Woodall et al (Psychiatric Bulletin, June 2006, 30, 220–222) describe how the introduction of nurse-led liaison services has left senior house officers (SHOs) with little to do on call. Senior house officers are left with routine ward work while nurses become skilled at emergency psychiatric assessment. The original purpose of the changes was to leave some of the simpler tasks to nurses, freeing the SHOs to carry out work traditionally considered to require a doctor. The pendulum has now swung too far, with specialist nurses taking over increasing amounts of doctors’ work.

These changes resulted from the implementation of the European Working Time Directive after vociferous protest by earlier generations of SHOs over poor pay and excessive working hours. The government, for financial reasons, was happy to heed these protests and has implemented these changes at a time when the length of postgraduate training is being reduced by the Modernising Medical Careers initiative.

The remedies proposed by Woodall et al are primarily bureaucratic and will take valuable time to implement. A more prompt and practical remedy would be for SHOs to return to where they belong, in the acute clinical front line, alongside their specialist nursing colleagues. Evaluation of the efforts of both, using audit systems already in place, would provide a useful opportunity to test the fundamental and as yet unanswered question that lies behind the current changes: do doctors have more to offer than nurses in the assessment and management of acute psychiatric emergencies?