Hospital Dr News

“More consultant cover needed out-of-hours”

Senior doctors need to be more available to work in acute admissions units, a survey finds.

The research, by the Royal College of Physicians, on the way care for very ill patients is managed recommends that hospitals need to increase the out-of-hours availability of consultants for acute care.

Care for very ill patients has improved significantly over the past few years due both to the introduction of acute medical admissions units in most major hospitals, and a major increase in the number of consultant physicians specialising in acute medicine to assist other hospital specialists working in acute medical admission units.

Despite these changes, the RCP says, many patients are only seen once per day in a formal ward round instead of the recommended two daily ward rounds. In three quarters of the acute medical admissions units accepting patients directly from GPs, there are regular bed shortages, so the report recommends that there are sufficient beds in future to ensure that very ill patients gain appropriate access to acute admissions wards.

Sir Richard Thompson, the new president of the Royal College of Physicians, urged the government to address the standard of care in hospitals in the evenings and at weekends. He said new working patterns are needed.

Forty eight per cent of consultant physicians responsible for assessing and treating the acute take still have to do routine clinics or other parts of their job as well as at the same time seeing the urgent patients. These duties should be cancelled on those days to allow physicians to concentrate wholly on the very ill patients.

Only 3% of hospitals provided weekend cover from consultant physicians specialising in acute medicine for nine to 12 hours and none for over 12 hours. Nearly three-quarters of hospitals in the survey had no cover from consultant physicians specialising in acute medicine over the weekend.

An accompanying statement from the RCP council recommends that consultant physician cover is available in hospitals every day for 12 hours per day.

Dr Jonathan Potter, clinical director of the RCP’s clinical effectiveness and evaluation unit, said: “Despite improvements in facilities and staffing, hospitals still need to address working arrangements to ensure that senior doctors are readily available to provide a consultant led service in acute medical admissions units seven days a week.”

Previous studies show that a consultant-delivered service is best for patient treatment and recovery.

Representatives of 126 hospitals completed the survey – 114 from England, six from Northern Ireland and six from Wales.

Read the RCP president’s blog on the issue.

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4 Responses to ““More consultant cover needed out-of-hours””

  1. chrissa says:

    pretty clear where this is going: the sub-consultant post cct for a while – whilst the old consultants are still around on their non 24/7 contracts and a de-facto staff grade job for everyone post cct in the near future. is that new consultancy worth all the hoop jumping to get there??

  2. DPC says:

    For this to happen-which clearly it needs to , there needs to be a clear committment from an employing trust to recruit more acute physicians. As there are not enough acute physicians being trained (thanks to the royal college) there needs to be buy in from physicians already in post to take their share of shop floor-aau sessions.We need to get away from “out of hours” -for acutely unwell patients arrive anytime during the 168 hour week.we should be aiming for the same standard of care at all times. It’s easy to map when patients attend then organise rota’s to fit that.what isn’t easy is to fill those rota’s .

  3. rob says:

    Perhaps Sir Richard could explain how the extremely important job of training medical trainees was allowed to be taken from the Royal College of Physicians and given to the Dept of Health who have no interest in training. The Royal College of Physicians has lost all credibility as a body of learning.

  4. chrissa says:

    the royal colleges have become obsolete a long time ago. they failed in just about everything. protetction of doctors’ turf? total failure. ensuring authority over training and being in charge exclusively – necessary to give any benefit to members – total failure. all they do is collect fees.

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