As far as the government is concerned, the implementation of the 48-hour for juniors has had no impact on either clinical care or the training of juniors. When the Working Time Directive (WTD) is criticised, the stock response is that there’s no evidence to suggest they’ve been compromised.
They have, however, acknowledged juniors’ concerns about their training and, back in July, at the eleventh hour, asked Medical Education England (MEE) to conduct a review.
It’s been a long time coming but, just before Christmas, MEE announced the review was underway. MEE has appointed Professor Sir John Temple, former president of the Royal College of Surgeons of Edinburgh and chair of the Specialist Training Authority, as review chair.
Sir John and his expert group will soon be listening to oral evidence, and this will include focus groups and face-to-face meetings. A final report is due to be presented to the health secretary by April.
Evidence is now the big issue. The government believes the PMETB Survey of Trainees for 2009 supports its current position. There is, however, a growing body of evidence which contradicts this just not from ‘official’ sources.
A survey by Remedy showed a high level of rota non compliance among juniors. Then a large survey among surgical trainees showed that two thirds felt training was being compromised. And then there’s the small matter of record numbers of junior doctor vacancies as more people are required to fill rotas. Are you telling me this isn’t compromising care?
Sir John needs to cast far and wide in his search for evidence. Often ignored, frontline doctors have important stories to tell. Mr Peter Mahaffey, consultant surgeon in Bedford, recently dropped me a line. He said: “There can barely be a senior consultant surgeon anywhere who hasn’t witnessed the extraordinary reduction in practical skills amongst trainees and more frighteningly the relative helplessness of new consultant colleagues fresh from this neutered training.”
He was responding to an article by Mr Munchi Choksey, consultant neurosurgeon at University Hospitals Coventry and Warwickshire NHS Trust, which criticised the Royal College of Surgeons for not having done more to resist the implementation of the WTD.
Sir John has to get beyond the usual suspects and canvass frontline opinion. The acquiescence of many of the profession’s representatives, including many of the royal colleges and the BMA, has brought the profession to this crisis point.
He also needs to park the knighthood, retain his independence and be prepared to tell the health secretary some hard truths about the impact of the 48-hour week, as I’m sure a rigorous evidence search will reveal.
Will this review simply re-arrange the deck-chairs on the Titanic? I hope not. Tomorrow’s patients also deserve confident, highly trained and experienced hospital doctors.
I love this talk of ‘no evidence’ of harm to training. I’ll have you know there’s ‘no evidence’ that running around on a motorway is a bad idea. We all already know it is. It’s just that we have more important things to do than sitting round waiting 5 years before we can audit all the ways in which it has effected care and training and say I told you so.
I repeat myself (having said this in many places before) because it is necessary to do so until someone who has the power to act accepts the principles!
The EWTD was never intended for the professions. I know of nobody who is successful in any walk of life who has not worked more than 48hrs per week ‘on the way up’ - and usually continues to do so once that have ‘arrived’!
The ‘leaders’ of the profession have been incredibly slow to ‘cotton on’ to the implications of the EWTD - mainly because they failed to grasp that the need to provide ‘emergency cover’ for 24hrs per day did not, necessarily, involve any training for juniors; nor does this ‘cover’, necessarily, HAVE to be provided by trainees! At last, the present President of the RCS has accepted that there is a problem - and has said so publicly.
So, here’s hoping that Sir John Temple will ‘grasp the nettle’ and accept that, in its present form, the EWTD is unworkable in hospital practice (and maybe general pratice, too); and that it is having an adverse effect on the profession as a whole, and trainees in particular.
Retired Orthopod.