03 April 2014
The implementation of the European Working Time Directive (EWTD) in the NHS has had an adverse impact on the training in certain medical specialities, including surgeons and doctors working in acute medicine, an independent taskforce reports today.
The report was commissioned by the government in response to concerns it had about the impact of the directive on patient care and doctors’ learning. The taskforce found that although some groups of doctors are able to receive the training they need within the 48-hour week, this is very challenging for others.
In certain specialities, doctors work longer hours voluntarily to gain the skills they need and deliver the care they believe their patients require. There is some evidence that the NHS could benefit from the better spread of good practice in the design of working rotas to help both staff and patients.
The directive was fully incorporated as regulations into the NHS in 2009 and means that trainee doctors work for a maximum 48 hours a week across a six-month period. It has had a beneficial impact in terms of preventing doctors from working very long hours and jeopardising patient safety through fatigue.
However, the rules, along with the associated court judgments stipulating when rest periods must be taken, have introduced an inflexibility into working patterns on the wards which has impacted on the quality of training for some doctors, and continuity of patient care.
The taskforce recommends:
- That the NHS should review best practice in the design of working practices, and share examples of the successful delivery of patient care and the training of junior doctors;
- The specific challenges faced by some specialties should be addressed in further work;
- The lack of flexibility brought about by the court judgments is tackled, whilst ensuring doctors don’t suffer undue fatigue;
- The possibility of creating protected education and training time for junior doctors should be explored;
- More consideration should be given to encourage wider use of the right for individual doctors to opt out of the current restricted hours.
Professor Norman Williams, President of the Royal College of Surgeons and Chair of the taskforce, said:
“Through the course of the taskforce, we heard how implementation of the directive has affected different medical specialities in different ways and any solutions will need to take account of these differences.
“We are all committed to providing excellent training, fair employment practices and the highest quality of patient care. We also agree that it would be undesirable to return to the old days when doctors worked excessively long hours.
“However the inflexibility of the directive is having deleterious effects on training and patient care in some specialties and there is a need for solutions. One option which deserves further exploration might be to separate the training and education of trainee doctors from their work on the wards. “This will help strike the right balance between delivering patient care and ensuring that junior doctors are able to acquire the knowledge and skills they need to become specialists of the future.”
The Health Secretary Jeremy Hunt asked Professor Norman Williams, President of the Royal College of Surgeons, to lead the independent taskforce in October 2013. It examined the impact of the EWTD on the NHS and doctors. This followed a Balance of Competencies review by the government which identified the impact and implementation of the directive as a key issue of concern for a number of medical professionals.
Health Secretary Jeremy Hunt said:
“The government commissioned this important work because we share the longstanding concerns of doctors and patients about the impact of the implementation of the Directive on patient care and doctors’ training. I am very grateful to the Royal College of Surgeons and other members of the expert panel for the way they have explored these issues and presented constructive solutions to address them. We look forward to working with doctors and patient groups to take them forward.”
The taskforce, comprising UK organisations from across the health service and education, took oral and written evidence from a range of specialists, healthcare organisations and patient groups. The group considered what impact the directive and court judgements had had upon the training of doctors in the UK, and whether any solutions could be recommended to allow different specialties within medicine the flexibility to provide streamlined and appropriate treatment for patients, in a way that was practical for the NHS.
Notes to editors:
The taskforce convened between October 2013 to March 2014.
Professor Norman Williams, President, Royal College of Surgeons (Chair)
Andrew Beamish - President, Association of Surgeons in Training
Andrew Foster CBE - Chief Executive of Wrightington Wigan and Leigh NHS FT
Chris Hopson - Chief Executive, Foundation Trust Network (FTN)
Dean Royles - Acting Chief Executive, NHS Confederation and Chief Executive, NHS Employers
Dr Diana Hamilton-Fairley - HEE representative and South London LETB, Director of Education & Quality
Dr Clifford Mann - President, College of Emergency Medicine
Dr Hilary Cass - President, Royal College of Paediatrics and Child Health
Dr Kitty Mohan - Co-chair, BMA Junior Doctors Committee
Dr Patricia Wilkie - President, National Association for Patient Participation
Dr Paul Flynn - Chair of the BMA Consultants Committee
Dr Ted Adams -Academy of Medical Royal Colleges Trainee Doctors’ Group
Professor Patricia Peattie - Academy of Medical Royal College Lay Advisory Group
Professor Terence Stephenson - Chair, Academy of Medical Royal Colleges
Sir Richard Thompson - President, Royal College of Physicians
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