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What will a seven-day NHS mean for healthcare professionals? What will a seven-day NHS mean for healthcare professionals?
(about 3 hours later)
David Cameron’s promise of a seven-day NHS has been met by scepticism from health professionals. A lack of funding and staff could make the prime minister’s dream difficult to realise, but some GP surgeries and hospital departments are already experimenting with extended opening hours. So what might a seven-day health service mean for an already stretched workforce? And what can others learn from professionals currently trialling the new working week?David Cameron’s promise of a seven-day NHS has been met by scepticism from health professionals. A lack of funding and staff could make the prime minister’s dream difficult to realise, but some GP surgeries and hospital departments are already experimenting with extended opening hours. So what might a seven-day health service mean for an already stretched workforce? And what can others learn from professionals currently trialling the new working week?
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In October 2013, the government announced a £50m pilot scheme to help GPs provide a seven-day service, with a further pot of £100m allocated last September for a second wave in 2015/16.In October 2013, the government announced a £50m pilot scheme to help GPs provide a seven-day service, with a further pot of £100m allocated last September for a second wave in 2015/16.
Eleven practices in Darlington, in County Durham, were successful in receiving a slice of the so-called challenge fund and used the money to run a project for six months. To reduce the strain on finances and staff, the practices formed a federation, pooling their resources to open just one practice, which is able to provide a seven-day service for the 100,000 registered patients in the area.Eleven practices in Darlington, in County Durham, were successful in receiving a slice of the so-called challenge fund and used the money to run a project for six months. To reduce the strain on finances and staff, the practices formed a federation, pooling their resources to open just one practice, which is able to provide a seven-day service for the 100,000 registered patients in the area.
Dr Chris Mathieson, a GP at the town’s Neasham Road surgery, explains that while uptake in the first three months was initially slow, there was eventually a big demand for services on a Saturday after word spread. Sundays, however, were less popular and the federation made the decision to remain closed that day, reinvesting the money to bolster its Saturday service with an extra doctor and nurses for routine appointments.Dr Chris Mathieson, a GP at the town’s Neasham Road surgery, explains that while uptake in the first three months was initially slow, there was eventually a big demand for services on a Saturday after word spread. Sundays, however, were less popular and the federation made the decision to remain closed that day, reinvesting the money to bolster its Saturday service with an extra doctor and nurses for routine appointments.
He says that while patients appreciate weekend openings, it is not necessary for every practice in the area to offer that service. Patients are willing to travel to neighbouring surgeries and are happy to be seen by other GPs.He says that while patients appreciate weekend openings, it is not necessary for every practice in the area to offer that service. Patients are willing to travel to neighbouring surgeries and are happy to be seen by other GPs.
Mathieson says they are capable of running a full medical practice at the weekend – with the exception of enhanced services such as minor surgery – but the main issue moving forward is, predictably, staffing.Mathieson says they are capable of running a full medical practice at the weekend – with the exception of enhanced services such as minor surgery – but the main issue moving forward is, predictably, staffing.
“There’s only a finite amount of hours that people are willing to work,” he says. “If staff work on a Saturday and Sunday it means they are not going to be in the practice on busier days during the week. So you will be actually damaging the service rather than improving it.”“There’s only a finite amount of hours that people are willing to work,” he says. “If staff work on a Saturday and Sunday it means they are not going to be in the practice on busier days during the week. So you will be actually damaging the service rather than improving it.”
The surgery also found that its out of hours urgent care centre was left short-staffed because doctors were electing to work at the practice at weekends instead.The surgery also found that its out of hours urgent care centre was left short-staffed because doctors were electing to work at the practice at weekends instead.
He adds that the only way around these obstacles is to allow staff to work more hours. But while GPs are effectively self-employed contractors and can legally do this, admin staff and nurses are bound by the European working time directive. So far, Darlington has been able to run a seven-day service with few major problems thanks to its staff, who have volunteered to work more flexibly for the needs of patients. But if the government makes weekend surgeries compulsory, Mathieson says, that will ignite anger from the unions, and contracts would need to be renegotiated.He adds that the only way around these obstacles is to allow staff to work more hours. But while GPs are effectively self-employed contractors and can legally do this, admin staff and nurses are bound by the European working time directive. So far, Darlington has been able to run a seven-day service with few major problems thanks to its staff, who have volunteered to work more flexibly for the needs of patients. But if the government makes weekend surgeries compulsory, Mathieson says, that will ignite anger from the unions, and contracts would need to be renegotiated.
Staff shortagesStaff shortages
Unless the government addresses the chronic shortage of GPs in the country, Mathieson struggles to see how the prime minister will achieve his ambitious aims. A ComRes survey of 1,004 GPs in the UK, commissioned by the BBC, revealed that only 20% of medical students chose to work in general practice on completion of their foundation training, despite a national target of 50% by 2016. The retention rate was no less rosy, with 56% of doctors expecting to retire or leave general practice before the age of 60.Unless the government addresses the chronic shortage of GPs in the country, Mathieson struggles to see how the prime minister will achieve his ambitious aims. A ComRes survey of 1,004 GPs in the UK, commissioned by the BBC, revealed that only 20% of medical students chose to work in general practice on completion of their foundation training, despite a national target of 50% by 2016. The retention rate was no less rosy, with 56% of doctors expecting to retire or leave general practice before the age of 60.
