There are large variations in the provision of medical cover at night following the introduction of the Working Time Directive, with some doctors being responsible for up to 400 patients, a study finds.
The research, by the Royal College of Physicians, reveals that doctors were responsible for an average of 61 patients at night but the range was from 1 to 400.
The seniority of doctor in charge of a ward also varied considerably; 63 teams reported that, on the night the survey was carried out, the most senior medical cover was a junior doctor in their first two years of training. Consultants were involved in the direct delivery of overnight care in only 6% of teams.
Day cover on the ward ranged between two and 65 patients per junior doctor, with the highest ratio per doctor in Wales and the lowest in London. This reflects a much higher number of trainees in the capital (in 2008 there were 1,135 specialist training posts in London compared with 146 in Wales). The average number of patients per doctor also varied considerably between specialties.
Dr Andrew Goddard, director of RCP’s medical workforce unit, said: “The very low number of doctors per patient at night in some hospitals raises serious concerns for patient safety and there are also worrying reports of very junior doctors being left unsupported, which urgently require further investigation.”
The survey - sent to consultant physicians in England and Wales on a specific date in November - also raises concerns about junior doctors’ welfare. Fifty eight percent of consultants reported an increase in sickness rates of juniors working under them compared with before the introduction of WTD-compliant rotas.
The survey claims to be the first to get independent evidence of current sickness rates for junior doctors across England and Wales, and shows that they are higher than a recent survey by the NHS Information Centre suggests.
The study proposes that high sickness rates in second year trainees may reflect a loss of team working and sense of belonging in doctors a year into their training.
It also shows a vacancy rate of 8.6% among specialist trainees.
Goddard said: “The 48-hour week was brought in to improve the wellbeing of doctors, and by extension prevent mistakes in patient care. The apparent rise in sickness rates of junior doctors since the introduction of the European Working Time Directive highlights the additional stresses that are being put upon trainees by new rotas.
“Far from benefiting their welfare, the poor implementation of the directive means that juniors are missing out on crucial support and valuable training opportunities, and patient care is being spread too thinly.”
On the day of the survey, data was available on 887 hospital teams at 11am, including 4,004 junior doctors caring for 18,854 medical patients, and on 670 teams at 11pm, including 2,263 junior doctors caring for 97,561 medical patients.
Tags: Juniors, Sick leave, WTD
