Hospital Dr News

Time to split service and training for juniors

Significant changes will be considered so doctors can overcome the restrictions of the European Working Time Regulations to train and work more flexibly, the Government has said.

In October 2013, the health secretary commissioned an independent taskforce to review the impact and implementation of the WTD on training of doctors and quality of patient care in the UK, and to recommend solutions to problems identified.

The taskforce reported, with six recommendations, in March 2014, with the government accepting them this week.

The government has committed to identifying training time that is not working time so that doctors can develop outside of regular duties, and to raising awareness of the voluntary opt out from the EWTD.

Under the 2009 Working Time Regulations, doctors are restricted to working a maximum of 48 hours per week on average over a six month period, unless they voluntarily opt-out.

Within the NHS, this has contributed to overly rigid shift patterns, affecting time for training.

Health Education England will explore if and how some training elements could be separated from work related activities, meaning doctors can have more opportunities to train outside of their regular duties and improve their skills.

Furthermore, the government will raise awareness of the voluntary opt-out. The Department of Health will consider ways to encourage more widespread use of the individual right to opt-out of the 48 hour restrictions for those who wish to, and where it is safe to do so.

This will allow doctors who want to spend extra time on work related training activities to do so. This would be particularly beneficial in some specialities such as surgery.

HEE is also working on a national programme that will provide support to trusts so they can redesign staff rotas and give doctors more time to access training.

The government will also ensure that the current contract negotiations for junior doctors and consultants take account of the recommendations of the report, including how training time can form part of working patterns and that doctors have appropriate rest times and breaks.

Former President of the Royal College of Surgeons, Professor Norman Williams led a taskforce of experts, including the BMA, NHS Employers and Royal Colleges, which reported to the Government in April with a range of recommendations.

The taskforce report found that the Directive has had a beneficial impact by preventing doctors from working very long hours and jeopardising patient safety.

However, it also found that doctors in certain specialty areas, such as surgery, work longer hours voluntarily to gain the training they need. For example, doctors beginning surgical training today will have 3,000 fewer hours to learn through training – equivalent to 128 whole days.

In addition, complex shift patterns can increase handovers between doctors, which can increase the risk of errors, and enforced rest breaks have resulted in cancellation of some clinics.

Health secretary Jeremy Hunt said: “We share the longstanding concerns about the impact of the implementation of the Working Time Directive on patient care and doctors’ training. Doctors should have the flexibility they need to access the training they want. This would lead to better care.

“We will never go back to the past with tired doctors working long hours, but it is clear that the Directive does have a negative impact on the training of doctors in some specialities. We will now look at how training and working time could be separately identified so we can give doctors the flexibility they need.”

Research in 2012 showed that a majority of surgical trainees were unhappy with the quality of their training and most blamed the reduction in working hours under the EWTD. Over half believed they should be working more than 48 hours a week and nearly half (49%) agreed that the working week should be between 57-72 hours.

Professor Norman Williams, chair of the independent taskforce, said: “As a taskforce we were clear that the one size fits all approach of the Working Time Directive in medicine is detrimental for training and patient care in some specialties. Our recommendations set out a clear path to getting to much needed solutions.”

Although the future of the Working Time Directive is not currently being negotiated, the European Commission is carrying out an impact assessment, including looking at options for new proposals.

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