Consultants hold the key to solving juniors’ lack of access to training following the implementation of the European Working Time Directive, a government-commissioned review finds.
The review, chaired by Prof Sir John Temple, acknowledges there are problems but suggests that they will not be eased by either increasing trainees’ work hours beyond 48 hours nor lengthening training programmes.
Instead, the Temple review suggests that rota gaps can only be overcome with a fundamental change in the way training and services are delivered. It says that, despite a 60% increase in consultant numbers over the past 10 years, hospitals remain reliant on juniors to provide out-of-hours services.
Sir John recommends a move to a consultant delivered service, with seniors more directly responsible for the delivery of 24/7 care.
Training should continue to be delivered in a service environment, says the review, called Time for Training, with appropriate consultant supervision. But, consultants should be prepared to work more flexibly and place a higher priority on training juniors.
It says some specialties, such as obstetrics and paediatrics, have already moved to more flexible consultant working, allowing trainees to gain experience under supervision.
Sir John said: “I recognise that the WTD may be reviewed in due course. However, the transformation of training needed now is paramount and must be addressed regardless of any modifications in order to produce well-trained professionals for the future.
“Training is patient safety for the next 30 years.”
The Temple review says trainers and trainees must use the learning opportunities of every clinical situation, with handovers being an effective learning experience when supervised by consultants.
Services must be designed and configured to deliver both high quality patient care and training. It suggests that reconfiguration of elective and emergency services, and an effective Hospital at Night programme, are two ways to support training. And rotas require organisation and effective management to maximise training opportunities.
However, the Temple review warns that as the ratio of trainees to consultants changes with increasing consultant numbers, it may no longer be feasible to train in all hospitals.
Dr Shree Datta, chair of the BMA’s junior doctors committee, commented: “The report makes it clear that high quality training can be delivered within the constraints of the 48-hour working week, however, this is dependant on implementing the recommendations in full. It cannot simply be put on a shelf to gather dust.
“It is also essential that there is an emphasis on resolving the problems faced by doctors working in specialties where the impact of the WTD on training is most severe. Seeking the input of those worst affected, such as surgical trainees, will be key in improving the opportunities for training at work.”
Earlier this year a BMA survey claimed that half of juniors were missing out on training opportunities following WTD implementation.
Mr John Black, president of the Royal College of Surgeons, said: “We are relieved that this report openly acknowledges that the WTD has critically damaged medical training in the UK. However, we are deeply disappointed that the remedies proposed are unworkable. It is unrealistic to put training concerns above those of patients and there are not the bottomless resources available to fund these proposals. The one obvious solution for the acute specialties - that of removing the WTD itself - is not assessed at all.”The Temple review recommends that consultants, in substantive roles, should remain clinically responsible for service delivery and training. “An expansion of any other grade will not support the move to a consultant-delivered service model,” it says.