23 January 2009
Patients across the country will be placed at risk and their quality of care will suffer as hospitals prepare for the full implementation of EU regulation to reduce doctor’s hours to 48 hours per week by August 2009. The Royal College of Surgeons has learnt that unsafe levels of staffing are already starting to be experienced as the UK is running out of available surgeons to fill the gaps in NHS rotas. The full extent of the problems is being hidden by some NHS Trusts who are employing their own doctors as locum cover and pressurising trainees to falsely report their working hours.
A survey of over a thousand surgeons by the Association of Surgeons in Training (ASiT) shows significant underreporting of hours worked by trainees as NHS Trusts struggle to meet the new restrictions. The study, entitled Optimising working hours to provide quality in training and patient safety*, shows:
- 90 per cent of trainees are exceeding their rostered hours on a weekly basis.
- 85 per cent reported coming in to do operations on their days off.
- Only 25 per cent felt that the working patterns held by their human resources departments accurately reflected their actual working hours and 55 per cent reported being pressured to falsely declare their actual hours worked.
- 68 per cent reported deterioration in the quality of training and operative skills as a result of shift-working patterns brought in to meet working time regulations and 71 per cent felt the reduction in working hours had not led to any improvement in their work/life balance.
- ASiT believe 65 hours a week is required to gain the necessary training opportunities and 80 per cent of respondents would support an opt-out of the European Working Time Regulation (EWTR) to protect training.
A further study of almost 500 surgeons demonstrates potentially unsafe levels of staffing because there are not enough surgeons available to fill rotas and gaps are appearing. Over half of those questioned had experienced gaps on their rota. NHS Trusts are now routinely papering over the cracks by re-employing their own trainee surgeons out of hours as “internal locums” to cover gaps in shifts – with over two thirds of rota gaps filled in this way. 64 per cent of trainees working with rota gaps feel that patient care has suffered as a result.
The College believes the training of future surgeons is being adversely affected by the working hour restrictions. The college’s regular monitoring of junior doctor training quality shows that trainee surgeons are not able to get into theatre to learn. Almost half of junior doctors in the first two years of surgical training go to theatre fewer than three times a week and one in 15 does not go at all.
“This is a worry for today and tomorrow,” said John Black, President of the Royal College of Surgeons. “On the one hand, the immediate effects on patient care in the NHS are potentially disastrous. There are simply not the surgeons in the UK to fill the gaps when every doctor’s hours are cut to a 48 hour per week maximum. On the other, trainees are telling the college they cannot gain enough experience to progress on the shortened hours. The choice for the nation is clear – do we want patients of the future to be treated by a group of highly skilled and experienced surgeons; or be passed around a wider group of lower skilled surgeons with less experience.”
Ben Cresswell, the President of ASiT, added “The increased tendency to shift working that we have seen over the past few years has been driven entirely by a desire to reduce hours. That desire has not come from the profession, neither from trainees nor from Consultants, and the hours reduction has been universally damaging due to significant fragmentation of the surgical team and a loss of continuity of care. We now have hard evidence that this fragmentation has harmed both quality of training and patient safety. The Association of Surgeons in Training is delighted to offer its full support to the Royal College of Surgeons of England, in it’s request for an opt-out of the EWTD legislation. We feel that such a concession offers the very best solution, in order to permit a return to excellence in training and to protect high quality patient care”.
The College is calling on government to put in place a long-term solution to safeguard patients and the training of future
- Introduce an opt-out for all the surgical specialties in England, to allow hours to be worked up to the figure defined by our trainee organisations.
- A revision of the rest-break legislation – formal rotas brought in to meet working time legislation have introduced unsafe levels of handovers between doctors and have proved more disruptive to work-life balance than the longer on-call system they replaced.
- The USA has decided to keep junior hospital doctors’ weekly hours at 80, largely on patient safety grounds. In Germany, the trade union representing hospital doctors in conjunction with the professional bodies has agreed that 61 hours is appropriate.
PDF Copies of Optimising working hours to provide quality in training and patient safety are available from the RCS press office.
Notes to Editors
- 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 www.rcseng.ac.uk.
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