The Doctors’ and Dentists’ Remuneration Body (DDRB) has published recommendations for reforming contractual arrangements for consultants and trainees to facilitate the delivery of healthcare services seven days a week in England, Northern Ireland and Wales. The recommendations will inform negotiations on the current national contracts for doctors. The Royal College of Physicians of Edinburgh (RCPE) has commented upon these recommendations.
Prof Derek Bell, President of the RCPE, said:
“We welcome the DDRB’s focus on patient care and its recognition that reform must be in the interests of everyone with a stake in the NHS. Understandably our Members and Fellows are looking for a contract and pay system that is fair and contains safeguards to address the challenges of the work that they undertake.
“The Royal College of Physicians of Edinburgh recognises the benefits of extending working at the evenings and weekends, and supports the development of a whole system approach to seven day working.
“However, we recognise this will require significant additional resources as well as strategic implementation. As well as increased cover from doctors, increased multi-disciplinary support will be required to provide, for example, diagnostic test results out of hours and ensure that resources are available in the community to support early discharge from hospital.
“To begin to address this we are hosting a workshop on consistent hospital services this month with the aim of producing a practical guide for hospitals and to inform future policy.
“Our Members and Fellows have, rightly, raised a number of concerns with the recommendations in terms of the impact that they will have on the working lives of junior doctors, trainees and consultants, as well as the impact on work life balance, morale, and the future sustainability of the workforce.
“The RCPE acknowledges that the ‘weekend effect’ impacts upon the quality of patient care whether this manifests itself as delayed treatment or poorer outcomes, including death.
“However, this needs to be set in the context of all clinical staff struggling to provide the best possible care under difficult circumstances; often with reduced staff, increased locum use and insufficient infrastructure or support services.
“The College has consistently called for safe staffing levels to be implemented across all hospital disciplines to ensure the delivery of excellent patient care.
“The DDRB notes that most international public healthcare systems do not currently provide a twenty four hour, seven day per week service. This highlights the need to ensure that any changes are properly assessed and based on evidence before being implemented. The College believes that more evidence is required to inform future policy, avoid over ambitious government plans, and provide sustainable solutions.
“If we fail to address the concerns of our Fellows and Members now then this will impact on the future sustainability of the workforce in the NHS. Only by providing appropriate working conditions in the NHS can we ensure that we recruit and retain a highly skilled workforce in what are clearly challenging times for the NHS.”
Dr Rosemary Hollick, Chair of the RCPE’s Trainees and Members’ Committee, said:
“Doctors in training are feeling increasingly under pressure and under-valued in what remains a difficult time for those working in the NHS. Morale is at an all-time low and we are facing a growing crisis in the recruitment and retention of doctors.
“Junior doctors are already routinely working seven days and play a crucial role in providing extended cover.
“Excellent training equals excellent patient care and this needs to be facilitated by a safe and supportive environment in which to train.
“Imposing contractual changes upon junior doctors and removing these safeguards will further devalue the role of doctors in training and directly compromise patient safety and quality of care.
“As the College’s committee representing Trainees and Members, we will continue to raise our concerns with these developments.
“We were also involved in setting up the working group on the role of the Medical Registrar, which is actively looking at how we support and value the this vital role.
“Maintaining the respect and trust of junior doctors and consultants is essential to delivering excellent patient care within in our NHS.”
