I read with great interest “Should the NHS work at weekends as it does in the week? No” and “can the NHS be run like a supermarket” elsewhere, and I was asked similar questions before. And I completely agree with the author that it may be good but not a model that NHS can afford at the present situation without private initiative. We need to assess our affordability, availability of human resources, to run 24/7 service. As the author rightly pointed out we are not commercially profit driven service. We are public service people and we do with passion. In supermarket you get things because you pay for it and in NHS you don’t pay. People might point out it taxpayers money. If only patients are very clever and if certainly know what they want and they can like self-cater service self-treat, walk-in do their own tests, treatments and self-care for themselves probably this model may work. But are we in that situation really. And if that is the case actually we don’t need these many people and hospitals at all. Elsewhere it is published about 80% patients don’t understand or retain about the advice given in spite of written information. Elsewhere they have to send text reminders to be compliant with the advice or treatment given.

I am sure there are occasions ambulances were called for paper cut injuries, or called in the middle of night for an on-going problem for few months, and wanted answers or solutions instantly. Wanted to be seen but won’t wait for results of the investigations arranged. Has anyone walked into a supermarket in the odd hours trying to speak to someone for advice and do you really expect you will get someone sane to give instant answer. What are the odds of it? And we talk about 24/7 consultant cover in hospitals particularly ED and other acute specialities. But these services need support from other services like transport, social services, and diagnostics. The perks of seniority are the social hours. Can we afford to lose our senior and trained people? Because they can’t and are not ready to adopt these changes.

More importantly the staff in supermarket are trained for few days to few weeks depending upon the skills they are needed for. Unlike medical professionals who are trained for few years. If we have to work like a supermarket the main problem will be keeping up the morale of staff. Keeping up the skills and retention of skilled staff within NHS is a big task. Already NHS is facing big difficulties in staff recruitment. We are already being pressurised by target culture. Though it has done a lot of good, we can’t risk of losing more staff. We might need to write more letters to Santa to train us about the time management, resource management and keeping everyone happy.

Yes it may be a good model to provide service 24/7 like a supermarket in patient perspective but it is not economically viable for NHS or for the staff’s morale, at least for now. It is inevitable, happening slowly and we need to face it one day.

Dr Rajesh Vasiraju MBBS; MRCS; MCEM.
Cambridge.

Competing interests: None declared