OOH GP services – A Shameful reduction in standards, and increase in expense

ITV enquiry by Alice McShane and Produced by Sam Collins reported 22nd July 2015: ‘Shocking failures’ of after hour care

What happens if you fall ill out of hours? You’d hope you’d be able to access the same standard of treatment as you would during the working day. But is this really the case? A recent undercover investigation of our NHS Out of Hours service for ITV’s Exposure series has alleged “shocking failures ” in patient care. The programme sent Mark Austin and undercover reporter Alice McShane to a privately run Urgent Care Centre in West London and today they join us to tell us what they saw.

Nothing is shocking to us GPs who provided both normal and OOH (out of hours) services during most of our working lives. Some of the best and most rewarding years of my professional career as a GP was when we had a local GP co-operative. All the GP principals were involved, and we met to exchange ideas on improvement and treatment protocols, and helped each other with cover for sickness etc. When Mr Blair and the Labour government offered us “exit” in 2004 (BBC news 30th Jan 2007) without significant financial hardship we were stunned but grasped the offer… But the service for patients now is not as good as it was 10 or even 20 years ago.. And it costs a lot more in real terms… A shameful reduction in standards, and increase in expense… politicians are the guilty ones. They have created the system which is driven by lies and perverse incentives. Combined with rationing of doctors and nurses, It will lead to more litigation..

The program has some jargon on Key Performance Indicators (KPI) being fudged, and the evidence that OOH is more target friendly than patient friendly. Dr Mike Smith (A Hammersmith locum and also director of Haverstock Health, another OOH provider in North London) says “We have reached a point where disregard for basic processes to ensure basic patient care and safety are being ignored……. The whole thing only works if you have a GP trained in risk management at the front door.. Attitudes to patient care are questionable..”

It is not a requirement to have A&E experience to qualify as a GP, although it is desirable.. Nor is it a requirement to be able to read X rays, but there are few doctors willing to do this job, so relatively untrained personnel are appointed.

In the OOH centres, failing to meet targets means less cash, and less profit if the targets are not met. Therefore, the targets are “gamed” to ensure profit.. E.g. Early discharge within 4 hours, with unofficial follow up afterwards seemed commonplace..

A barrister, Simon Butler said “there are serious concerns about what Care UK contracted to do, and the reality of the service”… There is good evidence of understaffing at an average of 20% and as high as 50% undercapacity at peak demand times..

Catch up with the last week of This Morning on ITV Player

22/03/2013: Patients Association Criticise GP Appointments and Out Of Hours Service

Caring for your elderly and “continuous care”

2/5/2013: NHS watchdog severely reprimands Serco – a private company providing out of hours (OOH) GP services in Cornwall

3/10/2013: GP crisis. Out of Hours (OOH) and Out of Doctors – A&E Attendances

27/06/2015: OOH (Out of Hours) is very variable, and a disgrace. There is “No effective oversight”.

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

Setting sail in a boat already holed. The new government will fail unless it rations health. Proportional representation would be better than the inevitable mess to come..

Why are we not controlling cancer pain adequately in the community?

The True History of GP Out of Hours Services | A Better NHS

The NHS and reckless election promises. How about posthumous voting?

 

The media does publish “good news” – but far too early, raising expectations unreasonably…. Do you know what is not covered in your Regional Health service?

The media does publish “good news” – but far too early, raising expectations unreasonably. Eastern researchers are not held in great esteem and this work on prevention of cataracts needs to be validated and confirmed in the West. Meanwhile, for many years to come, second cataracts will be rationed out by some post-code administrations, and prevention of the speed of dementia onset will suffer the same covert rationing… Do you know what is not covered in your Regional Health service?Oliver Moody in The Times 22nd July 2015 reports: Cataract eyedrop treatment offers thousands hope

Eyedrops that may cure cataracts have been developed by scientists in a breakthrough that could eliminate the need for surgery. British doctors carry out an estimated 300,000 operations to remove clouded lenses each year, making it the most common surgical procedure in the country.

Although the operations are cheap and take as little as half an hour under local anaesthetic, a drug that can sort out the condition without the need for patients to go under the knife would be a significant advance.

A team of Chinese scientists studied the DNA of two families with a genetic predisposition to cataracts and found that they shared mutations of a gene called LSS, linked to the production of an important structural molecule.

