Posts Tagged ‘WTD’

“EU laws having unintended consequences in NHS”

By Mike Broad - 12th January 2012 3:12 pm

Two royal college presidents wrote a letter to The Telegraph this week calling for changes to the Working Time Regulations and the language testing of overseas doctors in order to promote patient safety in the UK:

Dear Sir,

The language competence of doctors from the EU working in Britain, and the stifling effect of the European Working Time Directive on the time that trainee doctors have to learn on the job, need urgent action. EU laws that apply to all sectors can have unintended consequences in healthcare that can put patients at risk, whether in Britain or other member states.

Our institutions’ key concern has always been to ensure the highest quality and standards of patient care, and we believe that EU rules for testing language competence should be strengthened.

It is also essential to ensure that doctors are competent. But the existing EU legal framework fails to recognise that periodic revalidation and requirements to participate in continuing professional development vary significantly across member states. The increased mobility of health professionals in the EU has highlighted huge variations both in the practical abilities of professionals of similar grades, and in the systems set up to ensure quality, in different member states.

We urge the European Commission to introduce a Mandatory Pro-active Alert System, which enables states to notify each other if a doctor has been struck off the medical register in one state.

We continue to be concerned about the future of medical training - acute medical training, in particular - and the effect of the European Working Time Directive on acute medical and surgical trainees, which reduces the number of hours available for them to train. We call for flexibility at a European and a national level with regard to how on-call time and compensatory rest for trainees are calculated.

Finding solutions to these problems will help ensure that future consultants have had training of the highest quality.

Yours sincerely,

Professor Norman Williams, president, Royal College of Surgeons

Sir Richard Thompson, president, Royal College of Physicians

If you’re concerned about a lack of training opportunities in acute medicine then register to attend Acute & General Medicine Conference 2012 - it’s free for many to attend.

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Working time rules need “urgent” changes

By Mike Broad - 17th November 2011 5:06 pm

The European Working Time Regulations require “urgent and common sense” changes if they are to reflect the modern working arrangements of the NHS.

These are the views of the NHS Confederation’s European Office ahead of negotiations between employer and trade union representatives at European level regarding revisions to the legislation.

The EWTD imposed a 48-hour working week on junior doctors when it was imposed in August 2009. Repeated studies have suggested that it has compromised continuity of care and damaged the quality of juniors’ training, particularly in surgery.

Talks are expected to cover key issues for the NHS such as the way on-call time is counted and rest periods are enforced.

The NHS Confederation is a member of the negotiating body representing public sector employers across Europe. It says the EWTD must reconcile the need for workers to have adequate rest, with the need for flexibility about how working time rules are implemented on the ground.

Elisabetta Zanon, director of the NHS Confederation’s European Office, said: “This legislation needs a modern approach that fits in with the way our health service works. The NHS provides a large chunk of its care on a 24-hour basis. So it is only right that there should be flexibility about how the rules are applied.

“Politicians have tried and failed so far to find a sensible solution, and these negotiations provide an opportunity for people who are in touch with the issues on a daily basis to reach a common-sense agreement, delivering the best outcome for staff and patients, and allowing the NHS to provide a 21st century service.”

The European Commission set out plans to revise the directive earlier this year saying that maintain the ‘status quo’ was not an option.

Commenting on the negotiations, Prof Norman Williams, president of Royal College of Surgeons, said: “The RCS welcomes this renegotiation and calls for flexibility in the Directive to enable up to 65 hours of working time a week for high quality clinician training and patient care. Addressing the rules relating to on call time, compensatory rest, and the SIMAP and Jaeger rulings will allow for this flexibility.

“This is important particularly for trainees in the “craft” specialties who need to acquire skills that can only be honed by repetition and this requires time on the job. We therefore hope that the voice of the health sector - with patient safety at its core - is heard within this Social Partner negotiation process.”

Meanwhile, it’s been reported that most of the 300 training rotas exempted from the 48 hour limit are now compliant.

Rotas at 77 hospital trusts in England were “derogated” from the EWTD when it was introduced in August 2009, allowing them to operate at a maximum of 52 hours a week instead of 48 hours until 31 July 2011.

A total of 57 trusts that responded to a freedom of information request by BMJ Careers confirmed that their training rotas are now compliant with the 48 hour limit stipulated in the directive.

Read the RCP’s view on the issue.

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Juniors question feedback and supervision

By Mike Broad - 1st November 2011 11:24 am

Nearly a quarter of trainee doctors report that on a regular basis they are forced to cope with challenges for which they feel inadequately prepared, a survey reveals.

