The provision of a 7 day service in the NHS has been the subject of many news headlines recently. At Wrightington, Wigan and Leigh NHS Foundation Trust (WWL) we started to develop a comprehensive 7 day service for emergency care, predominantly within the division of medicine. A business case for £2.1million was successful and this allowed the Trust to recruit 36 additional staff in order to be able to develop enhanced cover and an enhanced service over Saturday and Sunday. An important point here however is that this included just 9 Consultants. The majority of staff recruited were not doctors they were, for example, porters, pharmacy technicians, health care assistants. With the additional Consultants in Acute and Emergency medicine the Trust was able to develop sustainable rotas, which provided 7 day 13 hours/day on-site Consultant cover in medicine and cover in the ED up until midnight. The rota for Consultants in medicine, which remains in use today, is given in Figure 1 below. The gastroenterologists and cardiologists provide “hot week” cover. During their “hot week” the Consultant has no other fixed commitments and is freed up to provide daily in-reach to the assessment wards as well as overnight on-call for procedures such as urgent endoscopy or temporary pacing respectively. The cardiology rota is currently 1:5 and gastroenterology 1:6 frequency.
Figure 1
Since the implementation of an enhanced 7 day working model at the Trust, there have been a number of observed improvements in quality measures which are strongly linked to the fact that every day of the week the Trust now has more staff on-site caring for patients. This includes reductions in unnecessary short /zero length of stay admissions (due to early senior decision making now happening 7 days a week and throughout the day) and mortality.
WWL has shown that an enhanced 7 day service is possible and does improve the quality of care provided to patients. Yet to succeed, it does require investment and it does require the provision of additional staff across the whole team to support the work and not just more Consultants/doctors on the wards.
Author: Dr Stephen R Gulliford FRCP – Consultant & Clinical Director, Unscheduled Care, WWL NHSFT.
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Twitter: @StephenGulli
