Surgeons are calling for a new contract for junior doctors based on training rather than hours worked.
Their demand has been prompted by a European Commission (EC) review of the Working Time Directive which is expected to lead to greater flexibility in the hours that junior doctors can work.
The EC has indicated that it wants to move swiftly on the issue and new legislation could be in force as soon as the autumn.
The Royal College of Surgeons (RCS) wants trainees to return to a system of working in teams on 1 in 6 rotas.
The new contract would specify that trainees would do a minimum number of operating lists, clinics and ward rounds. Hours would be mentioned only as a health and safety issue. Trainees would work, bond and train with the same team. Senior surgical trainees would work under the supervision of two consultants and junior trainees would work with a senior trainee and a house officer.
Team members would support each other so, for example, if some of them were up all night they would be sent home and others would take over. “It would rely on professionalism as it always used to be,” said RCS president Mr John Black.
A training-based contract would end the shift working system which the RCS claims has resulted in exhausted doctors who miss out on training if they have used up their 48 hours of allowed working time in a week.
The new contract would ensure juniors would get better training and would work in a safe service with fewer handovers. Patients would receive continuity of care. Trusts would save around £500 million a year because there would be a reduced need for locum cover.
“If you talk to any surgical trainees the system they find least disruptive is to work on call and the most disruptive is the full shift which they do for week. It leads to a poor lifestyle,” said Black.
He rejects the idea that the proposed new contract could result in juniors working unlimited hours. “It would not be open to abuse if it was written properly. The abuse at the moment is not that trainees are being worked too hard but that trainees are missing out on team working and are not getting enough training because they are being used for service needs to run hospitals. This contract would stop the abuse of a ruthless minute-counting approach to hours,” he said.
Black admits that a training based contract would not suit all specialties, particularly those where there is no requirement to work on call. Historically the BMA has always insisted on negotiating one standard contract for all juniors. But the time may have come, he suggests, for each speciality to have a different contract.
“What I am putting forward wasn’t produced by a load of old fogy consultant surgeons it was devised by the two surgical trainee organisations the Association of Surgeons in Training and the British Orthopaedic Trainees Association. They are approaching this not from a trade union point of view but from a professional view,” said Black.
Scoping talks on a new contract for juniors were opened in 2009 but fell by the wayside during the election. But Black said recent informal talks he has had with the Department of Health and NHS Employers have led him to believe that they would not oppose the idea of a training based contract.
“The idea of this contract hasn’t come from nowhere we have been talking about it and thinking about it for at least two years. We are floating the idea now because the new government has said it is dedicated to doing something about working hours and the EC is now saying that the present EWTD legislation is unsustainable. The consultation document for the review says that it is legally and morally indefensible to continue with the 48-hour week in the acute hospital sector. There is a chink of light, an opportunity, we are all now moving in the right direction.”
Dr Richard Marks, head of policy at the pressure group Remedy, said: “I agree that there have been major problems with the EWTD and training, and that the surgeons and other craft specialties have been most badly hit by this.
“But I’m not sure how easy it is would be to distinguish between ‘training’ and ‘hours worked’ at a contractual level. Working and training are very closely intertwined, and it isn’t easy to see where one ends and the other begins. I would be worried that this would be very open to abuse and endless dispute, both by employers and employees, unless the terminology could be defined very tightly.”
A BMA spokesman said the junior doctors committee had discussed a contract based on training but they were reluctant to negotiate a new contract in the current economic climate because there was unlikely to be any extra money on the table.