The annual survey of junior doctors, by the GMC, which provides a comprehensive picture of the views and experiences of 46,000 trainees across the UK, suggests there’s a need for improved supervision and feedback by consultants.

Twenty eight per cent of trainees report that they rarely or never receive feedback from senior colleagues.

Respondents continue to raise concerns about the Working Time Regulations, which were introduced in the summer of 2009. Almost two-thirds say they regularly work more than the limit of 48 hours a week, while nearly a third claim it’s taking them longer to meet the competences they need in their training.

The GMC is calling on senior doctors, managers and medical educators to help tackle these concerns as a priority. It is consulting on proposals for the approval and recognition of trainers to help strengthen arrangements for support and supervision.

The GMC does point out, however, that most training is meeting its standards. Overall satisfaction with training among juniors is continuing to increase, with 79% of doctors rating their training as excellent.

Niall Dickson, chief executive of the GMC, said: “Overall, trainees continue to be very satisfied with their training, but the concerns they have raised need to be urgently addressed by all those with responsibility for supporting doctors. In these difficult financial times for the health service throughout the UK, it is vital the education and training are protected and that these young doctors are given the support they need not only to provide good care now but to develop into great leaders for the future.”

The research reveals that a quarter of newly qualified doctors did not feel ready to take the next step in their careers.

Dickson added: “The trainee survey is a vital part of our work to support improvements in medical training and to make sure it meets the standards we require. Together with the postgraduate deans we will use these results to support inspections and to provide feedback to those responsible for providing education.”

Dr Tom Dolphin, chair of the BMA’s Junior Doctor Committee, said: “The GMC’s survey reveals some serious concerns about the level of supervision some doctors receive. In the current economic environment training is a soft target. We are concerned that, in an effort to save money, the time consultants can dedicate to training is being squeezed. We must ensure that trainers are given the time to train and supervise.

“We cannot afford to be complacent about the quality of training and supervision as it will have direct impact on the quality of healthcare that can be delivered to patients in the future.”

Ben Dean, an orthopaedic registrar, who carried out a survey on training for Remedy UK earlier this year, commented: “The issue with supervision is very complex. The supervision of training is something that has been affected by reduced hours and the consequent shift systems, hence reduced continuity of both patient care and training.

“Certainly increasing hours would help as it would improve supervisor training continuity and increase the experience gained by trainees. But people also need to regulate training properly.”

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EWTD: change likely to be too little too late

By Andrew Goddard, director of the Medical Workforce Unit, Royal College of Physicians - 25th October 2011 3:55 pm

Two years since its full implementation, the European Working Time Directive continues to be seen as one of the main culprits in the disintegration of clinical medicine in UK hospitals.

Interestingly, the rest of the European Union is also less than happy with the restrictions the directive creates, especially as it applies to doctors. There is therefore a considerable appetite for revisiting the directive in the EU, and the European Commission is currently running a consultation process for ‘social partners’ to understand the appetite for such revision and what it should entail.

‘Social partners’ in this context are representatives of trade unions and employers, and for health these are the European Public Services Union (EPSU) and the European Hospital and Healthcare Employers Association (HOSPEEM). The UK representatives for these organisations are the NHS Confederation European Office for HOSPEEM and UNISON, UNITE, the Royal College of Nursing and Royal College of Midwives for EPSU.

Although not official social partners, several UK professional organisations were also consulted by the Commission given the relevance of the EWTD to hospital practice. The Royal College of Physicians has played a leading role in this process, taking part in consultation meetings and submitting responses to the social partner process and the EC. This consultation asks whether the EWTD could undergo radical revision or whether revision of the specific areas of the definition of working time and the timing of compensatory rest (i.e. the SiMAP and Jaeger rulings) would allow the directive to be more workable.

The Commission has made it clear that it supports the right of an individual to opt-out and that there is no negotiation to be had over increasing the total working time beyond 48 hours. The consultation has arisen as much because of member states having to make use of the opt-out clause to allow the directive to be applied and there is concern that individuals may be pressurised to opt-out.

The responses from different UK organisations were interesting and summarise what may or may not be possible in both the UK and the EU as a whole. In short, there is very little enthusiasm for attempting a total redrafting of the directive.

This is unsurprising given the failure of previous attempts in the EU to get any agreement around this. There is, reassuringly, general agreement that a focused reworking of the directive around SiMAP and Jaeger will be worthwhile and have many benefits.

