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Seven day services in hospital cannot be delivered with current shortage of NHS physicians

The President of the Royal College of Physicians has questioned how the government can implement safe seven day services without the required number of doctors.

Speaking at an RCP conference on the future of medicine, Prof Jane Dacre pointed out that two in five consultant physician posts were unfilled in 2015.

She said: “Over the last year, our census data shows that 40% of consultant physician posts remain unfilled, nearly always due to a lack of candidates.

“Let me run that past you again – ladies and gentleman, two in five of our consultants are missing! If 40% of teaching or policing posts were unfilled, this would be a national crisis…but somehow we doctors are expected to roll our sleeves up and to muddle on through and fill in the gaps ourselves.”

She also pointed to gaps in trainee rotas. An RCP survey showed:

  • One in five consultants report significant gaps in trainee rotas such that patient care is compromised;
  • Nearly half report having to find a workaround solution to ensure that patient safety is not compromised;
  • One in ten report often having to act down to fill vacant trainee posts, and nearly a third of you have acted down as a one-off.

Dacre said: “My first big question for the Secretary of State is – if we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service?”

She added: “I feel sorry for NHS trusts, I really do. Across the country, they have created a raft of new posts to meet the exponentially rising demands for patient care, only to find that there is no-one to fill them. And our cash-strapped trusts would not be creating posts unless they really needed them.”

Seven day services impossible

Dacre also believes it is time to revisit our national contribution to health and social care.

She called on the Chancellor of the Exchequer to provide the investment needed to shore up debt-riddled trusts to prevent cuts, invest in social care to relieve the pressure on the NHS, and invest in more doctors and other healthcare staff.

She said: “The other huge wave of pressure building up around us is – that of financial deficit.

“The 151 Foundation Trusts expect to end this financial year a whole billion pounds in the red. That’s in about three weeks’ time. This deficit will start to bite deep into the day-to-day running of hospitals, resulting in more cost improvement programmes, meaning more cuts.

“And we need critical additional funding for social care in the forthcoming budget. Reductions in social care funding are putting real pressure on the NHS, by preventing patients leaving hospital because social support is not available.”

In 2013, the UK’s overall spending on healthcare was 8.5% of GDP, against an EU average of 9%.  However, countries like France, Germany and Sweden were spending 11% of their GDP on healthcare.

She said: “It is difficult to compare health systems but countries investing more do have better outcomes in some clinical areas.

“However, there is one stark fact about the difference in our investment. We have 20-25% fewer doctors than comparable health economies.”

She called for a real increase in the specialties where the demand is increasing the most, including acute medicine and geriatric medicine.

“It is meaningless to claim that there has been a 44% increase in the numbers of consultants in the NHS between 2004 and 2014 if we can’t get a single consultant to apply, as happened for some posts last year in Shropshire, Lincolnshire and Bristol,” she said.

“I know what I think. I think we need more doctors, full stop.”

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