Junior doctors' strike showed me how seven-day NHS should work

The government needs to invest in more allied health professionals to work alongside doctors every day of the week for a safe, effective NHS

am a junior doctor who took industrial action on 12 January by providing emergency medical cover for inpatients and for those admitted with heart attacks in a tertiary cardiology centre in central London.

I am a strong proponent of improving our healthcare system to provide a robust and safe service every day of the week. It is absolutely correct that a patient who is admitted as an emergency on a Sunday should be as safe and well supported as somebody admitted on a Tuesday. If you ask any doctor about safer and more effective weekend working, the mention of expanded diagnostic and therapeutic services will feature high on their wish list. Last Tuesday, I had the chance to experience working a “weekend” with these services, and the difference is remarkable.

Working during a normal weekend is not pleasant. In my department, each patient is seen every day by a senior clinician. It is my job to review all of the patients and enact the plans of the senior clinician to ensure that the patient is diagnosed correctly and receives the right treatments and therapies. I also respond to emergencies on the wards. Due to a severe lack of diagnostic and therapeutic services at the weekend, our interventions are severely limited. This means that the following are essentially out of bounds: ordering scans such as ultrasounds and CTs that aren’t for life-threatening emergencies, physiotherapy assessments and rehabilitation, discharge planning arrangements and social services reviews. World-class professors, who are leaders in their field, can make expert plans for diagnosis and treatment on a Saturday, but much of it still has to wait until Monday to happen.

I turned up to work at 8am on Tuesday 12 January – the fated first day of industrial action – and everything felt very much like a normal weekend. So far, so underwhelming. I started the ward round and accrued a list of tasks that needed to be completed for my patients. The strangest thing then started to occur. Unlike a normal weekend, my patient needed an echocardiogram (a heart ultrasound scan) and it happened. Another patient was unable to get out of bed because she had just come back to our ward after a long stay in intensive care. It was obvious she needed a physiotherapy assessment, but instead of accepting that she would have to spend a further two days in bed, the physiotherapist came to assess the patient. It was miraculous, but more importantly, it was exactly what should be happening at the weekend.

The government has stated that their aims for reforming the junior doctors’ contract is to remove a barrier to effective weekend working. I work three weekends in every seven and that is legal within the framework of the current contract. It is not a barrier to effective weekend working; it just ensures that me working these hours is recognised as antisocial and that my pay reflects that. Working during the strike further reinforced that doctors are just small cogs in a large machine. We are vital for the health and wellbeing of patients, but just as vital are physiotherapists, social workers and radiographers – who are in much scarcer supply at the weekend.

My eventual chosen field of medical practice is geriatrics – the care of older people living with frailty. This group of patients is the bread and butter of the NHS, making up a significant proportion of the patients who occupy hospital beds. Any acute illness has the propensity to reduce their mobility and two days of prolonged bed rest, without the aid of a physiotherapist to rehabilitate them, can have a profound and permanent effect on their ability to function and perform simple tasks such as wash or go to the toilet. I can treat their chest infection or heart failure, but it takes the entire team to get that patient better and to keep them healthy.
If the government is truly committed to a safe, effective, seven-day NHS it would do better to invest in more allied health professionals to work alongside the vast number of doctors who already work routinely every day of the week. Together, we can provide the care we all want to provide and ensure that plans diagnosis and treatment can be put into action, every day of the week.
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