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“Support extended consultant delivered services”

A leaked NHS London report suggests that over 500 deaths a year in London could be prevented if consultant cover was increased at weekends.

Sir Richard Thompson, president of the Royal College of Physicians, commented on the report in a letter published in The Independent.

Here is that letter in full:

Dear Sir,

Your article ‘Hospital staff shortages cause 500 deaths a year’ shows too few junior doctors are caring for too many patients over night and at the weekend. Patients who are admitted to hospital in the evening and at the weekend risk receiving sub-standard care.

Despite the best efforts of consultants who work above their contracted hours, patients are not getting sufficient input to their care from senior doctors during these periods. The supervision and training of junior doctors is also adversely affected by a lack of senior input during these periods. More doctors are required to provide this high level service.

The Royal College of Physicians believes that there is an urgent need to review workforce patterns in hospitals to ensure that medical in-patients receive direct input from consultant physicians on a seven day a week basis.

We previously issued guidance for physicians caring for very sick patients. Hospitals admitting acutely ill medical patients should have a consultant physician on-site for at least 12 hours per day, seven days per week, at times related to peak admissions. Consultants should have no other duties during this period.

We can begin now by reconfiguring acute services. Concentrating specialist services in centres of excellence will improve standards and help to provide a consultant delivered service.

Furthermore, junior doctors’ contract, the New Deal, and the European Working Time Directive must be renegotiated to provide more local flexibility when designing staff rotas in hospitals.

The RCP calls on the government to take urgent action to ensure that extended consultant delivered services – providing safer care for patients and the opportunity for excellent training of the next generation of doctors – can be achieved.

Yours faithfully

Sir Richard Thompson


Royal College of Physicians

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6 Responses to ““Support extended consultant delivered services””

  1. Malcolm Morrison says:

    Well said, Sir Richard! But it is not only MEDICAL patients who need proper care from senior doctors!
    retired Orthopod

  2. Andrea Franks says:

    Maybe you could mention this to Mr Crisp who recently advocated getting rid of a lot of hospital doctors and replacing them by nurses.

  3. marcus says:

    Deliberately leaked document to further pressure hospital consultants..There is a timebomb building up in internal medicine which RCP choose to ignore . There is zero interest in training in internal medicine and who can blame the juniors when work increases not decreases as you become a consultant, returning to the type of work you used to do as SHO,REG. You can be a GP with less training at least equal or better salary and no on-calls . It’s a no brainer . Why would anyone with half a brain choose a career in internal medicine?

  4. Old school says:

    Dah, what did you think would happen when the working hours were reduced, shift system was introduced and the time taken to become a consultant was reduced

  5. Supersub says:

    I think Marcus has it spot on. I’d be surprised if Sir Richard Thompson is volunteering for the nightshift.

    His argument for all patients being managed by consultants is fairly spurious, not least because lack of medical consultant involvement is not the only difference between daytime and night time working – you’ve got the whole range of non-medical disciplines, higher nursing numbers, investigations etc during the day.

    The RCP would be better off arguing for acute admissions being admitted under appropriate specialist teams rather than keep propagating the jobbing “all-rounder” general physician – now that’s something that really is proven to affect outcomes.

  6. marcus says:

    Supersub…the way its set up junior doctor training very poor ..no longer expected to make any decisions ..supposed to be getting training by watching consultants ..it’s laughable. They tried to copy US system completing ignoring fact that US internists would never admit 30 -50 plus patients on medical take, max would be 10 then you would discuss each case with resident and how to treat. Whereas in UK it’s an acknowledged fact that training comes a long way second to service. The acute medicine job is not one you could do for longer than 5 yrs as you would just burn out Problem is the people responsible Alberti et al never actually see any patients so they haven’t a clue

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