The RCP response provided focused solutions demonstrating how changes to SiMAP and Jaeger would solve many problems of running acute medicine in a 48-hour working week. The RCP has called for relaxation as to the timing of compensatory rest for both consultants and trainees to prevent short notice cancellation of activity and allow internal locums to cover for sickness absence. It has asked for resident ‘on-call’ time only to be counted as working time when the doctor is working and stressed that individual opt-out must remain.

The NHS Confederation response mirrors that of the RCP. It makes clear the difficulties in providing a 24-hour service under the constraints of the EWTD and the importance of providing adequate training experience. It also emphasises the risks to patient care if compensatory rest rules are applied to the letter.

The Royal College of Surgeons of England agrees that the issues of on-call time and compensatory rest are important, but pushes for a sectoral exclusion of hospital doctors and doctors-in-training from the directive which would allow these two groups to work beyond 56 hours. There is considerable resistance from the Commission to such a sectoral opt-out and this seems an unlikely outcome from this consultative process, even though it is attractive.

The BMA, perhaps alone among the responses, is ‘satisfied with the EWTD as it currently stands’. It believes that a redesign of training programmes will allow many of the issues of loss of training due to the 48-hour week to be resolved. It strongly opposes any change to the definition of inactive on-call time as working time and believes that the compensatory rest legislation is unworkable because of lack of clarity as to the implementation of the regulation rather than the principle.

Such a hard-line stance on the EWTD by the BMA is bad news for anyone hoping for a successful renegotiation of the New Deal on junior doctors’ hours. The New Deal is, if anything, the bigger problem for hospitals trying to run a 24-hour hospital service due to huge financial penalty of employing junior doctors over 48 hours a week. Thus, while many doctors may want to work 56 hours a week (and opt-out to do so) their employers cannot afford for them to do so.

Furthermore, even if the RCS is successful in getting a sectoral opt-out, it may just act as a cosmetic result if the New Deal is not renegotiated. The UK government is aware of the issues with the New Deal and has hinted that it would consider renegotiation. Without the BMA’s support, though, such renegotiation would be doomed to failure.

The social partners will announce the outcome of their discussions in late 2011. If agreement between the partners is reached, the Commission will then be able to start the legislative processes to change the directive. However, any process to get the directive changed will then take a further three to four years and, if agreement is not reached, the Commission will need to decide whether to push through change without the full support of the partners.

Either way, by then it will probably be too late for such changes to be helpful in the provision of acute services in the NHS.

This article first appeared as an editorial in Clinical Medicine (2011, Vol 11, No 5: 420–1).

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English NHS stops monitoring trainee work hours

By Mike Broad - 1st September 2011 9:27 am

The NHS in England has no national or regional oversight of whether junior doctors’ rotas are compliant with the 48 hours a week limit stipulated by European Working Time Regulations.

Wales, Scotland, and Northern Ireland regularly collect and review data on whether rotas are compliant with the ‘new deal’ contract for doctors in training, which is used as a proxy for compliance with the 48 hour limit in the EWTD.

However, in England, the ‘ministerial return’ hospital trusts previously submitted on compliance with the EWTD was cancelled in August 2010 “to reduce bureaucracy”.

The government is unable to provide information on the proportion of rotas that are compliant with the directive, according to a report in BMJ Careers.

The devolved governments, however, can point to data showing high compliance (Wales 100%, Scotland 99%, and Northern Ireland 78%).

Furthermore, none of the 10 strategic health authorities in England collects compliance data from trusts, with many responding that such information was available only at a trust level.

Dr Shree Datta, co-chair of the BMA’s junior doctors committee, said: “I think we’re talking about patient safety as well as doctor safety, so it would be really useful to see the ministerial returns back in place.”

A spokesperson for Department of Health in England said: “As part of the government’s commitment to reduce bureaucracy in the NHS, the Secretary of State has stopped the central collection of new deal compliance data which was used as a proxy to demonstrate compliance with the working time directive.

“Local organisations are still required to ensure compliance with the working time directive and to monitor that compliance.”

Back in April, royal colleges, the NHS Confederation and the BMA all called for changes to the compensatory rest aspect of the working time regulations and how the directive applies to on-call time.

They submitted views to the European Commission’s second stage consultation on the WTD, which is intended to alter the legislation before the end of the year.

The coalition government said it would renegotiate aspects of the working time regulations when it came to power in 2010.

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Toolkit launched to improve clinical handover

By Mike Broad - 11th July 2011 4:34 pm

A toolkit has been launched providing a framework for standardisation of clinical handover practice by the Royal College of Physicians.

