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Seven-day working in hospitals

Could seven-day services compromise everyday care?

Adequate funding is needed if pharmacy teams are to deliver seven-day services safely.

Peter Leslie

When the Royal College of Physicians (RCP) announced in 2007 it was recommending that “modern acute hospitals will require daily clinical review of the entire bed base by a competent clinical decision maker to ensure efficient patient flows and to reduce length of stay”, I knew change would be on the way for pharmacy, too. Since that time it has not only been the doctors who have had to step up to seven-day working: all the other allied professions are being expected to follow.

Pharmacy has always supplied seven-day cover through the on-call commitment that was negotiated in the 1990s, but the requirement and drive for more than just a supply service has been growing. The need for pharmacists to be available to obtain drug histories and carry out medicines reconciliation at weekends, as a minimum, is now with us.

The need for pharmacists to be available to deliver similar services outside the standard Monday-to-Friday week to support and provide clinical decisions, especially around the use of medicines at weekends, is now with us.

Some trusts have been providing a seven-day service for several years. Others run seven-day residency schemes. These worked because there was money available at the time.

So how do the trusts that do not have such schemes currently in place convert five- or six-day working into seven-day working? That is the challenge facing most NHS trusts.

What could happen is that services currently available on weekdays will be cut to provide a service at weekends

A major concern from the Guild of Healthcare Pharmacists (GHP) council is that there will be no additional funding made available for this increase in cover and the resources of information about patients’ medicines available from GPs will not be sufficiently accessible. What could happen is that services currently available on weekdays will be cut to provide a service at weekends. Staff will either end up doing extra hours or have their hours spread over the week. For patients, the scope of services will be reduced during weekdays. For pharmacists, we know seven-day working means putting in extra hours for no extra remuneration. This is the “more work for less” ethos that is coming from the Government, which goes hand-in-hand with potential downgrading of jobs and services as a means of saving money.

The RCP and the British Medical Association, in October 2013, reinforced their position to work towards seven-day working and the GHP agrees with this move. But, along with the RCP and BMA, we are calling for proper funding and resources to be increased so that the safe care currently provided on weekdays is carried into the weekend. Otherwise, the prospect is for the standard of care to be reduced to the lowest common denominator over seven days rather than the weekend standard of care being raised to the level currently demonstrated during weekdays.

 

Citation: Clinical Pharmacist URI: 20065870

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