The lens, which refracts light on to the retina at the back of the eye, is made up of millions of slender, fibrous cells containing proteins called crystallins, whose density plays a role in determining the clarity of a person’s vision.

Cataracts form when these proteins become damaged and the cells make opaque clumps that scatter light. Lanosterol, an enzyme produced by the LSS gene, appears to break these structures down in the healthy eye and keep cataracts at bay.

Tested on cloudy lenses taken from rabbits and on live dogs with cataracts, the compound was found to make their eyes significantly clearer and to break up the clusters of proteins on a molecular level. Scientists hope that it will have the same effect on people.

“Cataracts are the leading cause of blindness and millions of patients every year undergo cataract surgery to remove the opacified lenses,” they wrote in Nature. “The surgery, although very successful, is nonetheless associated with complications and morbidities. Therefore, pharmacological treatment to reverse cataracts could have large health and economic impacts.”

In an accompanying editorial J Fielding Hejtmancik of the US National Eye Institute said that the drug showed great promise. “The potential for this finding to be translated into the first practical pharmacological prevention, or even treatment, of human cataracts could not come at a more opportune time,” he wrote.

Because it has to bend light with such precision, the lens is one of the most delicately structured parts of the body, and the crystallin proteins that govern its shape are some of the densest human tissues.

As people age these proteins are not replaced and the fibre cells in the lens lose their alignment, often leading to a natural clouding effect in the eyes of old people. The cells can also be damaged by ultraviolet light from the sun.

Dr Hejtmancik said that a drug for treating or preventing cataracts would be of particular use in places where surgery was not cheaply available.

“Although surgery to remove cataracts is efficacious and safe, ageing populations around the world are predicted to require a doubling of cataract surgery in the next 20 years,” he wrote.

“The same population demographics suggest that the need for surgery could be reduced by almost half.”

Tom Whipple in the same paper reports: New drug could slow progress of Alzheimer’s

….After decades of failed attempts costing pharmaceutical companies billions of pounds, a manufacturer has released the results of a human trial that it says shows that it is possible to slow the rate of decline in patients with the disease.

…Although the effect of the new drug, solanezumab, was small, researchers said that it could have exploited a crucial chink in the disease’s armour, pointing the way to better treatments. However, others cautioned that the trial was too small to consider the results a breakthrough in what remains a poorly understood neurological illness….

Gone, but not forgotten | The Economist

 

 

 

New plan to develop frontline NHS Wales workforce

Recruitment to Wales is a problem because the aspirations of doctors and surgeons are for excellence. They hope their children will aspire as well, and the infrastructure and the attitude of the politicians needs to support such aspiration. This used to be the case, particularly in Education, where teachers from Wales were highly valued and sought after in the first half of the last century. With the WG elections next year, the last thing the assembly will want is Hospitals closing because of lack of applicants. Perhaps some are considering Australia? (Australia offers free weekends to lure NHS consultants)

The Aneurin Bevan Health Board on Friday 17th July announces yet another move to help recruitment. “New plan to develop frontline NHS Wales workforce“…

A new plan to strengthen the primary care workforce to deliver new models of care and look after more people close to their homes has been published by Health and Social Services Minister Mark Drakeford today

The primary care workforce plan will be backed by an extra £4.5m of funding as the Welsh Government continues to invest in primary care to recruit, educate and train the wide range of healthcare professionals who are key to providing health services in local communities.The majority of patient contacts with the Welsh NHS are in primary care services, such as GP surgeries; NHS dentists or local opticians. The plan outlines how the Welsh Government will continue to invest in GPs, community nurses, pharmacists, healthcare support workers and other clinical staff to provide more care closer to people’s homes and move services out of hospitals.

The plan supports the continued development of the 64 primary care clusters across Wales, which include GPs working with pharmacists, dentists, optometrists, therapists, nurses and healthcare workers.

It calls for a more robust and joined-up approach to workforce planning, including greater sharing of information, which will help redesign ways of providing care outside hospitals.

The strategy also includes a number of actions to stabilise core sections of the workforce, including GPs and nurses, by supporting people who want to return to practice or work part-time; exploring how training and working in general practice can be encouraged in areas of greatest need and communicating the opportunities afforded by general practice in Wales.

