The implementation of the European Working Time Directive (EWTD) in the NHS has had an adverse impact on the training in certain specialities, including surgeons and doctors working in acute medicine, an independent taskforce reports.
The report was commissioned by the government in response to concerns it had about the impact of the directive on patient care and doctors’ learning. The taskforce found that although some groups of doctors are able to receive the training they need within the 48-hour week, this is very challenging for others.
In certain specialities, doctors work longer hours voluntarily to gain the skills they need and deliver the care they believe their patients require. There is some evidence that the NHS could benefit from the better spread of good practice in the design of working rotas to help both staff and patients.
The directive was fully incorporated as regulations into the NHS in August 2009 and means that trainee doctors work for a maximum 48 hours a week across a six-month period. It has had a beneficial impact in terms of preventing doctors from working very long hours and jeopardising patient safety through fatigue.
However, the rules, along with the associated court judgments stipulating when rest periods must be taken, have introduced an inflexibility into working patterns on the wards which has impacted on the quality of training for some doctors, and continuity of patient care.
The taskforce report, called The implementation of the Working Time Directive, and its impact on the NHS and health professionals, recommends:
– That the NHS should review best practice in the design of working practices, and share examples of the successful delivery of patient care and the training of junior doctors;
– The specific challenges faced by some specialties should be addressed in further work;
– The lack of flexibility brought about by the court judgments is tackled, whilst ensuring doctors don’t suffer undue fatigue;
– The possibility of creating protected education and training time for junior doctors should be explored;
– More consideration should be given to encourage wider use of the right for individual doctors to opt out of the current restricted hours.
Professor Norman Williams, President of the Royal College of Surgeons and Chair of the taskforce, said: “The inflexibility of the directive is having deleterious effects on training and patient care in some specialties and there is a need for solutions. One option which deserves further exploration might be to separate the training and education of trainee doctors from their work on the wards.
“This will help strike the right balance between delivering patient care and ensuring that junior doctors are able to acquire the knowledge and skills they need to become specialists of the future.”
The Health Secretary Jeremy Hunt asked Professor Williams to lead the independent taskforce in October 2013. It examined the impact of the EWTD on the NHS and doctors. This followed a Balance of Competencies review by the government which identified the impact and implementation of the directive as a key issue of concern for a number of medical professionals.
Meanwhile, a survey has been released by the Royal College of Physicians on Core Medical Training which suggests that NHS pressures are taking precedence over training time.
Read the full report.