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Hunt calls for US-style ‘whole stay doctors’

The Health Secretary has decried the lack of continuity of care for patients and has called for the development of ‘whole stay doctors’.

In a recent speech, Jeremy Hunt cited a Royal College of Physicians survey which found that nearly a quarter of consultant physicians rated their hospital’s ability to deliver continuity of care as either poor or very poor.

He said recent conversations with frontline doctors had revealed descriptions of “episodic care” with “stable teams undermined by shift work” and the EWTR.

“All [the doctors] agreed on the need to rediscover teamwork. Continuity of teams matters as much as continuity of care – in fact they are one and the same thing,” the health secretary said.

Hunt’s solution is to introduce US-style hospitalists or whole stay doctors.

He described them as doctors not just responsible for dealing with the main cause of a patient’s admission, “but someone with an overview of the whole case, someone accountable for an entire in-patient care plan, and someone who makes sure there is a proper handover to a named, accountable GP on discharge”.

The Health Secretary said whole stay doctors would reduce lengthy stays and costs, and cited a US study that showed the presence of hospitalists was associated with lower probability of readmission for heart failure, acute myocardial infarction and pneumonia.

He has asked the Academy of Royal Medical Colleges to develop guidance to support hospitals to take it forward, which will be published in March.

Hunt also called for doctors to be better trained in general medicine.

“All doctors need to be generalists to a certain degree in order to make sure a person’s whole needs are taken account of – what the Royal College of GPs calls ‘whole person medicine’.”

But he warned that improving patient care was not just about structures, and health professionals needed to inject more compassion into their care.

Hunt said: “So often when considering the appalling suffering at Mid-Staffs, things came back to a culture – as Robert Francis described – ‘focused on doing the system’s business – not that of the patients’.

“And getting the right culture means reasserting a simple truth: every patient is a person. A person with a name. A person with a family. Not just a body harbouring a pathology; not a diagnostic puzzle; not a 4-hour target or an 18 week problem; not a cost pressure.”

He said the recapturing of continuity of care will empower and revitalise staff.

“Because the system changes and barriers which impaired personalised care also deprofessionalised and in places demoralised doctors and nurses,” he said.

Responding to the speech, Dr Alistair Douglas, president of Society for Acute Medicine, said: “Suggesting that the UK should move to a whole scale implementation of a US-style hospitalist model is overlooking what has already been achieved here by consultants in acute medicine.

“We have shown that around half of all medical emergency patients can be managed completely through to discharge by these specialists. 98% of UK hospitals now have AMUs. So we must not break this model.”

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3 Responses to “Hunt calls for US-style ‘whole stay doctors’”

  1. Malcolm Morrison says:

    Methinks Mr Hunt has the nerve of Old Nick (and I don’t mean Clegg)!

    It is he, his predecessors, and his Department that has helped to destroy the ‘continuity of care’ that used to exist (and still does in some places) in the ‘firm’ structure. What is so sad is that the profession has allowed itself to be ‘battered into submission’ by ‘the system’.

    What he said is, of course, correct (in principle, not the US ‘sell’). It is time for the profession to reassert its professionalism and stand up for professional standards. It must DEMAND that ‘continuity of care’ is practised properly (and is not just a political catch-phrase) – and this means proper ‘control’ of trainee doctors and their ‘attachment’ to ‘firms’ (now called ‘teams’ – but without a captain!) Any ‘system’ that puts the SAFETY of patient care in jeopardy cannot be allowed. Clinicians must not allow managers to overrule their CLINICAL judgments.

  2. joshek says:

    “whole stay doctors” – excellent idea. best to shackle them to the patients´bed, but an electronic ankle tag will probably have to do for practicality reasons … this “career” will obviously come with 24/7 presence and, some kind of full shift system if they are lucky. i am sure the best and the brightest will queue up for it … not …

  3. Tom Goodfellow says:

    When I was a lad we used to have “whole stay” doctors.

    I think they were called ….er…. consultants.

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