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EWTD Update from the President

27 May 2009

The Junior Doctors Committee of the British Medical Association met for its annual conference on May 9th. A motion which was passed by a large majority included the statements “The current provision of service and training in the 9 surgical specialties mentioned above will not allow optimal training to be achieved in a 48 hour week” and “The changes required to optimise training will not be implemented at Trust level by the August 2009 deadline”. Good news one might think for those opposed to the introduction of the 48-hour week for surgeons. At last the BMA juniors have woken up to the fact that the EWTD is a disaster for training. However in the latest BMA News Review their spokesman ignores the motion passed by his own JDC and confirms that official BMA policy remains that the 48-hour week should be introduced in August. Their own JDC admit it is impossible to train surgeons in a 48-hour week but still want to see it brought it. This can only mean they do not want surgeons to be trained under the current system, an interesting and challenging position, which I hope to see clarified.

On 20th May Alan Johnson the Secretary of State for Health wrote to the Chairman of Medical Education England (MEE) saying “I would like the MEE to commission the Postgraduate Medical Education and Training Board (PMETB) to conduct a review of the quality of postgraduate medical training within a EWTD compliant working environment”. He also states that “There is no evidence that training is any less effective since the gradual reduction in junior doctors’ hours over the past ten years, or that greater numbers of trainees are failing their annual assessments where 48 hour working has been introduced”. Surgeons will be astonished by the Secretary of State’s complacent belief that training is no less effective than before at a time when surgical trainee logbooks are the thinnest in living memory. However aside from the minister giving orders to the independent MEE and to the independent regulator PMETB, this initiative is very welcome. The Board of MEE had already decided to look at the effects of EWTD on training at its next meeting on June 8th, and it is to be hoped that PMETB will not distance itself from the current training crisis, an approach it adopted during the MMC/MTAS crisis of two years ago. Mr Johnson also joins the BMA in his self-contradictory approach. Everything’s fine with training, but I want you to conduct a review. Why? Because we all know it isn’t! Again we await clarification.

As August 1st approaches the Department of Health is collecting data from Strategic Health Authorities (SHA) on progress towards EWTD compliance. The College has looked at the data for the surgical specialties, and I am grateful to the Regional Specialty Advisors and others who helped in this task. On May 21st I attended a meeting of the Department of Health EWTD team and the Academy of Royal Colleges to discuss this emerging data. It was a truly frightening occasion, as specialty after specialty described the reality of mythical rotas with gaps which cannot be filled, dangerously thin levels of cover, multiple handovers and unplanned and untested service re-configurations. The number of unfilled junior posts, both service and training, now approaches 3,000. The April SHA data do not show further movement towards compliance compared with March. Overall national compliance fell from 78 to 72% as paper rotas are revealed as mythical. As the situation is examined more critically, I just wonder what the true figure will be, 60%, 50%, or even less?

I attended the recent Association of Surgeons meeting in Glasgow and was heartened by the massive support for the College position. However a speaker from the floor made the point that it is quite likely that the 48-hour week will be forced in whatever we do or say and that consultants will as ever shoulder the burden for the sake of their patients. He has a point but you must not despair. The fact is that the NHS will not be 48-hour compliant in August. The emerging SHA data prove this. The EWTD is unworkable, dangerous for patients and disastrous for training. This battle is for the soul of surgery, and must and will be won. Patients will ultimately suffer and some may even die if it is not. I do not know when, but sooner or later this government or its successor will have to exempt surgery, and I suspect many other specialties too.

John Black