Mr K W Dunn
Consultant Burns and Plastic Surgeon,
Burn Centre, Acute Block,
South Manchester University Hospital Trust,
Southmoor Road ,
Wythenshawe M23 9LT.
I currently work as a Consultant Burns and Plastic Surgeon, in the Manchester Burns Service. I qualified in 1984, completed the Fellowship in general surgery in 1988 and entered plastic surgery in 1989, as a SHO at East Grinstead leaving behind a registrar job in general surgery. I eventually became a senior registrar in Manchester in 1993, passing the FRCS part 3 in 1995 and gaining my consultancy in January 1996.
I am currently Clinical Director of the burns and plastic surgery service for Manchester and work primarily as an adult burns surgeon, with responsibilities to the paediatric service. I work in the pan-Manchester burns on-call rota on a 1 in 3, with my two colleagues, Miss Mamta Shah and Mr Peter Davenport where we do one week on and two weeks off call. The Manchester burns service is one of only three services nationally that offer this level of burn surgeon availability, 24 hours a day.
In my working week, I perform three burn lists, 2 adult and 1 paediatric and two adult burn ward rounds. The one at the beginning of the week is multidisciplinary, with all members of the adult burn team. I undertake one burns outpatient clinic per week, in conjunction with the adult burns service outreach team. I have a plastic surgery commitment on top of the burn surgery workload, there being no alteration to the work pattern of job plans during the weeks that we are on call.
The professional attraction of burns surgery is that primarily it is a relatively new specialty, very much in the throws of development and expansion. There are many unanswered questions in burn care generally, so it is difficult not to come up with clinically relevant research questions in day to day practice. As the evidence base for much of current practice is weak, it is still possible to make major contributions to the way burns services deliver care, without the need for major research grants, academic infra-structure or having to dwell upon some esoteric aspect of a rare condition that few people ever see.
Disadvantages include the fact that burn care is a totally trauma driven service and thus entirely unpredictable. The patients are perhaps some of the sickest trauma victims one might be called to care for, which is very time consuming and stressful. The on call arrangements typically take no account of these facts and the NHS expectation is that a full working week is done outside the burns care service requirements. However, there is a clear recognition of the need to change. Services can be contributed to and moulded by an interested individual, particularly if they are keen on team working and particularly if they do not have an overwhelming belief in their own infallibility or indispensability as burn injury patients have a knack for being unpredicatable.