Seventy three additional rotas for junior doctors have been granted a derogation delaying the full implementation of the Working Time Directive.

Following moves in the House of Commons earlier this week, a total of 273 clinical rotas now have a two-year exemption from the 48-hour week which came into force in August, with juniors being allowed to work 52 hours instead.

Applications for a delay were made on behalf of 79 rotas but six were turned down.

Dr Shree Datta, chair of the BMA’s junior doctors committee, said: “We recognise the need for pragmatism in cases where the safe delivery of patient care cannot be guaranteed within a 48 hour week. However, there is an urgent need to rethink how junior doctors work and train.

“Trusts have known the WTD was coming for over ten years, and it is worrying to find that some are so poorly prepared. The crux of the matter is that hospitals must work with doctors to find solutions which avoid disruption to patient services, and maintain the quality of training.”

Earlier this year health secretary Andy Burnham created controversy when he announced that just 3% of the rotas involved in a review of 6,646 across 247 NHS trusts needed the derogation.

A survey, in September, by pressure group Remedy revealed that the level of rota compliance with the WTD only looked good on paper. It claimed 47% of junior doctors believed their rotas failed to comply with the 48-hour week regulations.

Commenting on the increase in rota derogations, Dr Richard Marks, head of policy at Remedy, said: “This number is still probably the tip of the iceberg but at least the problem is being recognised and something is starting to happen.”

Earlier this month, research by the Royal College of Surgeons revealed that 64% of surgeons thought quality of care had worsened due to the 48-hour week.

College president Mr John Black said: “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.”

The government had set an original deadline of 28 May for trusts to request the derogation.

Dr Wendy Reid, the government’s national clinical advisor for WTD, said: “Patient safety is our top priority in the NHS. We have always said that we would keep the situation under close review and where there is a genuine need for extra time to safely implement the directive we would allow derogation. A very small number of services have made this request in order to effectively implement plans and be able to sustain them by 2011.

“The UK remains absolutely committed to enabling all junior doctors to work and train safely, in compliance with the working time directive.”

Read more on the Royal College of Surgeons report.

Only 200 clinical rotas in England require more time to implement the 48-hour working week for junior doctors, claims the government.

Health secretary Andy Burnham gave a two-year delay from implementing the Working Time Directive, which comes into force on 1 August, to just 3% of the rotas involved in a review of 6,646 across 247 NHS Trusts.

The rotas given a derogation included those providing 24-hour immediate patient care, supra specialist services and units in rural and isolated areas.

Dr Wendy Reid, the Department of Health’s national clinical advisor on the WTD, said: “A huge amount of work has been done to get us to the stage we’re at now.

“The royal colleges have provided tremendous support and, over the last six months, have formed a real link with strategic health authorities and worked on those 6,600-odd rotas.”

But the high level of rota compliance was disputed my medical leaders. Recent data from the strategic health authorities showed a more significant and worsening problem.

Mr John Black, president of the Royal College of Surgeons, said: “We’re at a loss to understand the success the DoH is claiming in addressing this issue. The relatively low numbers of rotas applying for derogation does not reflect the true story being played out at the frontline of hospital care.

“The situation is very serious indeed and misrepresentation of the nature and scale of the problems that hospitals will face in providing safe and effective services to patients in the coming months is grossly irresponsible and does a great disservice to those who rightly expect safe and high-quality care.”

The college has argued that trainee surgeons need to be able to work a 65-hour week in order to be properly trained.

Matt Jameson Evans, co-chair of Remedy, said: “Derogation for 200 rotas will have negligible impact on the huge numbers of non-compliant rotas that exist in reality. This is the year when rota gaps have reduced many training opportunities to just fire fighting service shortages.”

The BMA was disappointed by the derogation and urged the trusts involved to ensure their rotas are compliant in two years time. Dr Andy Thornley, chair of the BMA’s junior doctors committee, called on the government to focus on the impact to doctors’ training.

“We’re worried about how compliance has been achieved in some areas. In the last minute rush to maintain patient services, opportunities for trainees to learn new procedures have been reduced,” he said.

“If we do not equip our junior doctors with the necessary training we risk jeopardising the levels of medical expertise that patients deserve.”

The DoH’s Reid said the government were committed to sustainable compliance and would continue scrutinising rotas.

She said: “It is not the end on 1st August but the beginning. We need trainees to accurately report and have their hours honestly reflected. And the royal colleges and strategic health authorities have to continue working through this with trusts.”

An independent scrutiny panel reviewed all the services requiring derogation. The panel was chaired by Dr Judith Hulf, president of the Royal College of Anaesthetists and joint chair of the EWTD Reference Group, and also included representatives from the royal colleges, BMA, SHAs and NHS Employers.

A guide to the WTD.