Improve out-of-hours care - Royal College of Physicians
Junior doctors are having to care for too many patients because there are not enough consultants on duty at weekends and in the evenings, according to the Royal College of Physicians.
The RCP says there is mounting evidence of poor out-of-hours care in hospitals.
It is calling for a consultant to be on duty for at least 12 hours a day, seven days a week.
The RCP carried out a survey of 126 hospitals in England, Wales and Northern Ireland.
It found that none had more than 12 hours of weekend cover from senior specialists in emergency medicine.
Just 3% provided nine to 12 hours of cover, and nearly three quarters of hospitals in the survey had no specialist cover at all.
The survey follows research published in the summer which revealed people admitted as emergencies on a weekend were more likely to die than if they were brought in during the week.
The RCP also says consultants should be freed up to concentrate on the care of seriously-ill patients rather than holding clinics and performing other duties.
Nights and weekends
The president of the Royal College of Physicians, Sir Richard Thompson, says there have been some major improvements in the care of seriously-ill patients in recent years but out-of-hours is still falling short.
"Patients are still not getting the care they deserve at night and at weekends.
"Too many junior doctors are covering too many very ill patients, and this has to change.
"Our evidence shows that a predominantly consultant-delivered medical service is the best way to improve patient care."
The health secretary Andrew Lansley agrees.
"Patients do deserve better care at night and weekends and senior doctors should be available to provide acute medical care as needed."
Mr Lansley says he is already looking at ways to increase the involvement of consultants in direct clinical care at night and at weekends.
Some of the reports used by the RCP to support its argument were gathered by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which reviews the care of patients and has looked at problems in emergency care.
Dr James Stewart of NCEPOD says there is a bigger issue that needs to be looked at.
He argues that junior doctors need to be better trained to care for the very ill and to spot those who are falling ill on other wards.
"Concentrating on consultant involvement alone will not resolve this important issue unless junior doctors are educated and trained to a higher standard."
The RCP says doctors are already working long hours, with the latest census showing consultants work an average 50 hour week.
That is four-and-a-half hours longer than their contracts and more than the 48-hour limit set by the European Working Time Directive.
A survey carried out in April showed junior doctors were covering an average of 61 patients overnight, but one junior doctor was looking after 400 patients.
The RCP says that rather than increasing the hours of doctors still further, new shift patterns will have to be worked out.