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Hospital doctors told to rethink weekend working 
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http://www.bbc.co.uk/news/health-17305022
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Hospital consultants should consider working weekends to cut the spike in deaths, a doctors' leader says.

Dr Mark Porter, the British Medical Association's consultants chairman, said the mounting evidence about the problem meant it was time for doctors to put themselves forward if needed.

He said it would not be necessary for every speciality or hospital, but it needed to be looked at case-by-case.

There is a wealth of research into higher mortality rates at weekends.

At the end of last year, the research company Dr Foster found mortality rates rose by 10% at weekends. Other studies have shown similar correlations.

Staffing - and in particular the presence or absence of senior doctors - has been highlighted as a key factor.

At the moment consultant cover is commonplace in intensive care and A&E departments.

But in most other areas hospitals rely on consultants being on call, which means they give advice over the telephone and only come into hospital in emergencies.

Some trusts have started looking at changing normal working patterns, but Dr Porter said it needed to become much more common.

"It will need investment by trusts, but it also needs a willingness by doctors. That is the challenge for us.

"Consultants understandably feel like they have rightly got away from working weekends. They will have done that earlier in their career and are wanting to spend time with patients [during the week] providing really good care.

"But there is mounting evidence of an association between higher death rates and weekend care. We can't prove that it is a causal link, but we cannot ignore it either.

"It will be different for every speciality and every trust, but it is something that needs looking at."

He cited the example of his trust - the University Hospitals Coventry and Warwickshire - which has started getting consultant anaesthetists to work 12-hour shifts on Saturdays and Sundays.

"It makes a difference having the consultant there rather than just on call," he added.

David Stout, of the NHS Confederation, which represents managers, said the BMA was right to suggest a greater consultant presence would help.

"Having a consultant on call is very different from having one there, overseeing what is being done and making decisions on the wards.

"The key question is how we afford this. Hospitals can't just employ more.

"It may be that we need to reconfigure services and do some of this care on fewer sites so we make sure we have the right cover. We have to put patients first."

Ministers are already known to be keen to address the issue - and are currently considering offering financial incentives to hospitals to improve weekend services.

NHS medical director Sir Bruce Keogh added: "Having more senior staff and consultants around at weekends is fundamental to the NHS shifting from a five-day-week to a seven-day-week.

"It will mean better support for junior doctors and key decisions - like what tests to run, what treatment to give and whether to operate - can be made more quickly."

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Fri Mar 09, 2012 1:44 pm
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I have some issues with this.

In the hospitals where I've worked, there's an on-call consultant for the acute specialties - surgery, medicine, paediatrics, obstetrics & gynaecology. All patients admitted will have been seen once by the consultant. The rest of the time, the consultant may be at home, or in an office, or on the wards, depending on need. The majority of the time, they're not needed.

What happens Mon-Fri: two consultant ward rounds, one or two registrar ward rounds, one or two junior doctor ward rounds. That makes one ward round per day by a member of the team.

What happens at the weekend: nobody seen unless requires urgent review. Nurses should review regularly and contact a (usually junior) doctor if concerned. The majority of patients will be fine. Where there are problems is if the nurses are busy or cannot attend to a patient immediately, or if a doctor is contacted but has to deal with five more poorly patients at the time. This is when things go downhill and is down to a skeleton crew running the hospital. Similar situation at night.

Having all consultants on all the time will not be as beneficial. Pay will have to increase to compensate the extra hours. More rest time is needed so clinics and ward rounds during the week have to be altered/reduced/cancelled. The other problem is that you need more staff to complement the increase in consultants. If a consultant wants the patient to have xyz test and this can't be done until Monday due to no one available to run the test, then you're pretty much buggered.

Having full hospital staff 24/7 is financially unviable, especially when you're trying to save £20 billion.

What could potentially be an option is having one team (consultant, middle grade, junior doctors) looking at admission patients, and one team looking at only ward patients (and even then, just the poorly ones). A little more expensive, but could potentially work.

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Fri Mar 09, 2012 2:06 pm
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There's also the issue of patients who are admitted over the weekend tend to be more unwell/poorly than those admitted during the week. Most people will wait to see their GP. If they can't, it's because there's something serious.

It is quite entertaining to see how quiet the likes of A&E are on Christmas Day, Eid and New Year's Evening.

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Fri Mar 09, 2012 2:11 pm
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