David Oliver
The series of strikes by UK resident doctors in recent years has required contingency planning to ensure that NHS hospital services remain safe and open. 1 We've managed to do this through consultants stepping up to provide more of the acute admission and inpatient ward cover and with the help of non-striking resident doctors, locally employed and specialty doctors, locums, and non-medical practitioners.It's not gone unnoticed by some senior NHS managers and medics that in some respects, front door assessment and patient flow through acute beds functioned more smoothly than normal. 2This shouldn't be a surprise.If you have senior decision makers in bigger numbers than usual on the clinical shop floor for longer each day, with few intermediaries and no teaching or training to do, then yes, patients can be assessed more quickly and decisions made promptly, with far less need for review.It follows in the minds of some NHS managers, government officials, and policy advisers that maybe this is how things should work all year round-a model for the perfect hospital.