The GMC says that it will not hesitate to intervene if juniors are prevented from receiving adequate training or expected to take on tasks which are beyond their competence.
The regulator made the warning in response to a review of all the evidence on the impact of the Working Time Directive, chaired by Professor David Haslam, the former president of the Royal College of General Practitioners.
The WTD states that juniors should not work more than 48 hours a week, have a minimum of 11 hours continuous rest in every 24 hour period and a minimum period of 24 hours continuous rest in each seven day period.
The review of the evidence since its implementation in August 2009 suggests that rota gaps and vacancies have been exacerbated by the 48-hour week. However, it points out that the new arrangements were introduced into a system already under considerable strain with not enough doctors to provide adequate cover in all areas.
The report brings together evidence about the regulations from across the range of the GMC’s quality assurance activities. The key findings are as follows:
1. The quality of training and the levels of trainee satisfaction remain generally high.
2. There are concerns in some, but not all, of the 61 specialties.
3. Even in those specialties that are deemed to be adversely affected by the implementation of the regulations, not all training programmes are having difficulties.
4. Concerns about a 48-hour week are more consistently found in surgical specialties, obstetrics and gynaecology, emergency medicine, anaesthetics, and paediatrics.
5. The implementation of the 48-hour week is by no means the sole cause of the concerns: where difficulties have arisen, they have been magnified by a range of other factors including gaps in rotas and rota design. In those circumstances, which particularly affect specialities with high emergency or high out-of-hours workloads, the effects of achieving WTD compliance can include reduced supervision and lost or reduced training opportunities.
6. There are many providers and deaneries that are managing the process of implementing the regulations very well, and the GMC will work with key partners to identify and disseminate good practice.
For all the difficulties identified, the overall reported compliance score has increased since last year. Preliminary figures from the 2010 trainee survey show that overall satisfaction scores for their training programmes have also gone up compared to the 2009 survey.
The GMC says there are many examples of notable practice in the reports, and also many solutions to the issues, such as the creation of protected training time within the rotas.
Furthermore, none of the issues raised in the reports has been of sufficient gravity to be reported to the GMC as a specific concern or to trigger a visit. This lack of raising concerns about specific training that have not been resolved through local mechanisms is an important issue for further debate.
The regulator says that going forward it will continue to carefully monitor the impact of the 48-hour week on the quality of training and to make available the evidence it gathers to the NHS and other key interests as a driver to improvement.
The GMC is now considering how best to focus on the persistent problems for the specific specialty programmes, and how best to celebrate and disseminate the many examples of good practice.
It says it will also continue to act to resolve concerns and issues, working with partners.
Read the full report.
i am savouring this quote:”The GMC says that it will not hesitate to intervene if juniors are prevented from receiving adequate training or expected to take on tasks which are beyond their competence.” The gmc and the royal colleges are doing nothing, nothing whatsoever to give junior doctors the training opportunities back that are now blocked by tarted up nurses either on their way to “nurse-specialist-dom” or “nurse specialists” defending their newly conquered turf from intruding junior doctors. their lament about the reduced working hours has nothing to do with training - all they want is cheap 24/7 cover and in order to get this back, they want to undermine the ewtd.
the long hours of old came with several important differences to what is the reality of today: almost every job counted for training, there was none of this idiotic “signing off” for every small procedure or sinilar bureaucracy and this meant FREEDOM. every doctor could collect valuable experience in several specialties before having to decide what to settle in and for those who had enough, there was the ready made parachute into gp land: 2 years in hospital with the option to have almost anything count and then off to the gp registrar year. done. no college exams at all in them days required and none of the the ridiculous hoop-jumping parcours there is today to simply get in. nurses had done an apprenticeship, did the nursing and worked with the doctors instead of against them (compare this with the attitude laden “degree nurses” of today). in brief: the long hours of old were worth it. very, very different from today.
here is another quote:”The WTD states that juniors should not work more than 48 hours a week, have a minimum of 11 hours continuous rest in every 24 hour period and a minimum period of 24 hours continuous rest in each seven day period.” end quote.
the core message of this quote is not true. the 48 hour limit is the AVERAGE over a period of over 3 months - NOT the single week maximum. the single week absolut maximum is actually 91 hours (7 shifts of 13 hours each). another example of the spin and lies employed to undermine the ewtd.