Charles Dixon (Psychiatric Bulletin (Correspondence), November 2004, 28, 426) echoes the sentiments of many psychiatric trainees who have to comply with European Working Time Directive (EWTD) rest requirements. On the one hand reduction in working hours is seen as a welcome modernisation in the life of a junior doctor, on the other hand, at the expense of senior house officer (SHO) training, delegation of tasks traditionally performed by medical staff means that front-line psychiatric practice becomes increasingly multidisciplinary.

The apparent ease with which the SHO has become dispensable from the assessment of the patient in accident and emergency (A&E) must have grave implications for psychiatrists at all levels. Nurse-led teams assessing A&E patients out of hours already call upon the services of the on-call psychiatrist if faced with the possibility of the use of the Mental Health Act 1983, following their initial, often very comprehensive assessment. If there happens to be a medical complication, there are plenty of A&E staff close at hand to give advice.

Psychiatrists, in order to avoid being perceived as supernumerary in the initial screening of the patient presenting to A&E, must ensure they are represented on the teams carrying out these assessments. If the EWTD means that this can only be achieved by implementing a shift system we can see our future, and this is to be supported over and above a reduction of SHOs’ night commitments. Not only is this significant for SHO training, but it is of paramount importance in defining the role of the psychiatrist in the multidisciplinary team.