Dr Paul Harris, a partner GP at Belmont medical centre in Hereford, has been part of a similar pilot run in partnership with Taurus Healthcare. The scheme enlists doctors from across the county to work in three main hubs, seeing patients from practices throughout the region.Dr Paul Harris, a partner GP at Belmont medical centre in Hereford, has been part of a similar pilot run in partnership with Taurus Healthcare. The scheme enlists doctors from across the county to work in three main hubs, seeing patients from practices throughout the region.
Harris believes that, like it or not, the Conservative government will push ahead with a seven-day service and GPs will have to work cooperatively and collaboratively to make it work. Any refusal to do so will be self-defeating and lead to the eventual breakdown of the NHS.Harris believes that, like it or not, the Conservative government will push ahead with a seven-day service and GPs will have to work cooperatively and collaboratively to make it work. Any refusal to do so will be self-defeating and lead to the eventual breakdown of the NHS.
He says: “It doesn’t matter so much if you can’t get access to a local hospital because you don’t need those services very frequently, but it is a real crisis if you can’t get access to a good-quality GP.He says: “It doesn’t matter so much if you can’t get access to a local hospital because you don’t need those services very frequently, but it is a real crisis if you can’t get access to a good-quality GP.
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“If that happens, the service will just fall apart and we will end up with an American model, where you have a very expensive system which denies the poor access to healthcare. If we don’t get organised and align with what the government wants and work cooperatively then we will get shafted.”“If that happens, the service will just fall apart and we will end up with an American model, where you have a very expensive system which denies the poor access to healthcare. If we don’t get organised and align with what the government wants and work cooperatively then we will get shafted.”
Dr Alex Stewart, consultant clinical oncologist at the Royal Surrey county hospital, says the only way to make a seven-day NHS sustainable is to invest in training and development of skilled, qualified practitioners. She adds that although she is already offering patients radiotherapy and chemotherapy six days a week, her field requires a multi-disciplinary workforce of medical practitioners, nurses and staff such as porters and cleaners. Adequate planning by the government is essential when rolling out any further extensions to the service.Dr Alex Stewart, consultant clinical oncologist at the Royal Surrey county hospital, says the only way to make a seven-day NHS sustainable is to invest in training and development of skilled, qualified practitioners. She adds that although she is already offering patients radiotherapy and chemotherapy six days a week, her field requires a multi-disciplinary workforce of medical practitioners, nurses and staff such as porters and cleaners. Adequate planning by the government is essential when rolling out any further extensions to the service.
Stewart, who is also chair of the British Institute of Radiology’s (BIR) radiotherapy and oncology special interest group, says one of the biggest challenges is finding staff willing to work on the weekends. But she said seeing the hospital consistently meet its cancer waiting time targets as a result of weekend treatments was a strong motivator for staff.Stewart, who is also chair of the British Institute of Radiology’s (BIR) radiotherapy and oncology special interest group, says one of the biggest challenges is finding staff willing to work on the weekends. But she said seeing the hospital consistently meet its cancer waiting time targets as a result of weekend treatments was a strong motivator for staff.
It’s also important to ensure that ancillary services at the hospital, such as transport, are operating on those days, and that engineers and technicians are available to work on specialist scanners and equipment if needed, Stewart adds.It’s also important to ensure that ancillary services at the hospital, such as transport, are operating on those days, and that engineers and technicians are available to work on specialist scanners and equipment if needed, Stewart adds.
Comparing the NHS to supermarketsComparing the NHS to supermarkets
How can a hospital make sure it is prioritising the right services on those days? Nick Woznitza, a BIR member and reporting radiographer at Homerton university hospital, says seven-day working doesn’t necessarily mean that every single job function has to be covered at all times.How can a hospital make sure it is prioritising the right services on those days? Nick Woznitza, a BIR member and reporting radiographer at Homerton university hospital, says seven-day working doesn’t necessarily mean that every single job function has to be covered at all times.
“One of the analogies given is we need to offer an NHS similar to a 24-hour supermarket,” he says. “If you can buy your cigarettes at 4am then you should be able to have your lung cancer examination then, too.“One of the analogies given is we need to offer an NHS similar to a 24-hour supermarket,” he says. “If you can buy your cigarettes at 4am then you should be able to have your lung cancer examination then, too.
“But if you actually go into a Tesco at that time on a Tuesday the fish counter won’t be open, the butcher will be closed, there will be no freshly baked bread, and there will be no tills because the staff in store will be preparing for the next day’s work and stocking shelves.”“But if you actually go into a Tesco at that time on a Tuesday the fish counter won’t be open, the butcher will be closed, there will be no freshly baked bread, and there will be no tills because the staff in store will be preparing for the next day’s work and stocking shelves.”
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So while Homerton does offer routine imaging such as ultrasound to patients at the weekend, the hospital prioritises urgent investigations where an accurate diagnosis can guide immediate treatment or appropriate discharge. There simply isn’t the capacity to extend services any further.So while Homerton does offer routine imaging such as ultrasound to patients at the weekend, the hospital prioritises urgent investigations where an accurate diagnosis can guide immediate treatment or appropriate discharge. There simply isn’t the capacity to extend services any further.
“If you are running every machine seven days a week, you just need more people,” he says. “There is a shortage of radiologists and radiographers. But you can’t meet staffing through erosion of working conditions or, importantly, by not replacing capital investment.”“If you are running every machine seven days a week, you just need more people,” he says. “There is a shortage of radiologists and radiographers. But you can’t meet staffing through erosion of working conditions or, importantly, by not replacing capital investment.”