Government must produce “credible evidence” to support seven day working, BMA says

BMJ 2015; 350 doi: (Published 05 January 2015) Cite this as: BMJ 2015;350:h12
  1. Gareth Iacobucci
  1. 1The BMJ

The government’s plans for seven day services in the NHS lack “credible evidence” and risk wasting resources and endangering patient safety, the BMA has warned.

In a submission of evidence to the Doctors’ and Dentists’ Review Body for NHS consultants’ and junior doctors’ contracts1 the BMA said that the government had failed to produce detailed evidence and modelling on the changes that it wished to introduce, which made it “impossible for doctors to sign up.”

It added, “Furthermore, we believe that pursuing an ill informed seven day service model would be, at best, wasteful for the NHS and would, at worst, threaten patient safety. Implementation of seven day services should enhance patient outcomes and experience, be sustainable for the NHS, and be fair for doctors.”

Negotiations on contracts for consultants in England and Northern Ireland and for junior doctors across the United Kingdom were referred to the review body in October 2014 after talks between the BMA and NHS Employers stalled. This was after the BMA had raised concerns over a lack of safeguards for patient safety and doctors’ welfare.2

Plans to move the NHS in England to a new pattern of seven day working were first published in 2013 by a committee set up by Bruce Keogh, the national medical director.3 The BMA’s submission reiterated its support for the principle of seven day services, but it said that urgent and emergency care should be the priority for investment. The submission read, “Overall there is simply not enough credible evidence available to determine what services the NHS should provide seven days a week. A body of credible evidence, such as robustly evaluated local pilot schemes, is necessary for implementation.”

Mark Porter, BMA council chairman, said, “The BMA has been clear in its support for better seven day services, but the government needs to be clear about what an expansion of services will look like and, crucially, how it can be safely staffed and resourced, without existing services being scaled back. Doctors already work around the clock, 24/7, so the existing contract is not a roadblock to seven day services.

“We hope that, in its submission, the government has provided the detail, evidence, and modelling on the changes it wants to introduce, which it failed to produce throughout negotiations. This includes detail on what additional services it wants to make available, how much they will cost to deliver, and guarantees on what support services need to be in place to provide them safety. Without this detail, we are being asked to sign up in the dark to changes without knowing how patient care and doctors’ working lives will be affected—something the BMA cannot do.”

He added, “We believe patient need—not political rhetoric—should decide what services are available over seven days, which is why the BMA has repeatedly called for the government to work with doctors to make urgent and emergency care the priority for investment.

“In doing so, we can ensure that the most seriously ill patients have access to the best possible care around the clock. Only once this has been achieved can the debate begin as to what other services the NHS can afford to deliver within the current workforce and budget.”


Cite this as: BMJ 2015;350:h12


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