SENIOR CARE AND REVIEW
Many of the detailed recommendations also offer potential for improving standards, including the recommendation that ‘hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient’s case’. However, we believe this should not be a matter for local hospitals to consider and discount; instead this should be enshrined in national standards. The benefits of early senior review in reducing mortality, and of consultant-delivered care are clear and the requirement to have a named senior clinical lead responsible for individual patients could greatly assist efforts to improve continuity of care in increasingly fragmented clinical environments. Clearly, this will require moving towards a consultant presence seven days per week, over an extended working day, and this will have to be taken into account by workforce planners. The recent report from the Academy of Medical Royal Colleges and Faculties provides related standards which require to be implemented in the NHS.
Historically, the NHS has relied heavily on the goodwill and commitment of consultants to work well beyond their contracted hours. However, there is evidence that this ‘goodwill model’ is not sustainable.4 Doctors cannot be expected to absorb additional commitments ad infinitum while continuing to provide high quality patient care. This reality and the changing mood within the workforce, in which young doctors are increasingly choosing alternative career paths away from the medical specialties, must also be taken into account when planning what level of workforce will be required to provide high quality, safe patient care. In parallel, we must work to ensure that future generations of doctors are supported, do not become disengaged and less committed to delivering care and are prepared to work beyond hours as patients’ needs require.