Does the NHS really need 24/7 opening?

Doctor Doctors complain of being under intense pressure

On the face of it, having an NHS at your beck and call 24 hours a day, seven days a week sounds like a good idea.

After all, who doesn't appreciate having a supermarket that you can call into at all hours?

But - and this is the point doctors have been trying to make at their annual conference - is it really necessary or even affordable?

The health service has already tried to expand opening hours across GP practice.

Under Gordon Brown's premiership GPs were pushed into opening late into the evening and on Saturdays.

Most did, but some of the clinics failed to attract many patients and in a number of areas the extended opening has been reduced or stopped altogether.

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It does not take a genius to work out that in such a cash-strapped era something will have to give if seven-day working is to be achieved.”

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Another factor against 24/7 opening is the cost.

If there is going to be weekend non-emergency care, such as hip and knee replacements, and outpatient appointments it will need a lot more staff beyond just doctors - as London GP Dr Chaand Nagpaul spelt out to the British Medical Association conference in Edinburgh.

"It will actually cost formidably more as you factor in all ancillary services from porters, ward clerks, routine pathology, nurses and physios in hospital and community health visitors, social workers and pharmacists."

Others expressed similar sentiments. Surgeon Anna Athow warned the NHS would be at risk of losing money, while supermarkets open up because they can "make money".

It does not take a genius to work out that in such a cash-strapped era something will have to give if seven-day working is to be achieved.

But if questions marks do remain about the idea of convenient access across the whole system, one area that would undoubtedly benefit from more of a focus is the urgent and emergency care system.

Emergency care

Unlike routine care, patients needing this part of the system have no choice over when they need help. The system has to be there - as it obviously already is.

But at the moment the evidence suggests it is not working as well as it should be.

For instance, it has been recognised for some time that the chances of dying increase at the weekend, in part due to expert staffing levels being lower than on weekdays.

In fact, NHS England estimates that if mortality rates were the same as they are during the week then an extra 4,400 lives would be saved each year.

It is why the issue is being looked at as part of Professor Sir Bruce Keogh's review into the system.

The review is in its infancy, but Sir Bruce is already adamant about what he wants to achieve. "We need to build a safe, more efficient system 24 hours a day, seven days a week," he says.

The challenge is clear. Even if patients understand that the NHS may never be there whenever they want it like a supermarket, they will be rightly expecting high quality round-the-clock care when they really need it.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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