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Patients deserve better out-of-hours care

For many years now the Royal College of Physicians has been working to improve acute care in hospitals, from creating the specialty of acute medicine to producing two major reports.

As a result, there have been major improvements in the organisation of acute care, but there is mounting evidence of poor care being delivered at night and at weekends, particularly the recent NCEPOD reports.

It is clear we need to do something extra to increase the amount of care delivered by consultant physicians.

Last week the RCP council agreed to recommend for the first time that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week, who should have no other duties scheduled during this time. All medical wards should have a daily visit from a consultant; in most hospitals this will involve more than one physician.

We know that doctors are already working long hours – our latest census results say an average of 50 hours a week, which is four and a half hours more than their contract. More than half of those surveyed were working longer than the 48-hour limit set by the European Working Time Directive.

We are not expecting anyone to work longer than that, nor to increase their hours overall, instead we need to change job plans to reflect the different working patterns, which must include arrangements to ensure adequate rest.

The Department of Health are also considering policy in this area, and I have asked health secretary Andrew Lansley for a meeting to discuss the issue.

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7 Responses to “Patients deserve better out-of-hours care”

  1. Malcolm Morrison says:

    Hurrah! Ever since ‘job plans’ were introduced, I have argued that the first consideration of any hospital (and department) is the ‘cover’ for emergencies. Thus, the first thing to be decided in a job plan is the amount of time (or PA’s) that MUST be devoted to this. Only after this has been agreed can one see how much ‘time’ is available for other activities.
    But, of course, this would cost more money! Emergencies are not ‘sexy’ (like waiting times and numbers of operations) so ‘the powers that be’ do not see them warranting such expenditure – they do not see it as ‘cost-effective’ or ‘value for money’.
    Wait till one of them has a heart attack, fracture, or billiary colic!

  2. chrissa says:

    add to all this that the art of the appropriate referral by gp’s seems to be dying out as “just dump the patients on a&e” has become customary over the last decade …

  3. DoctorMonkey says:

    But who will do the work generated by the Consultants?

    Too few juniors (and even fewer interested as medical SHO rotas are filled with GP trainees and F2s) and no Nurse Practitioners would lower themselves to such work and many existing consultants seem incapable of doing their own work after generating it

    This is a problem of only looking at one part of the problem: if we had more doctors around that too would make life easier regardless of their grade

  4. chrissa says:

    new consultant jobs will be nothing like the traditional ones. new consultants will be trust doctors / staff grades in all but name – they will jolly well have to do their own donkey work as there will be no-one else to do it. the inflation of consultant numbers is at the heart of the loss of their status. that is what they mean by the “consultant lead service” – what else would anyone need these hugely increased consultant numbers for? how this could not have been obvious to everyone right from the start stuns me.

  5. DoctorMonkey says:

    I fail to see that much of a problem: consultants cannulate in radiology and endoscopy, they fill in request forms in clinic. All we are saying is that when they have sufficient time dedicated to inpatients they may do things there too.

  6. chrissa says:

    no problem at all dear doctor monekey – at least for those who accept that their job profile will basically be that of a registrar for all their careers in all but name. however those who underwent all the hoop jumping in order to get their cct in the hope of being a “traditional consultant” at the end of their training, those may, just may feel like having been cheated – but i may be wrong. true altruists are happy to just serve, no matter the conditions …

  7. jaz says:

    I think it makes a lot of sense. I just hope they don’t expect me to do it.

    Trainees in acute medicine are trained to do this sort of stuff, chose it, and actually enjoy it, so lets hope they increase acute medicine consultant numbers, and not rely on existing nephrologists, cardiologists, rheumatologists, endocrinologists (aka general physicians) to do this stuff.

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