The National Health System is on the brink of becoming a seven-day-service, with new plans unveiled to expand its weekend offering over the next three years, starting with urgent care services and supporting diagnostics.

NHS England's National Medical Director Sir Bruce Keogh has laid out ten new clinical standards outlining the standard of urgent and emergency care all patients should expect seven days a week, each supported by clinical evidence and developed in partnership with the Academy of Medical Royal Colleges.

The move comes on the back of findings that, shockingly, risk of mortality is 16% higher for those patients admitted on a Sunday than those coming in in mid-week.

This has been driven by variable staffing levels, fewer decisions makers of consultant level and experience and inconsistent support services such as diagnostics over the weekend, as well a lack of community and primary care services that might prevent unnecessary admissions and support timely discharge.

According to Sir Bruce, the new clinical standards "undo more than 50 years of accumulated custom and practice that have failed to put the interests of patients first", and he has recommended their adoption by the end of the 2016/17 financial year. 

Obviously a move to a seven-day-service will need greater resources, both financially and on the staff side. To implement the standards in a clinically and financially sustainable way, Sir Bruce said NHS providers and commissioners should explore new ways of working - in networks, collaboratives, and federations – considering distribution of services between organisations.

Incentives, rewards and sanctions

Also, he is recommending that NHS England back the standards with incentives and rewards and, conversely, sanctions for those hospitals that are non-compliant, in plans that will be discussed by the organisation later this week.

Increasing the number of doctors in training should also give the NHS "huge opportunities to work differently," he said, noting that, going by current projections, there should be a 60% rise in the number of consultants by 2020 to help meet demand.

"It seems inefficient that in many hospitals expensive diagnostic machines and laboratory equipment are underused at weekends, operating theatres lie fallow and clinics remain empty. This while access to specialist care is dogged by waiting lists and GPs and patients wait for diagnostic results," Sir Bruce said, stressing the need for change.

And support for the move seems strong. 

"Patients, employers, medical royal colleges and the government all want to see seven day care," said Dean Royles, chief executive of NHS Employers, and he told the BBC that the "clinical case for change is now overwhelming".

Practical implications

Mark Porter, Chair of BMA Council, agrees, and voiced support for urgent and emergency services getting priority for investment to ensure seriously ill patients receive the best possible care every day.

But he also noted that delivering more seven-day services will have a number of practical implications, and that "doctors are only one part of the solution".

As such, the BMA is in negotiations with NHS Employers and the Government to find "an affordable, practical model for delivering this care, while safeguarding the need for a healthy and productive work-life balance for doctors," he said.