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Group is set up to look at seven day working in the NHS

Authors: Gareth Iacobucci 

Publication date:  20 Dec 2012


Doctors working in the NHS in England will be required to work across seven days a week, under new plans tabled by the NHS Commissioning Board.

Hospital consultants and GPs face having their hours reorganised to give patients the same level of service at weekends as they receive during the week, to bring the health service in line with other sectors.

The proposals, included in the board’s first planning guidance for 2013-14,[1] will initially focus on improving access to diagnostics and urgent and emergency care but could extend to surgery in the future. General practices will be expected to extend their opening hours to weekends as part of the drive.

The BMA warned that the plans, which may require doctors’ contracts to be rewritten to guarantee seven day cover, did not give due consideration to the cost of implementing seven day working. But the guidance said that the move was “essential to offer a much more patient-focused service” and would also “improve clinical outcomes and reduce costs.”

The board’s medical director, Bruce Keogh, will establish a forum of national and local commissioners, service providers, and regulators to identify how to take forward the plans. The forum, which will report in the autumn of 2013, will examine the consequences of the non-availability of clinical services seven days a week and come up with proposals to tackle current deficiencies.

In an interview with the Sunday Times Keogh said that it was no longer acceptable for healthcare to be run for the benefit of doctors rather than patients and that the NHS should follow the lead of private sector companies such as the supermarket chain Tesco.[2]

He asked, “If you wanted a day case operation, and you didn’t want to take a day off work, why can’t you have it on a Saturday or Sunday?

“If you are an elderly person who struggles to get to the hospital, why does your niece, nephew, son or daughter have to take a day or a half day off work to take you to and from the hospital purely for the convenience of the people who are running it?”

He added, “Tesco have had to go through this—it was a complex issue for them.

“As we think this through, we will need to look again at the terms and conditions of service of people — their employment conditions.”

David Nicholson, the NHS Commissioning Board’s chief executive, said, “There are big challenges—not least the financial backdrop—but we must be ambitious. We want to make the NHS the best customer service in the world by doing more to put patients in the driving seat.”

The announcement came after the Academy of Medical Royal Colleges published a paper earlier this month saying that patients in hospital had a right to the same standard of care seven days a week.[3]

Dean Royles, director of NHS Employers, welcomed the move to look at a seven day service. “We want to ensure we have contracts of employment and a reward system that are better aligned to delivering services through the week,” he said.

But the BMA’s chairman of council, Mark Porter, was more cautious, warning, “While we are committed to improving services at weekends and in the evenings, today’s proposals to provide routine NHS procedures seven days a week are too crude and fail to take into account the resources, investment, and flexibility that will be needed to achieve this.”

Richard Thompson, president of the Royal College of Physicians, said, “For some time the RCP has been concerned that acute hospital care at weekends needs to improve.”

But he added, “We believe that to make this aim a reality some services will need to be redesigned and [this] may have resource implications.”

References

  1. NHS Commissioning Board. Everyone counts: planning for patients 2013-14. www.commissioningboard.nhs.uk/everyonecounts.
  2. Templeton SK. NHS will order doctors to work at weekends. Sunday Times  16 Dec 2012. www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1177687.ece.
  3. Iacobucci G. Patients should be reviewed by a consultant once every 24 hours, say royal colleges. BMJ Careers, 5 Dec 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20009964.

Gareth Iacobucci BMJ

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