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Home › News › Impact of doctor working time cap on patient safety and training getting worse, says new survey

Impact of doctor working time cap on patient safety and training getting worse, says new survey

01 August 2010

European law brought in to improve patient safety and the working lives of doctors, has “failed spectacularly” say surgeons on the first anniversary of its implementation. Results of a survey published today (1st August 2010) by the Royal College of Surgeons of England, show that since the restrictions of the European Working Time Regulations [EWTR] limiting doctors 48 hours a week, patients in NHS hospitals are in fact much less safe than they were a year ago, and the situation is getting worse.

The survey of 980 surgeons and surgical trainees covered all nine surgical specialties and all Strategic Health Authorities in England as well as surgeons based in Scotland, Northern Ireland and Wales, and compared responses to a similar survey undertaken last year. It reveals:

  • 80 per cent of consultant surgeons and two thirds of surgical trainees (66 per cent) say that patient care has deteriorated under the directive. This compares with 72 per cent of consultants and 59 per cent of trainees consulted in October 2009.
  • Two thirds of trainees (65 per cent) say their training time has decreased –a quarter more than in October 2009 (41 per cent).
  • More than a quarter of senior surgeons are no longer able to be involved in all of the key stages of a patients’ care (18 per cent - Oct 2009). 
  • Two thirds of trainees have reported a decline in training time in the operating theatre and 61 per cent of consultants report that they are operating without trainee assistance more frequently since the EWTR was introduced.
  • 41 per cent of consultants and 37 per cent of trainees reported ‘inadequate handovers’ (37 per cent/ 29 per cent – Oct 2009).
  • Almost three quarters of trainees (72 per cent) of trainees and two thirds of consultants (61 per cent) are consistently working more than the permitted hours. Over half of trainees say they cover rota gaps which result in them working in excess of their contracted hours (44 per cent - Oct 2009). 

The survey paints a picture of an NHS that, one year on, is still is totally overstretched due an arbitrary hours regulation. Patients are increasingly being assessed only by junior members of staff or routinely passed between many different doctors with varying levels of experience often with unsafe, inadequate or no handover procedure. Senior surgeons, under pressure to get through operating lists, are now operating alone while their juniors manage wards without support and guidance because working rotas are so finely stretched. This lack of exposure to vital hands-on training alongside experienced colleagues is rapidly eroding NHS care and causing a critical shortage of capable, skilled surgeons in the future.

John Black, President of the Royal College of Surgeons, said: “To say the European Working Time Regulations has failed spectacularly would be a massive understatement.  Despite previous denial by the Department of Health that there was a problem, surgeons at all levels are telling us that not only is patient safety worse than it was before the directive, but their work and home lives are poorer for it.  The new government have indicated they share our concerns, but there is not a moment to lose in implementing a better system which would enable surgeons to work in teams, with fewer handovers and with the backup of senior colleagues.” 

Charlie Giddings President of the Association of Surgeons in Training (ASiT) said: "The survey shows that 12 months after the full implementation of the EWTR there has been little progress with improvements to quality of training or to the quality of life of trainees and the subsequent impact on patient safety. High quality training will produce the high quality surgeons of tomorrow that patients expect and deserve. New innovative solutions are required rather than the minor short-term tweaks that artificially produce compliance at the expense of training and patient care, which Trusts have attempted so far.  ASiT looks forward to working with the new government to maintain the high quality of surgical practice that the UK is renowned for and that our patients deserve."

Howard Cottam, President of the British Orthopaedic Trainees Association [BOTA], said: "Anecdotally, orthopaedic surgeons in training have yet to see any of the promised improvements in the quality of training, and the College survey proves this to be the case.  Attempts to implement the EWTD have largely failed and the system remains reliant on the professional integrity of trainees who continue to cover the gaps in the rota.  BOTA genuinely looks forward to the promised work of the new government to limit the application of the EWTD in the UK."

A Consultant surgeon and Fellow of the Royal College of Surgeons, responding to the survey, said: “The European Working Time Directive has been a training disaster.  We are raising a generation of demotivated, demoralised and poorly trained surgeons.  The UK will pay for this and regret it for at least 30 years.”

ASiT and BOTA have both produced policy statements that working up to 65 hours a week (with that including time spent available on-call) offers the ideal balance between adequate training opportunities, good patient care and work-life balance. The Royal College of Surgeons fully endorses this call and all three organisations have been campaigning for this.


 RCS EWTD survey results


- Ends -
Notes to Editors

  1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit
  2. If you have any queries please contact:

Matthew Worrall  Email:; T: 020 7869 6047
Elaine Towell       Email:; T: 020 7869 6045
Heather Casey     Email; T 020 7869 6042
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