Seven-day psychiatrists

Unless you’ve spent the last few months in a cave, you’ll know that David Cameron is dead-set on turning our NHS into a ‘seven-day service’.

He hasn’t given much detail on what it’ll look like, or how it’ll differ from the current set-up (in which doctors already routinely work 7 days a week), but the current arm-twisting of doctors into a contract which would force them to work more weekend days for the same pay shows that he really wants it to happen. Whatever it is.

So how might psychiatrists adapt to working routinely at the weekend, instead of just being on-call for urgent jobs and emergency assessments? Despite the mean and unthinking way that the government have gone about their proposals, I do think that psychiatrists could make substantial changes to their practice to acknowledge that mental illness doesn’t just work 9 to 5, Monday to Friday. It depends on the setting though.

I see relatively little point in asking consultant psychiatrists on inpatient units to work routinely at weekends. If they work on a Saturday or a Sunday, it would only mean they’d have to make up their time off on a weekday at some point, so nothing would move quicker overall. Unless other staff were in work on the same weekend days, like junior doctors and OTs, there would be limited effect from a consultant presence anyway. There would also be substantial legal and practical issues to having a different consultant work routinely on the weekend on another consultant’s ward (for example, if all the inpatient consultants were on the rota to come in at the weekend). Patients under section are meant to be under the care of their responsible clinician, and they’re the only people who can give them leave or discharge them. This person shouldn’t be chopped and changed. Also, psychiatric care is like painting a picture – no matter how good the artists are, if too many of them help with the project, you’ll just end up with a confused mess.

Could psychiatrists work more routinely in A+Es? After all, we know that liaison psychiatry services are patchy, but would consultant presence at the weekend fix this? Well…possibly….but in many smaller A+Es a consultant psychiatrist would be sitting around drinking coffee all day. In the larger ones, their juniors would still be seeing patients first (or else how would they learn), limiting their workload. I don’t see why they couldn’t be at home, available for emergencies, as they already are.

What about community and crisis teams – could psychiatrists work more for these at the weekends? For me, this is the most likely setting in which psychiatrists could be seven-day beings. It seems entirely feasible for them to hold emergency clinics and do emergency home reviews, as well as follow-up on the more distressed patients that have arisen during the week. If they work in a team of many consultants, there would be relatively little stress in running a rota of weekend shifts, as the weekdays would still be covered by colleagues. But this too could meet with implementation problems. Weekend GP surgery pilots have had to be cancelled recently as no-one turned up; perhaps that might happen to consultant psychiatrists too.

Whatever the proposed plan, there needs to be recognition of the following:

  • Psychiatrists work hard at weekends already
  • We are chronically short of doctors (and other staff), seven-day working is not a fix for this
  • Psychiatry requires continuity of care, seven-day working should not jeopardise this
  • Working more at the weekends will leave staffing holes during weekdays
  • Doctors should be adequately compensated for working more at weekends. The current contract offer is a joke.

As always I’m keen to hear how things work (or don’t work) in your area, and your ideas for the way forward.

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About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

4 Responses to Seven-day psychiatrists

  1. donnakemp says:

    Reblogged this on LYPFT Planning Care Network.

  2. Mark Catlin says:

    Reblogged this on markcatlin3695's Blog.

  3. Judy says:

    All very good points, psychiatric treatment is typically long term, responsible clinician is an important concept for patients, if you are seeing a consultant it is unlikely that it is important that they see you at the weekend. I understand the key shortage is getting s12 approved doctors out to do MHA assessments, ………………….

  4. Fenella lemonsky says:

    Alex as ever good points. Locally OOH ( Barnet ) it is rare to see a consultant after 9pm unless MHA or another extreme reason. Usually if prescribing it’s needed a junior doctor comes unless the junior doctor needs
    Another opinion . I think it would be good to have more consultant hours outside the normal working day. However we already have a number of vacant posts we cannot fill and I’m currently involved on a consultant
    Recruitment round and one per one doctor has already said he could family commitments he is on able to work weekends. So yes a wonderful idea and it would benefit patients as well as for the junior doctors and long hours at the weekends however I’m unclear how logistically it would work.

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