Key facts
- A review of London hospitals found that reduced consultant presence on weekends is linked to higher patient mortality.
- Early findings suggest that improved weekend consultant cover could prevent over 500 deaths annually in London.
- Medical consultants were on site for an average of six hours per day during weekends, compared to 14 hours on weekdays.
- The hospital mortality rate for patients admitted at the weekend was 0.32% higher than for those admitted on weekdays.
- The Royal College of Physicians called for a review of hospital workforce patterns to ensure daily consultant physician input.
A review of acute medicine and emergency general surgery services in London has indicated that reduced consultant presence during weekends is associated with higher patient mortality rates. Early findings from the review suggest that improved consultant cover on weekends could prevent more than 500 deaths annually across the capital.
The survey, conducted by NHS London and London Health Programmes, involved 31 hospital emergency units. It revealed significantly less on-call consultant presence overnight and at weekends compared to weekdays. On average, admitting medical consultants were available on site for only six hours a day at weekends, a stark contrast to up to 14 hours a day from Monday to Friday. Similarly, on-call consultant emergency general surgeons were on site for four hours a day at the weekend, compared to 10 hours on weekdays.
The draft report, titled 'Acute Medicine and Emergency General Surgery: Case for Change', also highlighted that only half of patients admitted as medical emergencies on a weekend were consistently seen by a consultant within 12 hours, compared to three-quarters on weekdays. In the 2009-10 period, the hospital mortality rate in London was 0.32% higher for patients admitted at the weekend than for those admitted during the week. The report concluded that this difference diminishes significantly where reliable 24-hour services are available, and that reduced weekend provision is linked to higher mortality.
Andy Mitchell, medical director at NHS London, stated that the issue is not about finance or staff shortages but about current working practices failing to provide a high-quality seven-day emergency service. Richard Thompson, president of the Royal College of Physicians, wrote in a letter to The Independent that inadequate cover by junior doctors, influenced by contracts and directives like the European Working Time Directive, also contributes to the disparity in death rates. He emphasized the urgent need to review workforce patterns to ensure medical in-patients receive direct consultant input every day of the week, recommending at least 12 hours of on-site consultant physician presence daily.