Hospital doctors told to rethink weekend working

A shortage of senior doctors is said to be at the heart of the problem

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.

Challenge

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."