NHS relies too much on junior doctors says top medical body

Patients are being left in the hands of junior doctors because there is no adequate consultant cover on weekends, according to a new report.

The head of the Royal College of Physicians (RCP) said patients were not "getting the care they deserve" on weekends and during the night.

The College is calling on hospitals to ensure consultants are available every single day of the week for at least 12 hours per day.

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Its study found that none of the 126 hospitals it surveyed had weekend cover for more than 12 hours from specialists in acute medicine, and just 3 per cent provided nine to 12 hours of cover.

Some 73 per cent of hospitals in the survey had no cover at all over the weekend from specialists in this area, whose job it is to look after the most seriously ill patients and provide seniority in medical admissions units.

The study comes after reports over the summer revealed people admitted as emergencies on a weekend were more likely to die than if they were brought in during the week.

The death rate among people admitted as an emergency increased by 7 per cent at weekends in one year - or 3,369 more deaths than would normally be expected, one study found.

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A separate Government-ordered review from Professor Sir John Temple said too many junior doctors were left unsupervised on wards outside normal working hours.

It said the NHS was "too reliant" on trainees to provide out-of-hours care for patients and that some older consultants were reluctant to work later hours, preferring to stick to a standard week.

The RCP said yesterday it was concerned about the reliance on trainees, and research showed that a service led by consultants was "best for patient treatment and recovery".

RCP president, Sir Richard Thompson, said patients "are still not getting the care they deserve at night and at weekends".

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He added: "Too many junior doctors are covering too many very ill patients, and this has to change.

"Our evidence shows that a predominantly consultant-delivered medical service is the best way to improve patient care."

A survey for the RCP released in April found junior doctors were covering an average of 61 patients overnight. One junior doctor was responsible for 400 patients.

The latest research found that while care for very ill patients has improved significantly over the past few years, many patients are only seen once per day in a formal ward round instead of the recommended twice.

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The RCP wants consultants who do work weekends to be freed from other duties to spend more time seeing those who are seriously ill. This should involve cancelling other jobs, such as routine clinics or other duties.

The report found problems inside medical admissions units, with three-quarters of those accepting patients directly from GPs running out of beds.

The report relates to England, Wales and Northern Ireland.

Dr Jonathan Potter, clinical director of the RCP's clinical effectiveness and evaluation unit, said: "Despite improvements in facilities and staffing, hospitals still need to address working arrangements to ensure that senior doctors are readily available to provide a consultant-led service in acute medical admissions units seven days a week."

The Royal College is now recommending that all medical wards should have a daily visit from a consultant and, in most hospitals, this will involve more than one physician.

Grace Hammond