It is the HCSA’s policy to encourage and work with any properly focussed initiatives to eliminate the variation in survival rates and wellbeing which has been shown to exist for acute and emergency hospital admissions in the evenings and at weekends.
Policy and position There is already an established consensus in a number of specialties that the presence in hospital of consultant/SAS medical staff during out of hours/extended day periods is essential to provide good quality medical care. Some hospital departments already have consultant and senior doctors present during on call periods, for example, Radiology, Paediatrics and Paediatric Surgery.
There are other specialties which regularly see consultants undertaking weekend ward rounds and operating lists when they are on call at weekends. For many hospital doctors, working over 7 days for some part of their rostered working lives is not uncommon.
The HCSA supports the aims of 7 day services for patients, but this must be achieved by properly planned change and adequately resourced developments in medical staffing, working patterns and clinical facilities. It must be ensured that the increase in ‘consultant presence’ as recommended by the Royal College of Physicians and others, which is intended to adequately treat acute emergencies, does not simply drift into undertaking additional routine clinics at weekends etc.
Principles and safeguards The policy of the HCSA towards these changes in working arrangements is supportive where the work arrangements are balanced and:
• are agreed by all the doctors involved
• do not demand long periods of continuous working
• maintain adequate rest periods
• do not compromise opportunities for family friendly work patterns/work life balance
• provide time off in lieu to guarantee the protection of the health and wellbeing of the doctors concerned
Our membership surveys have found that our members hold the above principles to be very important.
Needs and opportunities Whilst fresh patterns of working by senior medical staff would reduce the additional manpower required to support 7 day provision of service by hospitals, extra medical staff will still be needed and this will in turn increase the salary costs. It is vital that this is properly recognised and delivered from the outset.
The HCSA recognises that fresh patterns of working present opportunities for part time and shift working, which can be attractive to some existing hospital doctors and those appointed in the future.
There are already some opportunities for innovation with existing levels of medical staff, which can bring fresh working arrangements into play now, delivering benefits and with adherence to the principles and safeguards mentioned earlier.
Where existing numbers of consultants and specialists in a department are adequate, the introduction of fresh patterns of working over 7 days can be achieved by an imaginative application of compensatory rest and innovative work patterning. This can eliminate the need for additional hours of work by members of the team and contain the impact of additional resourcing. This outcome was achieved by the Radiology Department at the Worcestershire Acute Hospitals Trust, which sought HCSA advice on the best way to approach such a change.
Consultant Contract is not an impediment to fresh working patterns The existing contractual provisions are not an obstruction to the introduction of the recommendations which have been put forward to address the disadvantage to patients admitted at weekends and evenings. Consultant and SAS doctors are already ‘on call’ and available at these times. Nor are the contractual provisions an obstacle to consultants and specialists working as normal over 7 days. Numerous examples exist of increased consultant presence being introduced successfully within the frame work of the existing contractual provisions. The example of Radiology in Worcester noted above is but one of these.