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Implementing the standards for 7 day working provision in your clinical directorate

Dr Mark TempleDr Mark Temple

Dr Mark Temple Consultant Nephrologist and Physician Heart of England NHS Foundation Trust & Acute Care Fellow and Future Hospital Officer,  Royal College of Physicians spoke at today’s Effective Clinical Director conference on:

•implementing 7 day working provision in your directorate
• the benefits of consultant delivered care
• developments from the Academy Working Group: what this means for Clinical Directors?


Acute illness is a seven day problem. Patients are just as likely to develop an acute medical condition requiring emergency medical admission on a Saturday or Sunday as on a weekday. There is now growing body of evidence that patients in the UK who are admitted as an emergency at weekends are at higher risk of death than those admitted during the week, and that mortality in hospital is higher during the weekend.  The Royal College of Physicians recommends that a consultant physician, without conflicting duties, should be available on site to review patients at least 12 hours a day, 7 days a week. The acute duties of this physician should be centred on the Acute Medical Unit (AMU) where at least 2 consultant led rounds should be conducted daily.  The RCP Acute Care Toolkit “Delivering  a 12 hour, 7 day consultant presence on the AMU” launched jointly with the Society of Acute Medicine in October 2012,  includes practical tips, rotas and calculations of the number of consultants required to provide this cover.   

The provision of high quality care to acutely ill patients requires the necessary staffing, diagnostic and specialist support services to be available 7 days a week throughout the hospital. The way care is organised in the AMU and the associated enhanced staffing  contrasts with the situation encountered on many of the wards receiving AMU transfers.  Furthermore transferring patients out of AMU often breaks continuity  of care, presenting an additional risk to the recently admitted patient  with an evolving acute illness, particularly when the transfer occurs during the week-end. To reduce this risk and improve the continuity and quality of care some hospitals have adopted enhanced review arrangements by a consultant post transfer. 

At Heartlands Hospital all patients transferring out of AMU receive a consultant review within 24 hours of their transfer irrespective of their new ward location, by the consultant team responsible for their ongoing care. This represents an important element of 7 day working for consultant physicians and is a priority duty in the first hour of each working day – the “golden hour” review. The review provides a framework for consultant duties on all medical wards and linked (buddy) surgical wards, focussed on a patient cohort likely to derive considerable benefit from senior clinical review. This includes patients where the diagnosis or management plan is unclear, those who are acutely ill or not responding to treatment and patients suitable for discharge.  

The Future Hospital Commission report to the Royal College of Physicians (September 2013) made a series of recommendations about the organisation of healthcare designed to improve continuity of specialist medical care to patients irrespective of their location in hospital or the community. Patients should be at the centre of integrated, joined up care provided as close to their home as possible 7 days a week.

Dr Temple's full presentation is available for download at the bottom of this page.

Mark Temple is a Consultant Physician and Nephrologist at Heartlands Hospital, Heart of England Foundation Trust, Birmingham. As Clinical Director of Acute & General Medicine and Associate Medical Director he led on improving the quality and continuity of patient care in the Trust.  

Mark was appointed to the post of Acute Care Fellow, Royal College of Physicians in 2011 and was responsible for the Acute  Care Toolkit programme. Toolkit 4 focussed on “Delivering a 12 hour 7 day consultant presence on the AMU”

Mark co-chaired the hospital activity work stream  for the Future Hospital Commission. The Commission’s report  “Future Hospital: Caring for medical patients” was published in September 2013. In May 2014 Mark was appointed RCP Future Hospital Officer to lead implementation of  the report’s recommendations. 

Future conferences of interest:

Implementing the Named Responsible Doctor and Nurse in Hospital
Friday 3 October 2014 
ICO Conference Centre, London


Delivering a 7 Day Health Service
Monday 6 October 2014 
Hallam Conference Centre, London


Expert Witness Intensive Training Course: 2 Day
Tuesday 14 October 2014 — Wednesday 15 October 
Hallam Conference Centre, London


Data Quality and Clinical Coding for Improvement
Friday 17 October 2014 
Hallam Conference Centre, London


Clinical Audit Masterclass
Tuesday 21 October 2014 
Hallam Conference Centre, London


Effective Clinical Supervision Skills
Thursday 6 November 2014 
BPP Law School, Waterloo, London


Consultant Job Planning
Wednesday 26 November 2014 
Hallam Conference Centre, London


Masterclass: Effective Time Management Skills
Friday 28 November 2014 
BPP Law School, London


Out of Hours Care in Hospital
Tuesday 2 December 2014 
Hallam Conference Centre, London


National PROMs Summit 2014
Wednesday 3 December 2014 
Hallam Conference Centre


Masterclass: Clinical Academic Researcher
Tuesday 9 December 2014 
Hallam Conference Centre, London


Presentation Skills Masterclass
Wednesday 10 December 2014 
Manchester Conference Centre, Manchester


Monitoring & Improving Patient Safety
Thursday 11 December 2014 
ICO Conference Centre, London



Download: Dr Mark Temple full presentation

10 September 2014


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