The general prospects for consultant posts in psychotherapy are mixed. Despite frequent recommendations, it is not an area which is generally undergoing expansion and the development of posts varies across the country.

The Liverpool training scheme in psychiatry began in August 1985 and at the time of writing is five years old. During this time 73 trainees have left the scheme; some having completed four years training in psychiatry, some completing a much shorter time. We thought, therefore, that it would be interesting to consider the posts trainees took on leaving.

Recent years have seen a steady move from a hospital based psychiatric service into a community orientated one. Mental health carers and psychiatrists need to be trained in order to be able to meet the changing demands placed upon them (Lancet, 1985).

It is interesting to observe just how much (or little) psychiatric services adapt to changing circumstances. The progressive move to community care, with the resettlement of seriously ill patients outside hospital and the avoidance of admission for many acutely ill patients, has shifted the focus of the psychiatric team away from its traditional institutional base – or rather the focus should have shifted. Yet it is probable that many psychiatrists, while paying lip service to the needs of patients in the community, have not altered their weekly routine. Hospitals, and the security they represent, retain their magnetic attraction for many staff. But with the growing number of out-patients and chronically disabled patients being supported by team members outside hospital, how should the multidisciplinary team respond?