Poor handover between doctors, nurses and multidisciplinary teams is a common cause of error in hospitals, and is a major preventable cause of patient harm.

The frequency of handovers, and thus the potential for mistakes, since the introduction of the working time regulations in August 2009.

It can lead to inefficiencies, repetitions, delayed decisions, repeated investigations, incorrect diagnoses, incorrect treatment, and poor communication with the patient, says the college.

Some hospitals do not even have a handover protocol in place, it warns.

The toolkit defines the principles behind good handover practice, what the handover framework should contain, and the specific elements within each handover that need to be carried out to avoid mistakes.

It also offers advice on how to audit and monitor the process, and defines the accountabilities and responsibilities in the process.

Professor Humphrey Hodgson, RCP education vice president, said: “There is increasing pressure within the hospital service, and different ways of working have evolved over the last few years. The shorter working hours for medical trainees under the European Working Time regulations, and the increasing use of short-stay medical admissions units, so that patients may well be transferred between teams, are only two of the reasons why a robust and effective handover system is needed for patient safety and high quality care.”

Dr Cordelia Coltart, RCP clinical adviser, who helped develop the toolkit, said: “The current moves towards shorter working hours must not detract from the ultimate responsibility of doctors to ensure safe, efficient and effective care for their patients.

“Handover has been identified as a particularly ‘high-risk’ step in the patient pathway, where errors are likely to occur. These errors are preventable and this toolkit aims to give practical guidance to assess and improve the handover process within your trust to improve patient safety and care.”

Download the toolkit here.

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Locum consultants must be qualified, RCS says

By Mike Broad - 19th May 2011 3:55 pm

The Royal College of Surgeons has warned trusts not to fill locum consultant positions with doctors ineligible to be called a consultant.

It blames the European Working Time Regulations saying trusts are struggling to find appropriately qualified locums to plug the many rota gaps created by a 48-hour week.

All patients should be able to expect the same standard of care whether they are treated by a locum surgeon or a permanent member of staff, the RCS says.

Only surgeons who are on the specialist register, or those within six months of completing recognised surgical training, are suitably qualified for locum consultant positions.

New guidance recommends that trusts do not extend locum surgeon appointments for longer than a year, as long-term cover is best provided by fully qualified surgeons working in permanent posts that provide stability to a department.

Mr John Black, president of the Royal College of Surgeons, said: “Locum surgeons are supposed to be employed to cover short-term absences in hospitals, but with the added pressure on surgical rotas caused by the European Working Time Regulations, the NHS is being forced to seek out alternative solutions in order to plug long-term gaps. The result is that some NHS hospitals are being staffed by inappropriately qualified or inexperienced, locum surgeons.”

Building on existing guidance, Locum surgeons: Principles and Standards, outlines what the RCS expects of both the trusts who employ the services of locums - either directly or through agencies - and of the locum surgeons themselves.

Employers have a responsibility to check the qualifications and skills of locum surgeons and ensure that individuals are aware of local policies and procedures.

Mr Chris Milford, author of the standards document and RCS council member said: “Locum surgeons perform an essential role within the NHS, covering periods of expected and unexpected leave or high demand to ensure that patients are provided with surgical care. This guidance reminds trusts, locum agencies and, locum surgeons that they should be complying with standards the RCS expects of all surgeons, including participating in outcome reporting and preparations for revalidation.”

Read the standards.

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RCP’s view on improving the working time regulations

By Mike Broad - 4th April 2011 12:44 pm

The Royal College of Surgeons, the NHS Confederation and the BMA have all called for changes to the compensatory rest aspect of the working time regulations and how the directive applies to on-call time.

Here is the Royal College of Physicians’ submission to the European Commission’s second stage consultation on the WTD - it’s conducting a review with the intention of altering the legislation later in the year.

Doctor’s experience: focused solutions

The RCP supports revision of the directive and would prefer a focused revision in the areas of classification of working time and the timing of compensatory rest, rather than addressing a wider range of issues at this stage. We have many practical examples from our membership of the impact that the current legislation has had on patient care and how relatively minor changes to implementing the directive would have great benefit to both the working conditions of doctors and the care of their patients.

Compensatory rest for on-call consultants and trainees

Many of our consultant fellows take part in on-call rotas for their specialties and are required to attend in the middle of the night to provide emergency procedures such as endoscopy in gastrointestinal bleeding or coronary angioplasty in acute coronary syndromes. These rotas are typically on top of normal 12-hour working days such that emergency attendance results in rest requirements being broken. Compensatory rest then has to be taken the following morning, which results in the cancellation of clinics and outpatient or inpatient procedure lists.

