Juniors caring for ‘too many very ill patients’, RCP survey shows

22 December 2010

JUNIOR doctors are caring for "too many very ill patients" because of a lack of consultants out-of-hours, the Royal College of Physicians has claimed.

They say patients deserve better care in hospitals in the evenings and weekends and that there are not enough senior doctors available during these times. Issuing a new statement on doctors’ working hours, the college said work rotas and the structure of the entire medical team need to be urgently reviewed.

The College also said it is concerned by "the mounting evidence of poor care delivered to patients in hospital" and has recommended for the first time that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours a day, seven days a week. That consultant, the statement says, should have no other duties scheduled during this time.

The statement follows a survey by the RCP of 126 hospitals from 109 different trusts in England, Northern Ireland and Wales. It found that none had more than 12 hours of weekend cover from consultants specialising in acute medicine. Only three per cent of hospitals surveyed provided this level of cover for nine to 12 hours and nearly three-quarters had no specialist cover at all.

The survey follows research published in the summer which revealed people admitted as emergencies on a weekend were more likely to die than if they were brought in during the week.

RCP president Sir Richard Thompson said there have been big improvements in the care of seriously ill patients in recent years but out-of-hours is still falling short.

He said: "Patients are still not getting the care they deserve at night and at weekends. 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."

He has been backed by health secretary Andrew Lansley who said: "Patients do deserve better care at night and weekends and senior doctors should be available to provide acute medical care as needed." The minister said he is already looking at ways of increasing the involvement of consultants in direct clinical care at night and at weekends.

Some of the reports used by the RCP to support its argument were gathered by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which reviews the care of patients and has looked at problems in emergency care.

Dr James Stewart of NCEPOD says there is a bigger issue that needs to be looked at. He argues that junior doctors need to be better trained to care for the very ill and to spot those who are falling ill on other wards. "Concentrating on consultant involvement alone will not resolve this important issue unless junior doctors are educated and trained to a higher standard."