I must first say how much I approve of the plans for 7 day working in the NHS. It is clear that treatment in many areas is not as effective on the weekend and the government’s efforts to improve this are commendable.
A lot of routine work can be done by auxiliary staff e.g nurses providing triage, chronic disease clinics and paramedics working in GP surgeries doing home visits. This takes the pressure off doctors so they can deal with more complicated cases only and to manage a practice of support workers. If primary care is more effective at the weekends A&E would not be so overused. If a facilitator was present in A&E who was not medically trained but trained to direct people to the correct service e.g GP surgery, walk in clinic, with a phone number to call this would help ensure people get the right treatment. I heard an example of a patient ringing 999 because she broke a nail. Clearly redirection advice and reassurance were all that was required and if the ambulance service could redirect such a call quickly it would reduce pressure on the service.
Hubs are being postulated of ambulance, social care and voluntary organisations which help the elderly cope at home, all being available in one centre based in hospitals. This could help with coordination of care and give a better service while reducing costs.
I have been a junior doctor in A&E myself and know how hard doctors work. I am suggesting that contracts remain the same, but Saturday and Sunday be counted as normal days for pay only and the 6th and 7th consecutive days of work be paid overtime as Saturday and Sunday are paid now. If you have a day off no overtime is paid. This makes it possible to stagger timetables so days off might be Friday and Saturday or Wednesday and Thursday. If teams are staggered there is no reason why doctors need do many more weekends than now preserving the special nature of the weekend by timetabling and ensuring 7 day a week services. With more support from nurses, phlebotomy, x-ray etc at weekends, timetabled in a similar pattern, doctors would be able to do their job effectively throughout the week with no change in hours . More doctors will be required to fulfil 7 day a week treatment but with support from auxiliary staff this could be kept to a minimum.
The principle of 7 day working must be in line with the Hippocratic Oath and doctors are morally obliged to ensure patient care is not dependent on which day of the week a patient is seen. With the change suggested in this article there could be room for negotiation with junior doctors to get a 7 day service while supporting the needs of doctors.
Kathy Smethers is a Councillor in Eastbourne, and also serves as a school governor. She previously worked as an A&E doctor in London before retiring to bring up her two daughters.