Emergency departments are always open 24/7 all year round. Yet, the staffing levels are modelled exactly the same as every other service: full staffing during the week, bare minimum levels at the weekends and public holidays.
At some point, we have to ask whether an Emergency Department can function as a Monday to Friday service with weekend adjustments. Because illness does not recognise weekends. Sepsis does not slow down on Sundays. Elderly patients do not stop falling because it’s a bank holiday. Mental health crises do not wait for Monday morning.
Yet, our systems still behave as though weekends are somehow “out of hours” rather than simply another phase of continuous demand. Anyone who has worked enough weekends in any A&E in world knows this already.
The waiting room does not care what day it is. The ambulance queue certainly does not. The corridor patients do not either.
In fact, weekends in many hospitals are often worse. There are:
- fewer discharges,
- reduced specialty presence,
- limited diagnostics,
- delayed social care input,
- thinner staffing across the hospital.
The result is the Emergency Department absorbs the pressure of an underpowered system.
For years, hospitals have tried to run weekend care on the assumption that demand is lower or somehow manageable with reduced infrastructure. But modern emergency medicine has evolved far beyond the era where weekends represented quieter periods.
EDs are now seeing relentless volumes, higher acuity, older patients, and increasing complexity every single day of the week. People who can’t see a GP over the weekend end up in A&E except they’ve not had an accident or in any emergency!
Yet, we have a very big problem is because the staffing models have not evolved at the same pace.
We still often treat weekday staffing as the “real” staffing and weekend staffing as contingency staffing. But if the workload remains consistently high across all 7 days, then perhaps the staffing needed during the week is simply the staffing needed at the weekend too.
That has enormous implications. Because once you accept that reality, you can no longer justify skeleton weekend rotas or reduced downstream support. Maybe there would still be slower specialty reviews but there shouldn’t be limited access to diagnostics and therapies,
or pretending Monday morning can absorb the backlog safely.
Emergency Medicine is unique because it is the visible end of every failure elsewhere in the system. When community care struggles, ED feels it. When inpatient flow collapses, ED holds it. When social care freezes over weekends, ED becomes the waiting room for the entire healthcare system.
And perhaps that is why corridor care has become so normalised. Not because clinicians accept poor care, but because the structure surrounding Emergency Medicine still operates on assumptions from a healthcare system that no longer exists.
The reality is that a 7 day demand definitely requires 7 day infrastructure. Not symbolic “weekend cover” but actual equivalence.
Equivalent staffing.
Equivalent diagnostics.
Equivalent decision-makers.
Equivalent discharge capability.
Because an Emergency Department cannot sustainably function at full demand with half-capacity systems supporting it two days every week. That’s like fighting with 1 hand behind your back.
Eventually, healthcare systems will have to reconcile this contradiction.
Emergency Medicine eventually has to confront the uncomfortable truth that the traditional weekday/weekend staffing model no longer reflect the reality of modern emergency care.
Either we accept that emergency care is now fundamentally a 7 day high-intensity service and resource it accordingly, or we continue designing hospitals around a weekday rhythm while expecting Emergency Departments to endlessly absorb the consequences.
And no department, no matter how resilient its staff are, can continue carrying that mismatch forever.
@Tsarina_muna My GP days are definitely more stressful than ED days. I am in training and would move to ST3 in August and not really looking forward cos of the intense stress in the GP land. In the ED ATM and i always leave on time, I work at my pace , it is opposite in the GP land.