Consultants hold the key to solving juniors’ lack of access to training following the implementation of the European Working Time Directive, a government-commissioned review finds.
The review, chaired by Prof Sir John Temple, acknowledges there are problems but suggests that they will not be eased by either increasing trainees’ work hours beyond 48 hours nor lengthening training programmes.
Instead, the Temple review suggests that rota gaps can only be overcome with a fundamental change in the way training and services are delivered. It says that, despite a 60% increase in consultant numbers over the past 10 years, hospitals remain reliant on juniors to provide out-of-hours services.
Sir John recommends a move to a consultant delivered service, with seniors more directly responsible for the delivery of 24/7 care.
Training should continue to be delivered in a service environment, says the review, called Time for Training, with appropriate consultant supervision. But, consultants should be prepared to work more flexibly and place a higher priority on training juniors.
It says some specialties, such as obstetrics and paediatrics, have already moved to more flexible consultant working, allowing trainees to gain experience under supervision.
Sir John said: “I recognise that the WTD may be reviewed in due course. However, the transformation of training needed now is paramount and must be addressed regardless of any modifications in order to produce well-trained professionals for the future.
“Training is patient safety for the next 30 years.”
The Temple review says trainers and trainees must use the learning opportunities of every clinical situation, with handovers being an effective learning experience when supervised by consultants.
Services must be designed and configured to deliver both high quality patient care and training. It suggests that reconfiguration of elective and emergency services, and an effective Hospital at Night programme, are two ways to support training. And rotas require organisation and effective management to maximise training opportunities.
However, the Temple review warns that as the ratio of trainees to consultants changes with increasing consultant numbers, it may no longer be feasible to train in all hospitals.
Dr Shree Datta, chair of the BMA’s junior doctors committee, commented: “The report makes it clear that high quality training can be delivered within the constraints of the 48-hour working week, however, this is dependant on implementing the recommendations in full. It cannot simply be put on a shelf to gather dust.
“It is also essential that there is an emphasis on resolving the problems faced by doctors working in specialties where the impact of the WTD on training is most severe. Seeking the input of those worst affected, such as surgical trainees, will be key in improving the opportunities for training at work.”
Earlier this year a BMA survey claimed that half of juniors were missing out on training opportunities following WTD implementation.
Mr John Black, president of the Royal College of Surgeons, said: “We are relieved that this report openly acknowledges that the WTD has critically damaged medical training in the UK. However, we are deeply disappointed that the remedies proposed are unworkable. It is unrealistic to put training concerns above those of patients and there are not the bottomless resources available to fund these proposals. The one obvious solution for the acute specialties - that of removing the WTD itself - is not assessed at all.”The Temple review recommends that consultants, in substantive roles, should remain clinically responsible for service delivery and training. “An expansion of any other grade will not support the move to a consultant-delivered service model,” it says.
Tags: Consultants, Rota gaps, WTD
Oh great. Resident on call for consultants here we come…
Resident on call for consultants will only happen at a great financial expense.
Also someone else will have to do my regular day time work. Even at flat rates 1 night 12hrs on call = 4 DCC PAs ie more than1/2 a weeks work. A weekend 2X12 hr daytime shift = 8 DCC PAs ie you would not work for the rest of the week.
This is crap. the people producing this report are not at the coal face. The fact of the matter is that surgical consultants are already working as flexibly as they can simply to deliver patient care. Given the constraints under which we work, trainees have to take pot luck and make themselves available when training opportunities arise. Surgical training has always been an “apprenticeship”. The current political drive to separate training and service provision is both misguided and counterproductive. Most trainees rightly regard their own training as being more important than the EWTD. Those that don’t are unlikely to achieve consultant status in the future, certainly within surgical specialties. The sooner the new government allows us to ignore the EWTD (as is done in most other European countries) the better.
This Temple chap, does he live in the real world?
I presume he is far too senior to be resident on-call.
There are mixed approaches across the country on how consultant work load is affected by EWTD. Not everyone works flexibly but there are good examples in place. Resident on call is not good use of consultant time however, as a body we have to accept that there are changes to be made in how we work as well as how we manage patients, where they are managed etc.
This will not go away. We should continue to think creatively on how we can ensure safe provision of care in a different way.
Saturday’s Daily Mail headlines wouldnt sit comfortably with the public….
Very happy to do out of our on call work (I do already with little recognition of the time spent doing menial duties) I am not happy to extend my working week beyond that currently contracted. My juniors semm to have quite a nice time of it with a day off in the week
It does not take a genius to work out that patients get better care under a Consultant delivered service. The problem will come when employers decide they want to eat their cake and have it, by having Consultants doing first on call out of hours in addition to our weekly workload. They have shown in the past that they get round the WTD by calling the out of hours work something that they can the interpret as not constituting working hours.
Back to 84 hour week anyone?
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Doctors are very good at using the retrospectoscope - but few are prepared to use the prospectoscope! This has been coming for a long time - ever since ‘they’ wanted a ‘consultant based’ as opposed to a ‘consultant led’ service. Let us face facts. The service should be provided by ‘trained’ doctors; and ‘trainees’ should be properly supervised at all times (including ‘out of hours’ emergencies); this has not always been so! If one qualifies at age 24, spends (approx) 8 years ‘training’ and then (approx) 32 years providing a service, then there has to be a ratio of one trainee to 5 trained doctors (a slight reversal of previous ratios!)
Clearly, part of ‘training’ is ‘doing’; and part of ’supervision’ is assessing when the trainee can ‘fly solo’.
We need to wake up to the fact that 20th century ’structures’ are inappropropriate in the 21st century. But there is enormous value in the ‘apprenticeship’ model of training; and I do not believe that restricting the ‘working week’ to 48 hours is adeqaute for the proper training of doctors (especially ‘crafts’ like surgery) or for the proper practice of medicine - to provide a personal service to patients, who want to be treatd by ‘their’ doctor.
Malcolm Morrison
Retired Orthopod. So it won’t apply to me - except as a patient!
If it was your parents getting looked after by an FY2 covering 200+ people, and they got ill at 6am at the weekend on the FY2s 4th day of 13 hour nights, would you expect the same level of care as 2pm on a tuesday?