Cancellation of these lists adversely affects patient care, both by delaying the consultation between patient and doctor as well as necessitating re-appointment. Frequently, these cancellations are at short notice so that patients have either undergone unnecessary preparation for their procedures or taken time off work to attend outpatient clinics.

Relaxation of the timing of compensatory rest, for example to be taken within the next 48 hours rather than before the next work period, would therefore have untold benefits for patient care

The same principle can also be applied to trainees in these specialties. Currently, the need for compensatory rest prevents many of them taking part in such rotas, depriving them of experience in these procedures, thus having a negative impact on their training and the future care of patients by the next generation of doctors.

A further example where increased flexibility would be helpful concerns the provision of internal locums for sickness cover. Currently, in most UK hospitals if a doctor calls in sick for a shift, other doctors on the rota are unable to cover the shift as their rest requirements will be breached such that compensatory rest will prevent them from doing their usual shift the following day. External locum doctors can occasionally be found (although our experience suggests that these are often of a poorer standard) but usually the vacant shift is not filled and patient care suffers as doctors in other teams struggle to cover the absent doctor’s duties. Flexibility about taking the compensatory rest would allow patient care to be maintained in this setting as well as improving doctors’ working lives.

Classification of on-call hours on site as working time

The SIMAP ruling has resulted in widespread changes to how trainees are employed by hospital trusts in the UK. Prior to this ruling, trainees were able to sleep ‘on site’ and thus be available for occasional emergencies as needed. This usually kept total working hours less than 48 per week as well as complying with the directive’s rest requirements.

Since the ruling, this practice has been abolished such that most trainees are now employed on full shift rotas. These rotas have resulted in increased disruption to sleeping patterns, increased job dissatisfaction and increased sickness rates, as demonstrated by published evidence from the RCP. For example, the sickness rate in second-year trainees (F2s) on full shift rotas in the medical specialties in 2009 was 3.5%. Previously, when resident on-call rotas were in place this was 0.8%.

It is impractical for many trainees to be on-call from home as modern training rotations in the UK involve large distances between hospitals such that trainees may live up to 30 miles away from their workplace. To be resident in the hospital would thus be much more practical (and reduce lost rest time by up to two hours). However, the current interpretation of the directive prevents trainees sleeping at or next to their hospitals.

Maintaining the opt-out

The RCP welcomes the commission’s acknowledgment that opt-out must remain. We believe that voluntary use of the opt-out must continue to provide additional flexibility to enhance patient care, while protecting rest requirements for doctors.

Most hospitals ask their consultants to sign an opt-out but there is no single register of who or who has not signed this. Furthermore, as the directive stands, there is considerable uncertainty as to how hour limits apply to an individual doctor who may have several employers including themselves.

Most consultant physicians work longer than 48 hours with the average physician in the UK working 56 hours per week. If the opt-out was phased out, the amount of work done by the equivalent of 1,500 physicians would be lost based on current numbers. This would lead to the collapse of the UK health system and thus, at present, the opt-out must remain.

Together, retaining the opt-out and finding focused solutions to on-call time and compensatory rest must form the cornerstone of a new more flexible EU approach. A broad EU working-time framework should allow flexible local implementation to balance the protection of doctors’ health against long hours with the provision of the highest standard of patient care.

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Scotland producing poorly trained doctors

By Mike Broad - 30th March 2011 9:39 am

The Scottish government has to take urgent action if it is to avoid creating a generation of inadequately trained doctors and compromising patient safety.

This is a warning from the Royal College of Physicians of Edinburgh which believes there are major problems with medical training throughout Scotland and the UK, and it threatens the sustainability of the health service north of the border.

The college believes the government has been unresponsive to successive reports and surveys which suggest the traditional balance between training and the provision of direct patient care has been eroded, with many juniors being required to plug gaps in hospital rotas.

A recent Scottish Academy of Medical Royal Colleges’ survey of trainees reveals that only 42% believe they would be adequately trained by the end of their specialty training.

The 2010 research also showed that 15 months after the implementation of the working time regulations more than 70% of respondent trainees stated that their rotas were not compliant in reality. Because of this, the college fears the full impact of the working time regulations may yet to be realised.

The college says there are insufficient numbers of doctors in some hospitals to safely staff rotas, particularly out-of-hours, leading to a number of patient safety incidents or ‘near misses’.

