Seven day consultant present care

Seven Day Consultant Present Care

Professor Norman Williams

Chair, Academy Steering GroupPresident, Royal College of Surgeons of England

The Benefits of Consultant-Delivered Care

‘the benefits of consultant-delivered care should be available to all patients throughout the week …. work should be undertaken by clinicians and employers to map out the staffing requirements and service implications of implementing a consultant-delivered service throughout the week’

The weekend challenge…

• Higher case-mix adjusted mortality - new admissions and in-patients

• Greater illness severity amongst weekend admissions

• Fewer consultants in hospital

Weekday

Weekend

Standard 1

Hospital inpatients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless it has been determined that this would not affect the patient’s care pathway.

Standard 2

Consultant-supervised interventions and investigations along with reports should be provided seven days a week if the results will change the outcome or status of the patient’s care pathway before the next ‘normal’ working day.

Standard 3

Support services both in hospitals and in the primary care setting in the community should be available seven days a week to ensure that the next steps in the patient’s care pathway, as determined by the daily consultant review, can be taken.

Seven Day Consultant Present Care – Follow up

Purpose: to develop a more detailed understanding of the implications of each of the standards for each specialty in order to encourage and assist implementation.

Approach

•Questionnaire (10 questions) sent to specialty organisations with inpatients•Responses from 36 different specialties•Followed up results with an additional 14 organisations•Final report reviewed by Academy Council on 13 November 2013•Issue has high profile:

• NHS Services Seven Days a Week Forum• HSJ gathering readers opinion• Sunday Times campaign

The Key Findings

•Report framed as a catalyst for local conversations.

•Factors such as the specific specialty and whether the patient is known to the consultant impact the duration of a consultant led review.

•Assuming the patient is known and looking at the most common durations given by specialties: for 30 inpatients, around six hours of consultant time is needed each day at the weekend to undertake consultant led inpatient reviews.

The Key Findings (cont’d)•Effective multi-disciplinary team working is essential.

•Opportunity for coaching and supervision of doctors in training.

•Some investigations, interventions, hospital based and community based services are more critical to effective weekend care than others. For example:

– laboratory services, radiology, ultrasound and cross sectional imaging

– emergency surgery, interventional radiology and therapeutic upper gastrointestinal endoscopy

– physiotherapy, occupational therapy, pharmacy– patient transport, access to social care

The Key Findings (cont’d)

•Planning in advance for transfer of care.

•Delivering consultant present care at weekends is likely to require additional consultant appointments as well as reorganisation of the existing consultant workforce and increased resourcing for community based services; careful job planning is essential to minimise the impact on patient care during weekdays.

The Key Findings (cont’d)

•How Trusts might meet this demand will depend on a number of factors, including:

– case mix and complexity of patients within a Trust, some of whom may require a high level of specialty expertise

– whether consultants are already covering weekends– level of ‘generalist’ skills– the flexibility of workplans.

•Possible resourcing approaches:– Invest to save – reductions in morbidity / improved

outcomes– Reshaping of services– Greater levels of networked / federated arrangements– Need detailed financial modelling

Thank you

www.aomrc.org.uk

www.hislac.org