The seven-day challenge
As hospitals within the NHS are required to extend more services into the weekend and evenings, pharmacists must prepare for new ways of working.
Your weekend is knocked out. You spend less time with your family,” says James, a hospital pharmacist who is trying to adapt to seven-day-a-week services. He already works on Saturday and Sunday on a shift rota, and is worried about how further extensions of the service, into the evening, could affect him. “It’s a concern, as someone with young children. It erodes your work-life balance.”
James is not alone. Across the country, more hospital pharmacy departments are extending hours and services to meet the demand — and pharmacists are encountering similar problems to James. To help tackle these concerns, the Royal Pharmaceutical Society held a summit on seven-day working on 20 May 2014 to explore how hospital pharmacies can make the transition.
So why are seven-day services important, and how can pharmacy departments help people like James adapt to the new way of working?
The idea behind seven-day working is simple: to provide the same level of essential NHS services to all patients seven days a week. In particular, the NHS plan, outlined in the 2012 report “Equality for all: Delivering safe care — seven days a week”, calls for a focus on admission prevention, early diagnosis and intervention, and early supported discharge.
The quality of services, particularly at weekends, also needs to be tackled. In 2012, a study published in the Journal of the Royal Society of Medicine analysed all 14.2 million admissions to NHS hospitals in England in 2009–10. It found that patients were 16% more likely to die within 30 days if they were admitted to hospital on a Sunday compared with a Wednesday, and were 11% more likely to die if admitted on a Saturday.
To address this problem, NHS England’s medical director, Sir Bruce Keogh, established the Seven Days a Week Forum, aiming to prepare hospitals for a seven-day NHS. This was followed in September 2013 by a report from the Royal College of Physicians’ Future Hospital Commission that detailed how hospital care should change.
A pillar of its plan was to make services available to acutely ill patients seven days a week, with a consultant-led presence on wards. In addition, it called for hospitals to ensure that “services [are] organised so that clinical staff and diagnostic and support services are readily available on a seven-day basis”.
They are used to working Monday to Friday, and now we’re dragging them into the dispensary at weekends.
This move is backed by the RPS, which in its standards for hospital pharmacy set a target of achieving “high quality care, including the challenge of seven-day care availability”.
The availability of pharmacists to deliver services such as discharges and medicines reconciliation is only one of many potential benefits. In 1991, the Oxford Radcliffe Hospitals NHS Trust adopted a seven-day residency model for its pharmacy department. This saw pharmacists working until midnight and remaining on 30-minute notice until the dispensary opened in the morning. The service meant that wards no longer needed to stockpile medicines, reducing ward supplies by 17% and slashing medicines waste by £30,000 a year.
Results such as this — providing a greater service that demonstrates pharmacists’ value — give cause for optimism among some hospital pharmacists.
“We are on the cusp of a revolution in pharmacy services,” says David Terry, deputy chief pharmacist at Birmingham Children’s Hospital, UK. “Not an evolution — a revolution.”
The hospital has 350 beds and until this year provided standard pharmacy services during office hours from Monday to Friday, with minimal dispensary services at the weekend. The department realised that this wasn’t enough.
“All our staff accepted that five-day services were no longer tenable,” Terry explains. “We’ve moved from staff expecting to work Monday to Friday as a contractual obligation. Now they are working Monday to Sunday for five days within seven.”
But despite this increased service, Terry’s department received no increase in funding, forcing the team to make some tough choices.
“Saturdays and Sundays were paid as overtime,” he explains. “That’s no longer going to be the case,” he says. “We’ve had to put in pay protection.”
We are on the cusp of a revolution in pharmacy services.
There has been no increase in the number of staff either, so the team has to work harder to maintain service levels across seven days. And the shift in working patterns had unexpected consequences for the availability of resources.
“The biggest implication is what happens to our specialist pharmacists. They are used to working Monday to Friday, and now we’re dragging them into the dispensary at weekends. That means they’re not doing their normal jobs during the week,” he says. “It’s a dilution of expertise.”
But there are opportunities too, Terry says, particularly once pharmacists become available on wards at weekends to offer their expertise. Birmingham Children’s Hospital is still working to achieve this. Terry also points to the possibility of pharmacists working as independent prescribers in accident and emergency (A&E) departments at weekends, and to the chance of recruiting community pharmacists to work in the hospital and bring their diagnostic skills to emergency care.
Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.20065814
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