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Better access to consultants needed

Patients admitted to hospital at evenings and weekends face uncertainty as to whether they will have access to consultants and other senior doctors, a report suggests.

Hospital patients should be seen by a consultant at least once every 24 hours, the Academy of Medical Royal Colleges has recommended.

Mounting evidence suggests that patients are more likely to die if admitted as emergencies in the evening and at the weekend.

The new report calls for health service bosses to ensure that adequate numbers of consultants are provided to enable consultant-led care seven days a week.

It states that hospital patients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless it has been determined that this is not necessary.

While the move is not a “panacea for all patient safety issues”, it could improve consistent quality care for patients, the report adds.

Professor Norman Williams, steering group chair and president of the Royal College of Surgeons of England, said: “The standards we recommend in this report reflect the importance of daily consultant-led care and the support that needs to accompany this to ensure that patients receive the very best treatment.

“It cannot be right that over weekends and bank holidays patients may receive a lower standard of care than they would during the week.

“Clinical staff and managers must work together to reshape hospital services in a way that strengthens the quality of care given to patients regardless of the time of day they are admitted.

“Similar arrangements will be necessary to support patients in the community when discharged at weekends. Ensuring that key staff are available to provide this support will come at a cost. However, this is crucial for the full benefit of seven-day consultant-led care to be realised.”

Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges, said: “The evidence for the benefits of consultant-delivered care is clear.

“We hope these standards will be supported and acted upon by the NHS Commissioning Authority so patients can receive the best care and treatment regardless of when they need it.”

Dr Paul Flynn, chairman of the British Medical Association’s consultants committee, said: “While there is no definitive link between a lack of consultant presence at the weekend and health outcomes, there is mounting evidence that patients are more likely to die if admitted as emergencies in the evening and at the weekend.

“This is a huge challenge for consultants and hospital managers and flexibility in developing new ways of working is vital. What works for one speciality may not be appropriate for another and it will be for senior doctors to discuss with their clinical teams what works best for their patients.

“Patients should receive high-quality care no matter when they are in hospital and we need to work together to explore how best to meet this challenge.”

Dean Royles, director of the NHS Employers organisation, added: “We know there will be significant challenges and we can expect some resistance to change.

“A different way of working requires a pay system that recognises weekends and evenings as normal working times. It needs to be patient care not overtime rates that drive this change forward.”

The Royal College of Physicians said hospitals which admit acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week.

Readers' comments (2)

  • if i want a car exhaust at the weekend do i want the ceo of kwick-fit poking around under my car or a qualified mechanic?

    if i mangle my hand trying to fit it myself do i want a casualty consultant or, my preference, a registrar? chances are the registrar took their registry exams within the last few years and is up to speed with all the latest best practice. consultants, well, most of them are so last century. hopefully five year revalidation'll get 'em up to speed.

    meanwhile perhaps if the general public could balance out the death rates by doing diy in the middle of the week we wouldn't have professors wasting our taxes on meaningless reports.

    “While there is no definitive link between a lack of consultant presence at the weekend and health outcomes, there is mounting evidence that patients are more likely to die if admitted as emergencies in the evening and at the weekend." oh, dr flynn, is this really what you dreamed of doing when you were at medical school?

    Unsuitable or offensive?

  • Maybe see the consultant once or twice a week in acute medicine if you are lucky.

    We know that when senior staff are not around - nights and weekends - poor decisions are being made - largely because teaching of medical junior staff is minimal.

    Unsuitable or offensive?

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