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Limited weekend cover has led to concerns over junior doctors’ training, says NHS chief

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4374 (Published 01 July 2014) Cite this as: BMJ 2014;349:g4374
  1. Abi Rimmer
  1. 1BMJ Careers

A lack of consultant supervision at weekends has led to concerns about junior doctors’ training, the national medical director of NHS England has said.

Addressing junior doctors at an Agents for Change event in London on Friday, Bruce Keogh said that he was concerned about the way the NHS ran at weekends. He said, “Many of you will know that I have raised a debate over the last couple of years about why our health service shuts down at about lunchtime on a Friday—or it certainly does for consultants—and then reopens again first thing on Monday morning and then grinds up to full speed by lunchtime on Monday. So we have a healthcare system that is only really working at most efficiency four and a half days a week.”

Keogh said hospital admission data showed that patients’ mortality was 11% higher if they were admitted on a Saturday and 16% higher if they were admitted on a Sunday, and surveys showed that junior doctors felt “increasingly strained” at weekends.

“Medicine is more complicated than it was when I was a junior [doctor],” he said. “There’s much more scrutiny, expectations are much higher, and when you start to combine that with the European Working Time Directive and the fact that you were saying as a group that you weren’t getting enough consultant support at the weekends—that made me worry about the adequate training of the next generation of doctors,” he said.

Unlike other industries, the NHS has never properly addressed the issues of weekend working, Keogh said. “The mortality figures and the junior doctor surveys were, I think, a wake-up call to those of us who work in senior positions in the NHS,” he said. “That’s really why I’ve started to focus on how we shift the NHS into that arena.”

He added, “I found myself thinking: not only are we running a service which is not that helpful in some ways for supervision and training, which clearly has evidence of high mortalities at weekends, which has evidence of inefficiencies and the lack of economy—it’s also not that compassionate a system.”