Patients should be reviewed by a consultant once every 24 hours, report says

BMJ 2012; 345 doi: (Published 04 December 2012) Cite this as: BMJ 2012;345:e8262
  1. Gareth Iacobucci
  1. 1BMJ

Patients in hospital have a right to the same standard of care seven days a week and should be reviewed by a consultant at least once every 24 hours in most circumstances, the Academy of Medical Royal Colleges has recommended.

In a new report published this week, the academy, which brings together 20 colleges and faculties, indentifies three key standards to ensure that all patients receive high quality, consultant led care led throughout the week.

Seven Day Consultant Present Care highlights substantial variation in the availability of consultants and other senior doctors across different locations and areas of medicine at different times in the week.1

It urges the NHS to ensure that “appropriate resources and adequate numbers of consultants” are provided at all times to deal with “unacceptable” deficiencies in the current system. At present, patients admitted to a UK hospital at a weekend are more likely to die during their hospital stay than those admitted during weekdays.2

The three standards recommended by the academy are, firstly, that hospital inpatients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless “it has been determined that this is not necessary for the patient.”

The second standard is for consultant supervised interventions, investigations, and reports to be “provided daily if the results will change the outcome or status of the patient’s overall care before the next ‘normal’ working day.” It says that this should include interventions that would enable “immediate discharge or a shortened length of stay.”

The final requirement is for support services in hospitals and primary and community settings to be “available daily to ensure that the next steps in the patient’s treatment, as determined by the daily consultant review, can be taken.”

The report does, however, acknowledge that it is outside its scope to look in greater detail at the availability of community services.

Norman Williams, chairman of the steering group and president of the Royal College of Surgeons of England, said, “It cannot be right that over weekends and bank holidays patients may receive a lower standard of care than they would during the week.

“Clinical staff and managers must work together to reshape hospital services in a way that strengthens the quality of care given to patients regardless of the time of day they are admitted. Similar arrangements will be necessary to support patients in the community when discharged at weekends. Ensuring that key staff are available to provide this support will come at a cost. However, this is crucial for the full benefit of seven day consultant led care to be realised.”

Terrence Stephenson, chairman of the Academy of Medical Royal Colleges, said, “We hope these standards will be supported and acted upon by the NHS Commissioning Authority so patients can receive the best care and treatment regardless of when they need it.”

But Richard Thompson, president of the Royal College of Physicians, cautioned, “While the RCP accepts this principle as an aspirational standard for all physicians, we believe this will require service redesign and may have resource implications to make this standard a comprehensive reality.”

Dean Royles, director of the organisation NHS Employers, said, “It’s clear that we need working practices to be different to be a truly seven day service.

“We know there will be significant challenges, and we can expect some resistance to change. A different way of working requires a pay system that recognises weekends and evenings as normal working times. It needs to be patient care, not overtime rates, that drives this change forward.”

Paul Flynn, chairman of the BMA’s consultants committee, said, “This is a huge challenge for consultants and hospital managers, and flexibility in developing new ways of working is vital. What works for one specialty may not be appropriate for another, and it will be for senior doctors to discuss with their clinical teams what works best for their patients.”


Cite this as: BMJ 2012;345:e8262