Extended Opening Hours is a No Brainer. So What’s Stopping Us?

The UK’s recent summer budget was certainly operating on summer time when the Chancellor reiterated his commitment to 8am to 8pm GP service delivery despite professional resistance and continuing evidence warning of the risks of such an edict.

The extension of working hours is, at best, a band-aid solution to a festering wound, which could be lethal if its only treatment is a dose of political posturing from both the profession and the politicians.

The global assumption that increasing face-to-face time with providers will improve outcomes has never been further from the truth.

The simple truth is clinicians operate better in the working week and during the day.

Only last month new data was published showing that despite the European Working Time Directive and the Seven Day Services Project, the increase in mortality after major surgery carried out on Fridays was seen consistently across eight of England’s nine regions.

The “weekend effect” is alive and well. The simple truth is clinicians operate better in the working week and during the day – we are human and subject to our hormones. The problem is that services are planned around optimal use of facilities but evaluated by the activities of providers.

This is a logic mismatch. Planning should be around what works and is preferable to forcing a universal 24/7. Where sound evidence supports rapid treatment (irrespective of the hour in the day or the month in the year) and improves outcomes, successful around the clock service provision follows.

So, rather than turning health institutions into travel destinations where maximal occupancy is the measure of good business acumen, we should be learning from established best clinical practices. For example, we have effective emergency services and urgent treatment to ensure optimal outcomes, as seen in the treatment of cardiac conditions where the rapid insertion of coronary stenting and initiation of thromboembolic medications has significantly changed patient outcomes.

Highlighting what works in an urgent setting through meticulous collaborative research and stakeholder involvement has provided the evidence in the cardiac arena and achieved a positive outcome.

But in longer duration problems it is harder to predict the trajectory of care. All may be well with a patient in the operating theatre on a Saturday but by midnight Sunday things may have changed for the worst.

What is needed is an in depth inquiry to see how healthcare professionals function across all aspects of care. A Seven Days Heath Research Directive might be a good start.

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