Higher patient mortality at weekends needs to be tackled but proposals for seven day working must be ‘sensible and realistic’, the chair of the British Medical Association consultants committee has told HSJ.

Paul Flynn, a consultant obstetrician and gynaecologist, said the government and NHS Employers would find the BMA “open for business” if obstacles to talks on how to increase consultant presence at the weekends were removed.

Dr Paul Flynn

Any new offers must prevent consultants working excessive hours, Paul Flynn warned

He warned any new offer must have strong safeguards to prevent consultants working excessive hours and must be properly funded.

Dr Flynn accepted mortality rates were higher at weekends for elective and non-elective patients, but said the evidence was “limited”. He said: “There are differences in mortality, and that is all anyone has proven. What we haven’t proven is what the cure for that is. We think rapid access to consultant level care will fix it but we don’t know that because nobody has done it and demonstrated it.”

The BMA walked away from negotiations with NHS Employers in October, bringing to an end 18 months of talks over changing consultants’ contract terms and conditions. The talks focused on removing the opt-out on non-urgent work at weekends and changing their pay progression.

Dr Flynn said the talks stalled because of a lack of data from NHS Employers on what the changes would mean and no agreement on safeguards: “We didn’t have anything other than pure assumptions not based on any fact at all to populate the modelling. If those obstacles were removed then we are open for business. The best option for patients and consultants is a national contract achieved through sensible, realistic negotiation.

“We were always prepared to talk about the removal of [the opt-out]. The problem was we needed to have safeguards to protect consultants from burnout and it was getting those taken sufficiently seriously to be put into the contract which was a very big obstacle for us.”

NHS Employers had recommended guidance on a 40 hour week and no more than 13 weekends a year, but Dr Flynn said: “Guidance is just that and we have had a lot of experience in the past with guidance where some employers just didn’t adhere to it. If it is in the contract it is absolutely clear it has got to be done, that was always the position for us.

“In the end this does have to be approved by consultants in a vote and it does have to carry their confidence.”

He said it was “wrongheaded” to portray doctors as the obstacle to seven day services arguing the real barrier was the cost. He said there needs to be “an honest debate with the public” about what employers can afford.

He added that the BMA would “definitely take it seriously” if there was a request to negotiate again.

The Review Body on Doctors’ and Dentists’ Remuneration is expected to publish its recommendations on the future terms and conditions for doctors in July.

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