The European Working Time Directive has been a catalyst for change.1 The reduction in trainee doctors’ hours to 48 is the final increment for all NHS staff. The improvement in work-life balance for staff must be achieved by changes in the organisation of care that protect patient safety and training. The Working Time Regulations are health and safety legislation, and flexibilities and constraints exist within the 48 hour week because the reference period for measuring compliance is six months.

Over the past year the medical profession—through the Academy of Medical Royal Colleges, individual college representatives, the BMA, and trainees from both the BMA and the academy—has worked with strategic health authorities, NHS employers, and the English deans to achieve safe, sustainable compliance. Some organisations were able to apply for derogation from the Working Time Regulations for up to two years until 2011, allowing doctors to work 52 hours a week averaged over six …