Seven-day services: the first 100 days of the new government

Establishing a seven-day health service is a key priority for the new government.

Following on from the Conservative Party’s manifesto commitment to provide a ‘truly seven-day NHS’, both the Prime Minister and the Secretary of State for Health have invested significant political capital in delivering this, pointing to evidence that suggests that an ‘uneven service’ is linked to poorer patient outcomes.

The principle of seven-day services has widespread support. However, a number of practical issues will need to be addressed before the government’s ambition can become a reality, particularly the challenge of ensuring that sufficient hospital consultants and other staff are available at weekends. Proposed changes to the consultant contract raise the prospect of difficult negotiations with the British Medical Association. It will also require additional investment at a time when most providers are already in deficit.

Changes to Monitor's risk assessment framework

The government has set out its intention to deliver seven-day services across the NHS. This includes developing primary care services, in particular extending access to GPs to include evenings and weekends. More than 50 pilot schemes are currently trialling extended opening hours and innovative ways for patients to access GP services, using funding from the Prime Minister's Challenge Fund set up under the last government.

The government also wants hospitals to operate a full service seven days a week. In addition to signalling its intention to make changes to consultant contracts, the government has suggested it will seek to address other barriers to seven-day services by increasing access to weekend diagnostic services and improving provision of more out-of-hospital care to facilitate weekend discharges.

Proposed change to consultant contracts

In the first clear move towards seven-day hospital services, in mid-July Jeremy Hunt announced changes to contracts for new consultants that will mean they are no longer able to opt out of non-emergency work in the evenings and at weekends.

The government has indicated that, under the new proposals, consultants will not be expected to work increased hours or more than 13 weekends in a year. Consultants will also continue to receive a higher rate of pay for working unsocial hours, with increased pay and benefits in particular service areas, such as A&E and obstetrics, and faster pay progression.

The proposals follow unsuccessful attempts by the previous government to agree changes to consultants’ terms and conditions with the British Medical Association (BMA). Negotiations between the government and the BMA in 2014 broke down, and in July 2015 Jeremy Hunt indicated that he will progress with the proposals whether or not an agreement is reached.