Hospital Dr News

“Seven day services can be introduced cheaply”

Innovative patterns of working in hospital departments already adequately staffed by consultants could enable trusts to provide seven day services at little extra cost, claims the Hospital Consultants and Specialists Association (HCSA).

This has been achieved by the radiology department at Worcestershire Acute Hospital Trust which has imaginatively applied compensatory rest periods – eliminating the need for members of the team to work additional hours.

The scheme, introduced with advice from the HCSA, kept a lid on the need for additional funding.

The example is cited by the HCSA in a submission of evidence to the pay review body (DDRB) on the consultant contract. Contract negotiations were referred to the DDRB in October 2014, after talks between the BMA and NHS Employers collapsed.

The HCSA has not been party to these talks. The DDRB has been asked to look at reforming the contract to deliver seven day services without increasing funding.

The HCSA says fresh patterns of working with opportunities for part time and shift working could be attractive to some hospital doctors.

There is no “one size fits all” solution. What may fit a large specialist regional centre would not fit a small district service. There is a need to look at staffing in general, the numbers of hospital beds available both at weekends and during the week.

Extension of work into a seven day pattern must be supported by a full complement of clinical and non-clinical support staff. There would also need to be safeguards including not demanding long periods of continuous working, and adequate rest periods and time off in lieu.

There would also need to be guarantees about a maximum number of weekends consultants should work in a year and guidance about age limits, especially taking into account the expected longer working life of consultants with later retirement.

Seven day services for patients must be introduced with properly planned change and adequately resourced hospital staffing, working patterns and clinical facilities. There must be assurances that the increase in “consultant presence”, recommended by the Royal College of Physicians to treat acute emergencies, would not drift into consultants doing additional routine clinics and other duties at weekends.

The HCSA says it has worked in partnership with a number of trusts to introduce increased consultant presence successfully within the framework of the existing contract.

The HCSA has also asked by Health Minister Dan Poulter to comment on proposals to reform pay progression. It says that any changes must be accompanied by a system of pay protection that ensures consultants do not lose out both in terms of future pay and pension.

“The notion that a resultant reform could lead to consultants working more unsocial hours for less pay is one that our members would find unpalatable. We already know that many consultants have and continue to seek work overseas and any reform that had weak transition and protection would see this trend continue,” the submission says.

“Likewise the potential for consultants to opt to retire earlier than had been anticipated would be a real risk if this element of reform was out of touch with expectations.”

On proposals to reform clinical excellence awards (CEAs), the HCSA warns: “Any thoughts about abolishing CEAs would be counterproductive and could impact on the willingness of consultants to volunteer for additional activity.”

HCSA Chief Executive/General Secretary Eddie Saville, concludes: “We know that morale amongst our members is at a low point, maybe the lowest it has ever been. We hope that the outcome of the DDRB’s observations will signal the rebuilding of morale and generate better engagement.”

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