A shortage of junior doctors is threatening to compromise clinical standards, the BMA has warned.
A survey by the junior doctors’ committee reveals that four in ten juniors are working on understaffed rotas following the introduction of the Working Time Directive.
Frontline services like emergency have been the hardest hit, an analysis of rota vacancies shows, with six out of ten of the doctors working in A&E reporting rota gaps.
JDC chair Dr Shree Datta said: “It is clear that it is an everyday experience for junior doctors to be working on inadequately staffed rotas. Given that inadequate staffing levels have been identified as a major factor in the delivery of substandard care - it is essential for patient safety that this problem is taken seriously.”
The BMA survey, which received over 1,500 responses, also shows that four out of ten vacancies were for specialist trainees with at least five years of experience. The majority of rota gaps reported were for juniors who have completed their foundation training years.
Since the WTD was introduced last August, there has been mounting evidence of junior doctor shortages and reduced opportunities to receive teaching and training.
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 there was further evidence of record numbers of junior doctor vacancies as more people were required to fill rotas.
Only 273 of 6,646 clinical rotas were granted a two-year exemption from the 48-hour week by the government, with juniors being allowed to work 52 hours instead.
Dr Datta is calling on the government to address the understaffing of rotas.
She said: “It is hugely alarming to that find so many doctors are working in teams short of experienced doctors. In settings like A&E, which is experiencing the highest levels of understaffing, it is especially critical that experienced specialists are on hand to make the decisions that can mean the difference between life and death.
“Clearly many hospitals are struggling to cope with the introduction of the 48-hour week. Running understaffed rotas cannot be the answer. Hospitals need to look more closely at how they organise their rotas. They need to look at reducing unnecessary bureaucracy and inappropriate work so that healthcare teams can offer patients the high quality care they deserve.”
The government asked Medical Education England to conduct a review of medical training post-WTD and is due to report later this year.
Three years ago we had little difficulty in recruiting to SHO posts with about 80 applicants per post. When the new training schemes were introduced, at the same time as visa regulations precluded vast numbers of doctors progressing with their careers in UK, the supply of doctors that we had been reliant on for so many years dried up. Futhermore, even when a Deanery fails to recruit to a post, the post gets advertised as a LAS. The Deaneries make it difficult for any appointee to a LAS to develop a portfolio to pursue their career progression and they are easily tempted out to another post. Add to that further bureaucracy over CRB checks and it is almost impossible to recruit to the post.
I have also been informed by my Trust that we have to pay VAT on doctors recruited through locum agencies. Is anyone able to confirm this? We have become increasingly dependent on agencies in the last 3 years to maintain services and to add VAT would seem illogical considering hospitals’ overstrained budgets. I had thought medical services were zero rated for VAT.
When the EWTD was being explained to me, I was informed that to be complicit in breaking the EWTD to maintain staffing levels could result in a 3 month prison sentence.
With current staffing levels, EWTD, “mandatory training days”, vast quantities of study leave and annual leave allowances, it is extremely dificult to maintain staffing levels and there is no reserve for unseen emergencies.
When faced with conflicting orders from on high, it is sometimes worth informing management of the impossibility of the task and carrying out the last order to the letter. Our emergency services would rapidly grind to a halt, and then perhaps our politicians will start listening again rather than using dictat and a big stick.
The problem is not a shortage of junior doctors but our refusal to address the fact that we need to re-think how we provide the service. Trying to continue in the old ways with fewer hours clearly will not work - the mathematics are simple and yet we are surprised. If there is a particulr problem in A+E departments, perhaps the problem is too many A+E departments?
What’s even more alarming is that many junior doctors are using their extra spare time to do locums, as in line with a cut in hours comes a cut in pay and bills have to be paid!
I am informed rightly or wrongly that a lot of these locums are being done in trusts other than their own, as the local trust won’t pay the local doctors the agency fees that they will pay out of trust locums. So you have a bizzare situation where junior doctors are actually working more hours than the the EWTD allows and for trusts other than their own being paid for at great expense by the NHS.
IN obsterics and gynaecology we had no problem attracting good candidates to LAT posts to fill gaps in the rota as these doctors had a good chance of getting a training number in the next round of recruitment. MTAS made the whole system so inflexible and rigid that this type of progression is now virtually impossible. It is not the EWTD so much as difficulty recruiting throughout the year that has caused our problems.
I am not sure why all of us are surprised with this situation. We are trying to manage triple whammy-Comply with EWTD. Change in legislation for non European doctors and No career progression for junior doctors.
I think we must be the only country in Europe which is trying to comply with EWTD. As far as I know it is not being complied by French or Italians but we being British we are trying our best to comply. This has created the anomaly whereby juniors are working longer hours as locum but are shown to be doing exact hours on the rota. What a farce?
Home office and their VISA policy is another big ass. We recently appointed an overseas doctor who passed his PLAB examination and had all the credentials (and we had 8 vacancies) Home office then informed him that he has to go back to India to obtain a VISA as there is no mechanism to convert his PLAB VISA to a working VISA. He spent £800 to return to Mumbai got VISA and returned. During that period we spent another £1600 in locums. Will Home office do anything about this idiotic situation?
Now we are employing more doctors from Hungary and Poland who cannot speak English properly. There has already been a disaster in the community by a German doctor, I suppose we will await similar scenario in hospital.