The government’s “utopian” plan for a seven-day NHS is doomed to failure due to a lack of doctors, money and diagnostic testing services, the leader of England’s non-specialist hospital doctors has warned.

Prof Jane Dacre’s gloomy prognosis is a blow to David Cameron’s key election pledge of turning the NHS into a seven-day service by 2020 in order to improve patients’ quality of care.

Deepening shortages of NHS medics and the inadequacy of vital support services – especially in social care – to allow patients to be discharged, means the promise is unrealistic, especially with the service’s £2bn deficit, Dacre said.

In an interview with the Guardian, the president of the Royal College of Physicians said: “I certainly have concerns about our capacity – not our capability – but our capacity to deliver some of the manifesto promises, particularly in an environment where we’re constantly being told how difficult it’s going to be financially.

“This idealised utopian NHS where you can have seven-day services, access to care seven days a week … sounds brilliant, but I suppose the best predictor of future performance is past performance.



“And it’s difficult to see how that vision is achievable in the length of time that we’ve been given to achieve it. There are an awful lot of things that need to be fixed before we can start moving onto the big picture,” Dacre added.

The NHS could need as many as 40% more hospital doctors – 38,000 on top the 95,000 it already has – if it was to provide full emergency care services at weekends, she suggested. “If you assume that we’re just about coping in the five days that we’re working now, you need another two days’ worth. You’re asking for two days’ more work out of people. More doctors will be needed to do it,” Dacre said.

Jeremy Hunt’s speech in July this year caused ‘collateral damage’ among hospital doctors, Dacre says Photograph: David Gadd/Sportsphoto Ltd./Allstar

Hospital doctors will get stressed, burned-out and “feel stretched all the time … It’ll just be a constant hamster wheel” trying to deliver a seven-day service unless there is a major expansion in doctor numbers, she warned.

The NHS also needs an unspecified amount of extra money, over and above the £8bn more ministers have earmarked, to fulfil the pledge, she added.

And she warned that routine services currently provided on weekdays, such as clinics offering checkups used by millions of patients, would be hit by expanding the NHS into a seven-day operation. They would need to be cancelled or moved. And so the patients would have to be rebooked, she said.

Dacre believes a seven-day NHS is unrealistic at the moment because many hospitals do not provide the diagnostic, pharmacy, physiotherapy or occupational therapy services at weekends that doctors rely upon.

Similarly, she also identified the growing unavailability of both social care and lack of mental health services outside hospitals on Saturdays and Sundays as other major obstacles to realising what is now a key Conservative pledge.

Dacre’s plain-spoken scepticism will embarrass Cameron and Jeremy Hunt, the health secretary, who have repeatedly pledged that there will be “a truly seven-day NHS” in England by the end of this parliament.

She also criticised Hunt for causing “collateral damage” with a speech in July that many hospital doctors interpreted as a slur on their professionalism and dedication to their patients because Hunt said too few of them worked at weekends.

“They felt quite angry … It was uncalled for and unfair. Sixty-seven percent of our fellows and members are already doing it [working at weekends]. They’re in work, Jeremy,” she said, in an echo of the social media campaign by doctors that Hunt’s speech unleashed.

Leaders of other medical bodies welcomed Dacre’s comments.

“It’s highly ironic, and extremely worrying, that the government is hailing seven-day working as the solution to making patients safer when, in reality, it could have the opposite effect,” said Dr Maureen Baker, chair of the Royal College of GPs.

“Seven-day access is a good soundbite that might have won votes at the election but at a time when general practice is already creaking at the seams, it is a waste of NHS resources to be offering ear-syringing on a Sunday teatime, and it is our routine family doctor service that will suffer.

“We are overstretched, overstressed and overloaded, and ministers are out of touch if they think that routine seven-day services are achievable with the current resource and workforce pressures facing our profession”, Baker added. There is already evidence that some GP surgeries that had started opening at weekends – a longstanding Cameron ambition – have stopped doing so or cut back their opening hours due to lack of demand.

“Most consultants undertake shifts at nights and weekends, two-thirds of GPs work beyond so-called normal hours, and juniors doctors are training and treating patients around the clock. They are doing this under enormous pressure from rising patient demand, falling resources and staff shortages in many key specialities, including general practice,” said Dr Ian Wilson, chair of the British Medical Association’s representative body.

“Before expanding what the NHS currently offers, the government needs first to resource urgent and emergency care across community, general practice and hospitals to address the stresses these services face.

“Ministers then need to provide a detailed plan of how it intends to provide additional resources and staff to fit its plans so that patient care during the week is not damaged by their proposals,” added Wilson.

Andrew Gwynne, a shadow health minister, said: “David Cameron’s key election promise now looks to be in tatters. Labour has said all along that you cannot deliver a 7-day health service without the extra resources and staff the NHS needs.”

The Department of Health declined to respond directly to Dacre’s comments. A spokesman said only that: “Many doctors already work weekends but the simple fact is that there remains too much variation in standards of clinical care across the week and this is supported by Prof. Sir Bruce Keogh and the Academy of Medical Royal Colleges. We are determined to tackle the problem and improve care for patients.”

• This article was amended 15 October 2015. An earlier version said that Prof Dacre is “the leader of England’s hospital doctors”. This has has been corrected.

