Dr Hampson must be congratulated for the very real achievement of modernising her job plan (Psychiatric Bulletin, August 2003, 27, 309-311). It is surely right to maximise the efficient use of consultant time by excluding routine tasks that can be safely delegated. I wonder however if the new job plan might not be even more stressful for the consultant than before.

My reservation is around the area of ‘supervision’ of other disciplines and the role of advisor to GPs, a role that involves ‘ hearing about patients’ rather than seeing them.

The processes for communicating a clinical problem involve presenting a short summary of the patient, usually verbally, lasting maybe 5 minutes. It is similar perhaps to the ‘elevator pitch’ used in the film industry to outline a movie proposal to a prospective producer.

Listening to the elevator pitch is wearing for the recipient (particularly if the metaphorical elevator is a slow one or seems to belong to an unusually tall building). The effect is similar to a PMP exam, where a series of hypothetical problems is laid before the candidate.

Many of the telephone and verbal vignettes may be risk reduction transactions rather than genuine requests for advice. As such they are more likely to be generated by less confident or skilled practitioners, who are also less likely to be proficient at summarising key points. In the new way of working the consultant may increasingly serve as a risk depository. Am I alone in finding delegated working more stressful than direct patient contact?