Patients are more at risk since the European Working Time Directive was introduced in August, a survey of surgeons reveals.
The research, by the Royal College of Surgeons, shows that 64% of surgeons thought quality of care had worsened due to the 48-hour week.
A third say handover arrangements are inadequate in their hospital and 23% say they cannot stay involved in all stages of individual patients clinical care that require their expertise. With so many shift changeovers, the WTD has compromised the time available for handovers and damaged continuity of care.
Furthermore, 62% of surgeons said they were not working a truly compliant 48-hour week with 70% estimating they worked more than 48 hours, averaging between 55 and 60 hours a week.
Trainee surgeons in particular are staying on unpaid after the hours limit because they want to see through care for patients. Some are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week.
A quarter of respondents say other professionals in the healthcare team are acting up to cover tasks previously done by surgeons and 43% say they are covering rota gaps in other areas of their own hospital to keep services running.
The Royal College of Surgeons says hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result, there is an emerging ‘grey’ market in hospital cover with doctors true working hours being kept off the books.
The college has also learned that more than 100 further hospital rotas have applied for a ‘derogation’ from the government because they cannot meet the legislation.
The government set an original deadline of 28 May for trusts to request the derogation, which is a two-year delay to WTD implementation during which time juniors can work a 52-hour week. It claims all but 200 rotas are compliant.
Mr John Black, president of the Royal College of Surgeons, said: “Throughout this affair the call from the Department of Health has been that this legislation is about making patients safer. We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.
“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead-end shifts as locums because there is no way the service could keep running otherwise.”
Earlier this year, surgical trainee organisations called for a 65-hour week and the college called for a sectoral opt-out of the European legislation to achieve this.
Nine hundred surgeons responded to the survey.
A spokesman for the DoH said there is no evidence of harm being caused to patients.
A recent survey by Remedy showed that 47% of juniors claimed their rotas were non-compliant.
Tags: Derogation, Patient safety, WTD
