02 December 2010

Sir Richard Thompson, president of the Royal College of Physicians, said today that patients deserve better care in hospitals in the evenings and at weekends.  Introducing a new statement produced by the RCP’s Council on doctors working hours, he said that many hospitals did not have enough senior doctors present to care for patients out of hours and at weekends, and that new working patterns would be needed in future.

Sir Richard Thompson, president of the Royal College of Physicians, said today that patients deserve better care in hospitals in the evenings and at weekends.  Introducing a new statement produced by the RCP’s Council on doctors working hours, he said that many hospitals did not have enough senior doctors present to care for patients out of hours and at weekends, and that new working patterns would be needed in future.

The RCP is concerned with the mounting evidence of poor care delivered to patients in hospital*, and has recommended for the first time that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week, who should have no other duties scheduled during this time.  All medical wards should have a daily visit from a consultant; in most hospitals this will involve more than one physician. 

Doctors are already working long hours - the latest census of the Federation of the Royal Colleges of Physicians of the UK shows that consultant physicians are working an average of 50 hours a week, which is four and a half hours more than their contract.  More than half of those surveyed were working longer than the 48-hour limit set by the European Working Time Directive.  A previous RCP survey released in April also showed that junior doctors were covering an average of 61 patients overnight, but one junior doctor was covering 400 patients.

Because consultant physicians are already working longer hours than their contract for, the recommendation means that instead of increasing the amount of hours worked overall, job plans will need to change to reflect the different working patterns and must include arrangements to ensure adequate rest.  The statement builds on previous RCP surveys, audits and reports on acute medicine, which have led to improvements in the way acutely ill patients are cared for.

The RCP will be seeking an urgent meeting with Secretary of State for Health Andrew Lansley to discuss the issue, and will be opening discussions with organisations responsible for doctors’ employment.

Sir Richard said:

‘Despite major improvements in the care of acutely ill patients which were led by the RCP following our major report in 2007, patients are still not getting the care they deserve at night and at weekends. Too many junior doctors are covering too many very ill patients, and this has to change.  Our evidence shows that a predominantly consultant-delivered medical service is the best way to improve patient care.’

Notes:

 

*  Papers illustrating poor care at night and at weekends in hospital

  1. An acute problem? A report of the National Confidential Enquiry into Patients Outcome and Death, 2005.
  2. Caring to the end? A report of the National Confidential Enquiry into Patients Outcome and Death, 2009.
  3. Bell CM, Redelmeier DA. Mortality among patients admitted to hospital on weekends as compared with weekdays. N Engl J Med 2001; 345: 663-668.
  4. Aylin P, Yunnis A, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. A large, multi centre study.  Qual Saf Health Care 2010; 19: 213-217
  5. Barba R, Losa JE,Velasco M et al. Mortality among adult patients admitted to the hospital on weekends. Eur J  Intern Med 2006; 17:322-4

 

RCP Council Acute Medicine statement, December 2010