European Working Time Directive in force
From 1 August the European Working Time Directive (EWTD) will be fully applied to doctors for the first time. Junior doctors’ weekly hours will reduce from 56 to 48. This directive has triggered widespread debate across Europe. Arguments against its introduction include that trainees will not develop particular skills in craft specialties, such as surgery, cardiology and anaesthesia, so will not achieve the required competencies by the indicative deadlines.
It's impossible to provide a safe surgical service and obtain safe surgical training in a 48-hour week
Ben Creswell, President of the Association of Surgeons in Training, said: “We know for a fact that it’s impossible to provide a safe surgical service and obtain safe surgical training in a 48-hour week, and we know from national survey data that trainees are already routinely working in excess of their hours.”
The Royal College of Physicians says that a “one size fits all” approach is not appropriate. In a statement the college said: “Each organisation and individual physicians will need to consider carefully which mechanisms, such as derogation, consultant expansion, service configuration and innovative practice, best ensure patient safety and protects medical training in their specific setting.
“While we support individual trainees’ right to ‘opt out’ of the EWTD to preserve their opportunities for training, or so they can gain work as an internal locum, we would caution rota planners against using the ‘opt out’ as a blanket solution to compliance difficulties.”
According to the BMA Junior Doctors Committee, the NHS has had more than ten years to prepare for the EWTD, yet the implementation of change has been slow and patchy. They argue that this has increased concern that junior doctors, who reach the end of their training, will have less experience, less confidence and fewer skills than before.
In May, Health Secretary Alan Johnson launched a review of how the EWTD will impact on junior doctor training. Medical Education England (MEE) commissioned the Postgraduate Medical Education and Training Board (PMETB), the independent regulator of standards of training, to identify areas where changes to training need to be made.
The BMA welcomed the review, but identified a range of practical changes that need to be made to protect the standards of junior doctor training. These are:
- reintroduction of training lists
- increasing the flexibility of training programmes
- more NHS investment in simulators and skill labs
- consultant trainers have more protected time to supervise junior doctors
- more consultants to ease reliance on juniors.
According to the DH, there will be flexibility to derogate from the full requirements of the EWTD services where more time is needed. The derogation will enable doctors in training to work an additional four hours a week for up to two years (2011) and exceptionally three years to 2012.
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