Furthermore, many consultants have insufficient time within their job plans to adequately supervise the training of juniors.

The college is recommending a series of measures which must be adopted by the incoming Scottish government as an urgent priority. These include guaranteeing protected training time for juniors, and for consultants involved in supervising training, thus readjusting the balance between service and training.

The government has to ensure that NHS Boards, as doctors’ employers, recognise these training needs.

It also has to account for training time when planning future workforce numbers, and protect patient access to consultants.

Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, said: “Successive reports and surveys have highlighted major problems within the NHS in relation to the training of doctors and their ability to provide high quality patient care. We have now reached a tipping point, where this evidence can no longer be ignored or considered in isolation. Instead, it is imperative that policymakers look at the totality of this evidence and recognise the fundamental problems which exist.

“It is essential that we safeguard the future ability of the NHS in Scotland to deliver safe, high-quality, patient care. To do this, we need to ensure an adequately planned, trained and resourced medical workforce. Failure to do so could lead to a generation of inadequately trained doctors and in turn, compromise patient safety. This would not be in the interests of patients, doctors or policymakers and we urge politicians from all parties to recognise the gravity of this situation and to commit to the recommended actions.”

The college is urging the Scottish and UK governments to secure a “relaxation” of the working time regulations, and to expand the medical workforce - a proposition it acknowledges as “unpalatable” in the current financial climate.

Medical organisations are currently submitting views to the European Commission, as part of its review of the Working Time Directive.

UK bodies are seeking changes in the way time spent on-call is counted and more flexibility in the timing of compensatory rest.

Last year’s Temple Review recognised that as a result of working less hours juniors were being less well trained, and called for a fully consultant-delivered health service.

Later that year, the Collins Review of Foundation Training found that many young trainees are being required to practice beyond their competence and without adequate supervision.

Dr Kerri Baker, chair of the college’s trainees committee, said: “Trainee doctors report feeling disillusioned and let down by their training experience gained within the NHS. Many believe they are gaining insufficient training to enable them to function safely and efficiently as the consultants of the future and are also increasingly used only to plus gaps in hospital rotas, often being forced to sacrifice quality training for service provision.

“It is vital that they receive protected, quality training time which will enable them to become fully trained to provide the standard of specialist care rightly expected by patients.”

Read a blog on the issue.

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Employers demand more working time flexibility

By Mike Broad - 28th March 2011 9:39 am

Care will suffer unless NHS employers and employees are given more flexibility over how the WTD is implemented, the NHS Confederation has warned.

Its demand has been prompted by a European Commission (EC) review of the Working Time Directive. In a submission to the EC, the NHS Confederation’s European Office called for changes in the way time spent on-call is counted and more flexibility in the timing of compensatory rest.

The submission criticises the European Court for its narrow interpretation of the rules and suggests it has adversely affected staffing levels, costs and time available for patient care in the UK.

Hospitals have had to employ extra doctors and other staff, at considerable cost, it says. Many have had to rearrange working patterns completely to avoid situations such as cancellation of clinics and outpatient or inpatient procedure lists at short notice. Continuity of care can be badly affected if there are frequent handovers, and trainee doctors have less time to learn valuable skills, it adds.

The NHS Confederation calls for individual healthcare staff to be allowed to maintain the right to seek an opt-out from the 48-hour ceiling.

Elisabetta Zanon, director of the NHS Confederation’s European Office, said: “The European Working Time Directive needs a new approach which is realistic and fits in with the way our health service works. The quality of care patients receive is highly dependent on having an adequately staffed health service. NHS trusts ability to provide this level of care has been affected at times by this directive.

“We are keen to seize the opportunity we have now to influence the European Commission’s forthcoming proposals to change the existing working time rules. We want to work with the European institutions and workers’ representatives to come to a common sense compromise which delivers a solution for all parties.”

It wants a new definition of on-call time and more flexibility over the timing of compensatory rest. Currently, the whole of the resident on-call period is seen as working time whether or not the member of staff is working. And, compensatory rest, which must be provided when a worker’s daily or weekly rest requirements cannot be met, has to taken immediately after the end of the working period and be equivalent to the rest missed.

A consistent message in the consultation so far is the call for trainee doctors to be given more time to gain relevant experience and learn how to carry out procedures.

The Royal College of Surgeons, as part of its submission to the consultation, called for a new contract for juniors based on training rather than hours worked. It wants trainees to return to a system of working in teams on 1 in 6 rotas, and 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.

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 NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, foundation trusts and PCTs.

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