Only 200 clinical rotas in England require more time to implement the 48-hour working week for junior doctors, claims the government.
Health secretary Andy Burnham gave a two-year delay from implementing the Working Time Directive, which comes into force on 1 August, to just 3% of the rotas involved in a review of 6,646 across 247 NHS Trusts.
The rotas given a derogation included those providing 24-hour immediate patient care, supra specialist services and units in rural and isolated areas.
Dr Wendy Reid, the Department of Health’s national clinical advisor on the WTD, said: “A huge amount of work has been done to get us to the stage we’re at now.
“The royal colleges have provided tremendous support and, over the last six months, have formed a real link with strategic health authorities and worked on those 6,600-odd rotas.”
But the high level of rota compliance was disputed my medical leaders. Recent data from the strategic health authorities showed a more significant and worsening problem.
Mr John Black, president of the Royal College of Surgeons, said: “We’re at a loss to understand the success the DoH is claiming in addressing this issue. The relatively low numbers of rotas applying for derogation does not reflect the true story being played out at the frontline of hospital care.
“The situation is very serious indeed and misrepresentation of the nature and scale of the problems that hospitals will face in providing safe and effective services to patients in the coming months is grossly irresponsible and does a great disservice to those who rightly expect safe and high-quality care.”
The college has argued that trainee surgeons need to be able to work a 65-hour week in order to be properly trained.
Matt Jameson Evans, co-chair of Remedy, said: “Derogation for 200 rotas will have negligible impact on the huge numbers of non-compliant rotas that exist in reality. This is the year when rota gaps have reduced many training opportunities to just fire fighting service shortages.”
The BMA was disappointed by the derogation and urged the trusts involved to ensure their rotas are compliant in two years time. Dr Andy Thornley, chair of the BMA’s junior doctors committee, called on the government to focus on the impact to doctors’ training.
“We’re worried about how compliance has been achieved in some areas. In the last minute rush to maintain patient services, opportunities for trainees to learn new procedures have been reduced,” he said.
“If we do not equip our junior doctors with the necessary training we risk jeopardising the levels of medical expertise that patients deserve.”
The DoH’s Reid said the government were committed to sustainable compliance and would continue scrutinising rotas.
She said: “It is not the end on 1st August but the beginning. We need trainees to accurately report and have their hours honestly reflected. And the royal colleges and strategic health authorities have to continue working through this with trusts.”
An independent scrutiny panel reviewed all the services requiring derogation. The panel was chaired by Dr Judith Hulf, president of the Royal College of Anaesthetists and joint chair of the EWTD Reference Group, and also included representatives from the royal colleges, BMA, SHAs and NHS Employers.
A guide to the WTD.
