390 days, 7 hours, 9 minutes and counting ...
I have had the opportunity over the past few weeks to attend two national events that explored the implications of the implementation of the next stage of the European Working Time Directive (EWTD) when the maximum number of hours worked by doctors in training will be reduced from 56 h currently to 48 h. The previous reduction in junior doctors' hours in 2004 to 58 h/week was largely achieved by means of a number of initiatives that included employment of more doctors, radical rota design and service reconfiguration. However, the most significant issue from the point of view of doctors in training was the almost universal implementation of shifts. While this change in working pattern did enable compliance with the Directive, there were other consequences. The first of these was the sudden demise of the traditional medical firm structure. No longer would the same team of juniors doctors, registrars and consultant be on call together especially over weekends. The other concern was the impact of a short working week and shifts on medical training. Is it possible to train doctors to a high standard under these circumstances?The first conference, hosted by the BMA and entitled ‘Rising to the Challenge’ was held on 26 June 2006. A summary of the main issues discussed is as follows:
- It is highly unlikely that any aspect of EWTD legislation will be reprieved in the very near future and certainly not before August 2009. In particular, there will be no immediate change to either the SiMAP or Jaeger rulings, which have defined time spent on call in hospital (even if asleep) as working time.
- NHS Trusts will be primarily responsible for EWTD implementation; we were informed that some Trusts had already implemented far in advance of the deadline rotas that were 2009 compliant.
- As of October 2007, just over 50% of training posts were compliant with current regulations (i.e. 56 h/week) and if current trends continue just 65% of Trusts will meet the requirements of the August 2009 deadline.
- However, the vast majority of managers contact were confident that they will be fully compliant by the deadline.
- The specialties that are least compliant are surgery, obstetrics, anaesthetics and medical specialties.
- At present just 25 of 27 EEA states are compliant with the Directive.
The second conference was held by Health Care Workforce and was called ‘EWTD: the Final Countdown’ on 2 July. I would draw their website to your attention: http://www.healthcareworkforce.nhs.uk/wtdexhibition2008. Follow the link and you will be able to access the keynote speeches and presentations. Furthermore, you will encounter the ticking clock reminding us of how much time we have left until the deadline of 1 August 2008 (390 days at the time of writing this). Much of what was presented at the BMA conference was repeated here. However, one encouraging piece of research from the University of Warwick suggested that a shorter working week combined with sensible shift arrangements resulted in reduced medical errors. This finding is clearly if importance as patient safety must at all times be paramount.
The question remains, however, will it be possible to train doctors and at the same time achieve the demands of EWTD 2009. I feel cautiously optimistic that it will be possible to achieve both aims. However, action is needed by all concerned with doctors' training. The first step is to acknowledge that EWTD 2009 is coming our way relatively soon. As I said before, the clock continues to tick.
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