Doctors’ representatives are hoping that a review of the Working Time Directive in Brussels will lead to greater flexibility in the hours that junior doctors can work.
The European Commission recently set out plans to revise the directive which, from August 2009, imposed a 48-hour week on junior doctors.
The consultation says maintaining the ‘status quo’ is not an option. ‘A revised WTD will be instrumental for improving working conditions and providing businesses and employees with the necessary flexibility for implementing innovative and balanced solutions at the workplace,’ it says.
The 48-hour week has been heavily criticised in the UK for creating medical staff shortages, compromising continuity of care and damaging juniors’ training. Last Autumn, the health secretary acknowledged the problems and suggested the government would re-negotiate an opt out for junior doctors.
The consultation doesn’t shy away from discussing controversial areas, such as whether periods of time spent on-call at the workplace should be counted differently (i.e. not always on a hour-for-hour basis); whether there should be more flexibility on the timing of compensatory rest; and, whether the reference period for calculating working time should be extended to 12 months.
On the controversial issue of an opt-out, the EC consultation notes that of 27 member states, 16 currently allow its use but 11 of them only permit it in sectors or activities which make heavy use of on-call time. It says it makes more sense to ‘reduce the need for using the opt-out in the long term, by providing more targeted forms of flexibility [on on-call time and compensatory rest], than to re-open a debate on its abolition in which no consensus appears possible between the social partners or between the co-legislators’.
Mr John Black, president of the Royal College of Surgeons, said: “The RCS are delighted that the EU have acknowledged the need for flexibility in working hours regulation with this review. We will examine these new proposals and take a full part in responding.
“UK surgeons and physicians know that the European Working Time Directive has failed to improve work-life balance while putting patients at risk through diminished training and excessive shift handovers. The UK government have acknowledged this too and this EU review presents a clear opportunity for UK politicians to negotiate an effective solution.”
However, the consultation is non-committal when making reference to the RCS’s desire for junior doctors to be able to work up to 65 hours a week.
It also re-states the importance of protecting health staff from excessive working hours. ‘On the one hand, patient safety needs to be ensured by making sure health and emergency services are not delivered by workers whose skills and judgement are undermined by exhaustion and stress resulting from long working hours.
‘On the other hand, the sector is already facing a gap in supply of skilled professionals that will widen in the future unless appropriate measures are taken to address it. In order to recruit and retain health workers, it is important to make the working conditions more attractive. Reasonable working hours and work-life balance are crucial in that respect.’
Dr Richard Marks, head of policy at pressure group Remedy, responded: “We are delighted that the European Commission does not consider maintaining the status quo is an option. Plans to deconstruct the EWTD need to be developed as quickly as possible.”
However, Dr Shree Datta, co-chair of the BMA’s junior doctor committee, called for more focus on implementing the Temple review recommendations, which blamed consultants for problems with juniors’ training and called for a truly consultant-delivered service.
She said: “Changing European legislation can take many years and it is not clear how working a few extra hours will solve the problem of getting access to high quality training.
“We need to move away from the idea that changing the working hours of junior doctors is a magic wand that will solve the problems of getting access to quality training and focus on implementing the recommendations of the Temple review.”
Read the full document.
Tags: WTD
the ruling mafia is trying to get their 24/7 slaves back. this needs to be fought teeth and claws.
Having qualified in 1984 and now being a consultant in a busy surgical specialty I have worked through all the models of staff rostering from 1 in 2 rotas with prospective cover to shifts.
Although it may be considered politically incorrect, to learn any practical skill from plumbing through to surgery, there is no substitute for practice and repetition to become good at waht you do.
Whilst some of my training years were extremely tiring and hard work, I am glad that I have had the opportunity to take part in a large number of cases in a supervised setting before I became a consultant. This has made me a much safer doctor to be let loose on my own. New colleagues are more like old SRs and need significant help during their first few years whilst they are gaining the same experience.
My 17 year old son is learning to drive and no doubt will soon pass and be classed as competent. I think those of us with common sense will realise that it will be some time and after a few near misses that he will become a safe driver.
Our trainees bemoan the fact every day that their exposure to cases is so limited by the current working arrangements. My on call registrar was mentored in a case during last night by another registrar trainee who had made himself avaialble to increase his surgical exposure whilst not on call / on shift rather than lose this opprotunity to me. Despite volunterring to come in, I was forbidden to attend unless there were problems. Surely we need to take some cognisance of the message from such acts and not just turn a blind eye to them as we both know they are sensible.
I cannot talk for other specialities but all of our surgical trainees seem to want more time at work doing cases and gaining experience with less time on days off / compensatory rest and fewer of them sharing the work.
This isn’t about ruling mafias and slaves it is about providing safe skilled artisans which only comes with a structured apprenticeship with ever increasing autonomy.
I am grateful that I trained 20 years ago.
KM - please analyse with what exactly your time in the hospital was spent 20+ years ago and compare it with what junior doctors’ time is spent today - e.g. being used as the gofer for attitude laden “degree nurses”, smthg you did not have to put up with when you were a junior. for as long as there is no nursing deserving the label restored to the wards and the ludicours bureaucracy reduced, trainees spending more times in the hospital does nothing whatsoever to improve their training.
