment of a dedicated emergency surgery consultant has resulted in an increase in day-time consultantsupervised operating, shorter hospital stay for emergency admissions, improved training for surgical trainees, as well as providing potential financial savings for the trust.

In October 2003 the British Medical Association (BMA) announced that 60.7% of consultants in England had voted in favour of the new consultant contract; since that time the option of taking up the new contract has been available. The basis of the new contract is a job plan with ten programmed activities (PAs) of four hours each (three hours in premium time). These may be divided into the following categories: direct clinical care, supporting professional activities (SPAs), additional NHS responsibilities and external duties.