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Situational questions

Seven day service

In 2015, the concept of a “seven-day NHS” was proposed – an NHS that would deliver a consistently high level of care every day of the week. The reason for this were concerns regarding outcomes for patient admitted to hospitals over the weekend, as highlighted by the Department of Health & Social Care’s findings. A stark statistic in 2015 was that there was a 16% increase in the risk of mortality for patients admitted to a hospital on a Sunday, as compared to a Wednesday – this was particularly prominent in patients with acute or unspecified renal failure, who were at an increased mortality risk of 37%. Patients with neck of femur fractures presenting during the weekend had a 24% increased likelihood of having to wait longer than 2 days for their operation, potentially affecting their long-term outcome. The “Seven-day Services indicators” publication in September 2019 later highlighted that patient discharged home over the weekend (Friday – Sunday) had an increased risk of having an emergency readmission within a week, as compared to those discharged on a Wednesday. Those who had an emergency admission on a Saturday were also more likely to have a slightly longer hospital stay.

Here are some key aspects of the Seven-Day Service initiative in the NHS:

Components: The Seven-Day Service initiative includes various components, such as extending the availability of routine and emergency care, diagnostic services and elective procedures to weekends and evenings. It also involves improved access to primary care services and ensuring that patients receive consistent levels of care regardless of when they seek medical attention.

Emergency Care: One of the critical aspects is providing consistent emergency care services, including accident and emergency (A&E) departments, throughout the week. This aims to reduce waiting times and provide rapid access to care for patients with urgent medical needs. This also helps in reducing ambulance off loading and 4,12 and 24 hour breaches in A & E.

Elective Services: The initiative also involves expanding the availability of elective (non-emergency) procedures and surgeries to weekends and evenings. This can help reduce waiting times for elective treatments and surgeries.

Staffing: To ensure success of the seven day service NHS need to ensure adequate staffing levels.  The NHS has worked on recruiting and retaining staff to meet the increased demand though number of reasons exists that make recruitment and retention of staff within the NHS a mammoth task.

Integration: The initiative emphasizes the need for better integration between different healthcare services including primary care, hospital care and community care to provide more seamless and coordinated care to patients.

PatientCentred Care: A central goal is to provide patient-centred care that is responsive to patients’ needs and preferences. This includes involving patients in decisions about their care and ensuring they have access to services when they need them.

Quality Improvement: Continuous quality improvement is an essential part of the initiative. The NHS monitors and evaluates the impact of the Seven-Day Service on patient outcomes, waiting times and the overall quality of care.

The Seven-day Services indicators provide information on how we can effectively measure both improvement and variation in care provision across the week. Indicators on the following topics are included:

  • Emergency readmissions within seven days of discharge by day of discharge
  • Mortality within 30 days of admission by week-part of admission
  • Length of stay following an emergency admission by day of admission

NHS digital previously published data on seven day service indicators up to 2020 April. This is no longer available.

It’s important to note that implementing a Seven-Day Service in a healthcare system as large and complex as the NHS is a significant undertaking, and progress may vary across different regions and healthcare providers. The goal is to provide better access to care and improve patient outcomes by ensuring that healthcare services are available and consistent throughout the week.

Impact of seven day service on job planning for consultant

The implementation of a Seven-Day Service in the NHS (National Health Service) in the United Kingdom has had a significant impact on job planning for consultants. This initiative aimed to extend healthcare services to seven days a week and reduce variations in care quality and access across different days of the week.

Seven day service planning requires careful job planning for work pattern for all involved in patient care. Following are some key elements to consider when job planning for consultants:  

Changes in Working Patterns: Consultants have seen changes in their working patterns and schedules. With the expansion of services to weekends and evenings, consultants are required to work on days and at times when they previously did not. This can impact their work-life balance and personal lives. You should look at the frequency of weekend work/on-call.

Increased Workload: Seven days service means that consultants are often dealing with a higher workload. This can include providing clinical care, attending emergencies and performing elective procedures during weekends and evenings. As a result, consultants’ job plans need to be adjusted to accommodate increased working hours.

Rotational Shifts: Some consultants may be required to work rotational shifts, including weekends and nights to ensure that there is adequate coverage for emergency care and other essential services leading to changes in their job planning and schedules. The consultants had the option to opt out of weekend work though at risk of salary reduction but with new consultant contract proposal by Jeremy Hunt this is not possible.

Service Redesign: To support the Seven-Day Service, healthcare organizations often undergo service redesign to ensure that the right mix of staff and resources is available at all times. This can involve changes in the way services are organized and delivered.

Quality Improvement and PatientCentred Care: Consultants are encouraged to play a role in quality improvement efforts related to the Seven-Day Service. They need to participate in initiatives aimed at improving patient outcomes, reducing waiting times and ensuring patient-centred care.

Flexibility and Adaptability: Consultants may need to be more flexible and adaptable in their approach to job planning. This can include being willing to work on weekends, participating in on-call rotations, and collaborating with colleagues to provide continuous care.

Resource Allocation: The implementation of the Seven-Day Service requires healthcare organizations to allocate resources, including consultant time and expertise, more efficiently. Consultants may need to work closely with management to ensure that staffing levels are appropriate to meet the increased demand.

Career Progression: Consultants who actively contribute to the success of the Seven-Day Service and demonstrate leadership in quality improvement initiatives may see opportunities for career progression and leadership roles within their organizations.

Overall, the impact of the Seven-Day Service on consultant job planning can vary depending on the specialty, location, and healthcare organization. While it has brought about changes in working patterns and demands, it has also provided opportunities for consultants to contribute to improved patient care and healthcare system efficiency. Effective communication, collaboration and support from healthcare organizations are essential for consultants to successfully adapt to these changes.


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