At last, a glimmer of hope! It is quite an achievement to get the EU Commission to ‘review’ anything! BUT minor chnages to hours, or the interpretation of ‘flexibility’ or compensatory rest periods, will not solve the problem. The WHOLE PROFESSION must grasp this opportunity to get to grips with the issue of ‘emergency cover’ - which is a service requirement, so should be covered by ‘trained’ doctors. Trainees need to learn about care of ‘emergencies’ - but under proper supervision (which includes allowing the trainer to decied when the trainee is ready to ‘fly solo’). Good training needs the trainee to be part of a ‘team’ (or firm’), as an apprentice, which allows for ‘continuity of care’ = for both patient and trainee.
Retired Orthopod and fromer Tutor
well malcolm, that is not what john black et al want: they want the old status quo back: the consultant doing private work at the golden nugget during his/her oncalls wile the minions provide the residential 24/7 cover in the nhs hospital for peanuts - because, you know, that system is the only one that really works for “training”, according to john black et al. …
Chrissa, I am well aware that some of ‘our leaders’ are somewhat ‘conservative’ - but not all! I accept that there are two different issues for ‘emergency cover’ - one is for ‘pre-reg’ HOs (or now F!) where I think there may need to be some ‘cross cover’ (with suitable ’second line’ support) and maybe more ‘Hospital at night’ type of cover by suitably trained nurses providing ‘first line’ care; the other is the SpRs (now STs) who do not necessarily need to be ‘resident on call’.
Hence my call to the WHOLE PROFESSION to review the whole issue of ‘emergency cover’. Who NEEDS to be resident? Which types of patient NEED a ‘resident doctor’ on call? How much ‘emergency’ work does a trainne NEED in order to acquire the necessary skills to practice safely? What sort of staffing structure will provide proper, safe, care for ‘emergency’ patients?
malcolm - i really appreciate your approach: always logical and professional. i am old enough to have a personal record of 122 working hours in one week … what was different then, was the quality of the work: from pre-ho day one, you were a doctor. you were recognised and respected as a doctor and you had real responsibility. you were the one who dealt with the admissions, be it via gp or a&e. you issued orders to the nursing staff for which you were fully responsible - not suggestions for discussion by jumped up degree nurses whose hobby it is these days to torpedo junior doctors’ standing. yes, the juniors today have terrible knowledge deficiencies - but this is not their fault. they are hungry for real medical knowledge and sick to the core of the bullshit they have to spend their time with in medical school. they get treated like children at a time in their careers when you and i were taking care of departments on our own at weekends.
work today is not the same. it is a tedius struggle against unhelpful staff that is supposed to support you, against a ludicrous bureaucracy and litigation happy patients that are far more demanding, rude and without basic manners than was the case 20 years ago. 48 hours per week of that hell is more than enough. john black’s lament about “training” is pure hypocrisy: he is doing nothing, nothing whatsoever to treat doctors’ time as a valuable resource that should be filled with meaningful work. he just wants trainees time to be vavailable in unlimited quantities - which will further devalue trainees time and will only result in them being used as cheap gofers. john black needs to be fought.
Chrissa, you are so right. The real problem today is that it would appear the public have lost all trust in EVERYBODY (not only doctors) in a position of ‘authoity’; nobody wants to accept any RISK (even tholugh life is full of it!); and our ’seniors’ (managers, politicians and SOME consultants) are all scared of being sued so want to ‘cover their backs’.
But the problem is there - and it needs to be solved! Wallowing in nostalgia and adopting an ‘ostrich attitude’ will not make it go away. In my opinion, ONLY the profession as a whole can really come up with a solution - even if it does mean ‘turning a Nelsonian eye’ to EU regulations and accepting that both being ill AND having treatment ALWAYS carries a risk (which, sometimes, in the very sick, can be quite large)
malcolm - here is where we differ. with today’s reality of the job - expecting doctors to work for more than 48 hours for the t&c on offer will only ensure that the best and the brightest will no longer see medical school as a viable career option. turning a “nelsonian” eye to the ewtd while leaving the t&c as they are today is the recipe for disaster. med schools are already accepting waffling, helper syndrome riddled people in droves … because the smartest have better things to do.
Chrissa. I agree that we don’t have to go back to “the good (or bad?) old days” re. hours; but I know of no one who is successful in any walk of life who worked ONLY 48 hrs pw - particularly when ‘on their way up’, but also after! What I am saying is that the ‘juniors’ hours should not be eaten up almost entirely by ‘night and weekend cover’! Patients need 24hr care - but not all patients need a resident doctor ‘on call’ and, in spite of the (understandable) antipathy to nurses ‘taking over doctors’ duties’, I believe, in some instances, they can provide a useful ’service’.
The problem of T&C - and pay - is a separate, but realted, issue. When the doctors ‘duties’ have been defined, then one can negotiate an appropraite salary structure.