Measures include:

• Increase the number of Welsh Government-funded places on return-to-nursing practice courses
• Investment in advanced and extended skills, including non-medical prescribing and advance practice education
• Working with health boards and universities to develop an education and training programme for physicians associates in Wales
• Establish how Wales can move to a position where multi-professional training becomes the norm for centrally-funded NHS education programmes
• Expand the range of care settings in which training can be carried out and build on the experiences of learning wards in community settings
• Analyse existing and future Welsh language population needs and the support needed by the workforce to meet those needs
• Establish a national programme of organisational development for the 64 primary care clusters
• Expand the GP retainer scheme, which offers flexible working opportunities to encourage professionals thinking of retiring to stay in work part-time
• Reimburse medical school fees when a newly-qualified doctor commits to a career in general practice
• A national GP recruitment campaign promoting the benefits of a career in Wales
• Changing the law to make it easier for GPs registered to work in England to work in Wales for short periods of time without the need to make a full application to join a Welsh health board’s performers list
• Working with medical schools to increase the proportion of general practice and community placements medical students experience.

ProfessorDrakeford said:“Our goal is to meet the rising demand for healthcare by making the most of the skills our dedicated primary care workforce already have and supporting them in their continued desire to innovate and improve the services they provide every day.

“This can be achieved by bringing together teams of people with the necessary skills to meet the needs of people and the local communities they serve. It is also important that everyone in those teams works at the top of their clinical competence – they only do what only they can do.

“This prudent healthcare approach to developing our primary care workforce will improve access to care and the continuity and quality of that care.  It is also central to rebalancing the workload of all those who work in primary care so roles and services are sustainable and can adapt to meet future demand.”

Australia offers free weekends to lure NHS consultants

Government should not be surprised or offended. After all, we have been stealing doctors from Africa, and the Indian subcontinent for years, and only allowing 11:2 applicants to have places to train in Medical School here in the UK. (Medical Schools: your chances – applications-to-acceptance ratio was 11.2.) Who would want to be a consultant in the UK when the minister derides their contribution …?

	Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

Kat Lay in The Times 22nd July 2015 reports: Australia offers free weekends to lure NHS consultants

Australia is sending a message to NHS consultants: come and enjoy our glorious sunshine and beaches and we will not make you work seven days a week.

Health recruiters are trying to lure British consultants with big salaries and promises of a better “work-life balance” after the health secretary’s threat last week to impose seven-day contracts.

An email advertising six-figure salaries for consultant radiologists said that the weekend working contract might mean that it was “time to start thinking about a new life in Australia”.

The BMA said that it showed that Jeremy Hunt’s speech last week, in which he said he would remove opt-outs of weekend working from new consultant contracts, had been “a spectacular own goal”. Two online petitions against Mr Hunt continuing as health secretary have amassed more than 200,000 signatures between them.

The email sent to doctors last week from the Head Medical recruitment agency based in Edinburgh promised that in Australia “the work/life balance not only genuinely exists as a way of life, but is also promoted by the employer as a unique selling point.”

Mr Hunt, speaking at the King’s Fund last Thursday, said: “No doctors currently in service will be forced to move on to the new contracts, although we will end extortionate off-contract payments for those who continue to exercise their weekend opt-out.”

He accused the BMA of being “a roadblock to reforms”, adding: “Be in no doubt: if we can’t negotiate, we are ready to impose a new contract.”

A BMA spokeswoman said: “His attack on the profession is being used as a recruitment tool to lure doctors away from the NHS at a time when many parts of the health service are facing a recruitment and retention crisis.”

The pay scale for consultants in England starts at £75,000 and goes up to £101,000 after 19 years. In contrast, there are adverts for a £190,000 general surgeon post in Queensland, a £165,000 psychiatry post in Queensland and a £118,000 emergency medicine consultant job in New Zealand.

The email from Head Medical sought consultant radiologists with salaries from £125,000 to £400,000.

Even abortion clinics move and change location if necessary.

Radhika Sanghani in The Telegraph headlined “Abortion protesters force British clinic to close – but no one will say where- The British Pregnancy Advisory Service has claimed that ‘intimidating protesters’ have forced an unnamed abortion clinic in the UK to close”

It would have been more accurate to say the clinic has to move. Demand will be reducing as there are fewer teenage pregnancies – good news – but there are still plenty of accidents in the older woman.. (Teenage pregnancy in England and Wales at lowest rate ..) We should never ration abortion..

