Juniors' working patterns still not safe and effective
15 February 2013
Junior doctors need working patterns that deliver training and do not risk patient safety, the BMA has insisted.
The association stresses the point in response to GMC research, published today, that shows some doctors are still working nearly 100 hours a week during their busiest times.
The findings come from a GMC study into the impact of the EWTD (European Working Time Directive). The regulations stipulate that doctors in training should not work more than an average 48-hour week.
The study of 82 trainees from across the UK finds the regulations have reduced working hours overall, but have increased shift working. This has affected trainees’ performance at times, the research suggests.
Some juniors also feel unable to manage their workloads due to badly designed and understaffed rotas — issues trainees feel powerless to challenge.
And some trainees say the reduced working week has decreased training opportunities and led to a lack of continuity in out-of-hours care.
Poor rota design
BMA junior doctors committee chair Ben Molyneux said the association had been raising concerns about the poor implementation of the EWTD for years.
He said: ‘Badly designed, understaffed rotas can leave junior doctors doing long stretches of night shifts with fewer training opportunities. There is clear evidence that tired people are more likely to make mistakes, and it is essential that this problem is addressed.
‘The BMA is currently taking part in exploratory talks with NHS Employers about government proposals to change junior doctors’ terms and conditions. Tackling the problem of potentially dangerous working patterns will be an important part of these talks.’
Dr Molyneux added that the solution did not lie in increasing working hours.
Professor Sir John Temple’s 2010 report Time for Training made 33 recommendations on how to deliver training in an EWTD-compliant week, including moving to a consultant-delivered service and more effective clinical handovers.
Dr Molyneux said: ‘We must learn from the GMC research and the recommendations of the Time for Training review to ensure working patterns deliver on education and do not threaten patient safety.’
Outdated practices
He added that hospitals must not continue to rely on outdated working practices. He said: 'We need to move to a consultant-based system of delivering healthcare service to patients, and ensure high-quality patient care and high-quality training go hand in hand.'
GMC chief executive Niall Dickson said: 'It is clear the current system is not working as it should. In some cases doctors, are still too tired and there are issues around continuity and training opportunities.
‘We must never go back to the ridiculous hours worked in the past, when patients were routinely put at risk by exhausted young doctors. But the current system is too complex, and the way it is implemented far from satisfactory.’
Mr Dickson said the GMC would work with the NHS, medical royal colleges and postgraduate deaneries to help address the problems raised and enhance training.
Academy of Medical Royal Colleges chair Terence Stephenson said: ‘We would back a move to introduce greater flexibility into the [EWTD] so rotas can support both service and patient safety while enhancing training.’