The article by Simpson and De Silva in the September issue (Psychiatric Bulletin, September 2003, 27, 346-348), outlining two team referral models of multidisciplinary teams (MDT) working in Old Age Psychiatry, was of interest to us, primarily as the debate echoed changes which have occurred within our own service within the past few years. However, we believe that we have moved the service one important step further.

Until August 2002, the Old Age Service in Eastern Hull, a socially deprived urban area, worked largely by the ‘Whitby model’ described in the article. However, despite this model, a large catchment population, high morbidity and referral rates (including many inappropriate ‘ urgent’ referrals), demanding cover arrangements, and the relative clinical isolation resulting from working in scattered community settings, all contributed to sustained stress and low consultant job satisfaction.

In response, the service was remodelled to involve two consultant psychiatrists working closely together. Although one of the consultants takes the lead for a rural population, both have input into urban Eastern Hull and work as integrated members of the MDT. Each has an area of special interest across the whole patch - one consultant deals with hospital liaison, while the other leads the memory clinic and family therapy. Protected time is provided for CPD, personal and service development issues.

The incorporation of this arrangement into MDT working has, we believe, improved the depth and quality of discussion on clinical issues, cover is simple, and consultant job satisfaction has vastly improved. The MDT values the model and we believe that overall service quality has improved. Others may wish to consider similar service innovations.