Even abortion clinics move and change location if necessary. The attitude of people unsympathetic to abortion is sad. When I was a GP in Pembrokeshire in the 1980s we had quite a few Irish women asking for help…

 

Your notes are the property of the secretary of state – but he has never had them before until after death. Now he and the PM want them and their “data” before death.. is any IT handling safe in government hands?

Your notes are the property of the secretary of state – but he has never had them before until after death. Now he and the PM want them before death.. It is the “data” that they really want, and they seem to think it will help the assessment of GP workload. It will, but it is only part of the picture, and using the data alone would reinforce the over-management style of the last 20 years. \why not trust the professionals – they say they are overworked so they are… Taking time to get the data is simply procrastination.. The ethical issues don’t worry NHSreality as the politicians don’t have the brainpower and the time to drill down to individual level. Their failures in IT so far tell us they won’t get far! Anonymised data sets are essential to preserve confidentiality – especially if psychiatric histories are not to become a potential time bomb. Selling data to drug companies can be safe – but is any IT handling safe in government hands?

Randeep Ramesh on 17th March2014 reported: Online tool could be used to identify public figures’ medical care, say critics

OmegaSolver’s Patient Analyser tool has been taken offline after concerns over use of ‘patient-level’ data

Randeep Ramesh reports in the Guardian 21st July 2015: PM plans patient data grab in proposals for seven-day NHS

Privacy campaigners raise concerns over NHS official’s letter to IT companies asking for confidential data for patients who get a ‘seven-day’ service

Randeep on 26th June reports: NHS patient data plans unachievable, review finds

Major Projects Authority says care.data and NHS Choices schemes have ‘major issues’ with schedule, budget and project definition

and on 17th June 2015: NHS patient data audit uncovers ‘significant lapses’ in confidentiality

HSCIC starts spot checks after failures including researchers getting patient-identifiable data without approval

On 19th Jan 2014:NHS patient data to be made available for sale to drug and insurance firms

Privacy experts warn there will be no way for public to work out who has their medical records or how they are using it

In a worse case scenario NHSreality can forsee GP records being culled to contain the minimum, and a written old fashioned record, or a second database being used for “confidential data”. Already this may have to happen in Wales, where punishment for going private is endemic..

Health boards take over 42 doctor’s surgeries as GP shortage crisis deepens. It’s happening now. Implosion of your health services due to prolonged rationing by undercapacity, underprovision and denial.

It’s happening now. Implosion of your health services due to prolonged rationing by undercapacity, underprovision and denial.

Vivienne Aitken reports for the Daily Record 17th July 2015: Health boards take over 42 doctor’s surgeries as GP shortage crisis deepens

and in the same paper on 19th July: NHS crisis: Doctors claim a lack of new GPs is putting patients’ lives at risk.. and we need action now

HEALTH boards are resorting to emergency measures to help practices where doctors are facing burnout and patients are waiting longer to be seen as the GP shortage crisis in Scotland grows.

SCOTTISH LABOUR last week said the country’s GP surgeries were in trouble as doctors retire amid a shortage of new recruits. Here, two doctors warn that urgent action is vital to protect patients.ortage crisis in Scotland grows.

Remember Neil Roberts warning on 2nd October 2014 in GP Mag: GP workforce crisis could force 600 practices to close, warns RCGP

New research from the college estimates that the recruitment and retention crisis in general practice threatens to force 543 practices in England alone to shut down in the next 12 months, with up to 600 at risk across the UK.

RCGP data show that over 90% of GPs working in these practices are aged over 60.

The research found:

• More than 1,000 GPs will be leaving the profession on an annual basis by 2022.
• Around 22% of GPs in London could step back from front-line patient care within the next five years (with 41% of London GPs aged over 50).
• The number of unfilled GP posts has nearly quadrupled in the last three years (2.1% in 2010 compared with 7.9%  in 2013)….

Well reality has happened. Judith Welikala confirmed the figures 4 days ago in the Local Government Chronicle: Nearly 600 GP practices closed since 2010

Nearly 600 GP practices have closed in the last five years, data seen by LGC’s sister title Health Service Journal reveals.

However, patient list sizes have steadily risen over the same period, which suggests a shift towards larger scale providers.

Between 2010-11 and 2014-15, 599 GP practices closed, according to Health and Social Care Information Centre figures. Ninety-four practices opened during this time (see graph below).

Ninety-one practices closed in 2010-11, rising to 115 in 2011-12 and 145 in 2012-13. The figure fell to 99 in 2013-14, but jumped to 149 practice closures last year.

The numbers include practices that have merged or been taken over, and are therefore still providing services. There has been a push by policymakers to scale up primary care, and it is a feature of the new models of care outlined in the NHS Five Year Forward View.

The average number of registered patients per practice has steadily increased in the past five years, from 6,610 in 2010 to 7,171 in 2014, according to the information centre (see table below).

Average list size, 2010-2014

Year	Average practice list size
2010	6,610
2011	6,651
2012	6,891
2013	7,034
2014	7,171

Richard Vautrey, deputy chair of the British Medical Association’s GP committee, told HSJ the figures “demonstrate the trend towards bigger practices which has been a steady pattern over recent years”.

However, he said: “It is likely that this could be accelerating as practices which were previously sustainable are becoming unsustainable because of funding cuts, rising workload and difficulties with GP and nurse recruitment.”

Dr Vautrey predicted there would be a “significant difference from the steady state situation” in the current financial year, as “all of these pressures are coming to bear”.

He said there were “significant changes going on around the country, with practices actively considering mergers, which they weren’t doing before, and with a number of small practices and with older GPs deciding that enough is enough and closing as a result of the various pressures they’re facing”.

He said he thought 2013-14, when fewer practices closed, was a “blip”.

“The only thing that could potentially account for it… would be that [reviews into GP practice funding] hadn’t yet started at that point, and so maybe some practices were waiting to see what the approach of NHS England would be before making any decisions about closing or merging with other organisations,” he said.

 

Rationing of weight management services undermines health efforts

Dennis Cambell in The Guardian 20th July reports: Rationing of weight management services undermines health efforts

When everyone except the politicians talks openly about post-code and covert rationing we really are in denial. They have become the laughing stock of the professions. No wonder we have all disengaged..

Access is being restricted to exercise programmes, NHS health checks and mental health services, according to research by Royal Society for Public Health

People who are dangerously overweight are being denied vital help because weight management services are being rationed to save money, despite rising obesity, public health experts have revealed.

Access is also being restricted to exercise programmes, NHS health checks, mental health services and efforts to help smokers quit, according to new research by the Royal Society for Public Health.

In a survey it conducted of 100 public health officials working for the NHS and local councils just under half (49%) said that weight management programmes had been rationed in their area in the last year. Almost as many (44%) had seen restrictions placed on the availability of exercise referral programmes, which help people with diabetes or heart problems adopt healthier lifestyles.

Live Andy Burnham says he will follow Labour whip and abstain on welfare bill – Politics live

Rolling coverage of all the day’s political developments as they happen, including David Cameron’s speech on tackling extremism and the debate on the welfare bill

Read more

Experts claimed the rationing would undermine efforts to counteract expanding waistlines. “To ration nationally agreed weight management programmes is both short-sighted and quite stupid. It could well be unethical if patients’ hope of returning to good health is prejudiced,” said Tam Fry, a spokesman for the National Obesity Forum.

UKactive, which promotes physical activity, said limiting exercise referral programmes, in which GPs give patients a programme of regular exercises, was hard to understand given the known benefits of tackling sedentary behaviour.

“These findings are extremely worrying,” said Steven Ward, its executive director. “Being physically active can treat, prevent or manage 20 lifestyle diseases, such as diabetes and heart disease. This is a time for an industrial-scale rollout of services, not for reducing already established services.”

Over a third (35%) said access to NHS health checks had been limited in their area, while 32% had seen child and adolescent mental health services rationed, despite the sharp recent rise in concern about their unavailability.

People who are dangerously overweight are being denied vital help because weight management services are being rationed to save money, despite rising obesity, public health experts have revealed.

Access is also being restricted to exercise programmes, NHS health checks, mental health services and efforts to help smokers quit, according to new research by the Royal Society for Public Health.

In a survey it conducted of 100 public health officials working for the NHS and local councils just under half (49%) said that weight management programmes had been rationed in their area in the last year. Almost as many (44%) had seen restrictions placed on the availability of exercise referral programmes, which help people with diabetes or heart problems adopt healthier lifestyles.

Live Andy Burnham says he will follow Labour whip and abstain on welfare bill – Politics live

Rolling coverage of all the day’s political developments as they happen, including David Cameron’s speech on tackling extremism and the debate on the welfare bill

Read more

Experts claimed the rationing would undermine efforts to counteract expanding waistlines. “To ration nationally agreed weight management programmes is both short-sighted and quite stupid. It could well be unethical if patients’ hope of returning to good health is prejudiced,” said Tam Fry, a spokesman for the National Obesity Forum.

UKactive, which promotes physical activity, said limiting exercise referral programmes, in which GPs give patients a programme of regular exercises, was hard to understand given the known benefits of tackling sedentary behaviour.

“These findings are extremely worrying,” said Steven Ward, its executive director. “Being physically active can treat, prevent or manage 20 lifestyle diseases, such as diabetes and heart disease. This is a time for an industrial-scale rollout of services, not for reducing already established services.”

Over a third (35%) said access to NHS health checks had been limited in their area, while 32% had seen child and adolescent mental health services rationed, despite the sharp recent rise in concern about their unavailability.

King’s Fund asks Hunt: How will seven-day care be funded?

On 17th July the Commissioning review reported: King’s Fund asks Hunt: How will seven-day care be funded? Is the minister grounded in reality?

Kings Fund: (Health and social care: three priorities for the new government Mounting deficits, worsening performance and declining staff morale mean that the NHS is facing its biggest challenges for many years, while pressures on social care are escalating. The challenge for the government will be to strike a balance between addressing unprecedented short-term pressures and initiating the long-term changes needed to place the NHS and social care on a sustainable footing. The stakes could not be higher.)

Yesterday, the secretary of state set out his 25-year vision for the NHS, but Chris Ham, chief executive of The King’s Fund says the £8 billion increase will not cover his seven-day care plans.

Ham welcomed seven-day care as “the right ambition” but branded it “difficult to deliver”.

This was partly due to challenges to ensure sufficient numbers of staff are available at the weekend, and also “the question about how it will be paid for”, he added.

“The £8 billion increase in the NHS budget the government has pledged by 2020 is the bare minimum needed to maintain standards of care and will not cover the additional costs associated with a seven-day NHS,” he said.

However, The King’s Fund said there was “much to welcome” from Hunt’s speech, including the continued focus on safety and quality of care, and the emphasis on transparency and learning, rather than target-driven systems.

Ham commented: “Many of the themes in the speech will strike a chord with NHS staff but they will take time to deliver results.

“The test will be whether the emphasis on devolution and self-improvement can be maintained in the face of short-term political imperatives – ministers invariably find it difficult to resist intervening, particularly when NHS performance declines,” he said.

Kings Fund priorities:

1. New funding and higher productivity

2. A new approach to NHS reform

3. A new settlement for health and social care

Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

Department of Health: Unsocial hours pay unnecessary for staff retention

The Commissioning Review on 17th July 2015 reports: “DH: Unsocial hours pay unnecessary for staff retention”

An interestingly naïve point of view. In an undercapacity market based economy you would expect the minister to understand the drivers…

The Department of Health (DH) branded unsocial hours payments unnecessary for the recruitment and retention of staff, in the Agenda for Change report, released this week.

They told the committee working on the report that the increased payments between 8pm-6am on weekdays, and all day Saturday and Sunday are not “in themselves necessary to recruit and retain the staff the NHS needs”.

All of the parties involved in creating the report (including    ) supported the implementation of seven-day care where there is an identified clinical need to do so, however some bodies disagreed about unsocial hours payments.

Contrasting the DH, the Royal College of Nursing (RCN) warned that three quarters of nursing staff who do shift work were reliant on shift premia, and imposed changes to terms and conditions would cause further distress and risk industrial upset at a time of great uncertainty and upheaval.

The report suggested that money could be saved, as currently when over half of a shift is classed as unsocial hours the whole shift is paid with unsocial hours premia.

Currently, some employers share the Agenda for Change definition of unsocial hours starting at 8pm, however others use a 10pm definition, as suggested by NHS Employers. The report said “neither time would be seen as out of line”.

National and international evidence reveals that employees are generally compensated for working unsociable hours, reflecting factors such as increased worker costs, disruptions to family life, effects on worker physical and mental health and overall employee well-being, the report said.

The report also noted that there “appears to be potential for efficiencies in the healthcare system through a move to seven-day services, for example from improved patient care, better patient flow through the system, reduced length of stay in hospital and better utilization of assets and resources.”

In the context of current financial constraints, it concluded that it would be important to identify these, and further work is needed on this.