Pressure mounts over European Working Time Directive
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7445.911 (Published 15 April 2004) Cite this as: BMJ 2004;328:911
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Sir
Whilst I cannot speak for the rest of Europe, it will be apparent to
all in the UK that the equivalent of thousands of doctors will be lost to
the EWTD. Hence the present acute concern in government.
It will be equally apparent to working doctors that thousands of
doctors could be liberated for clinical work from committees and other
management tasks.
Many doctors concede the regrettable necessity for some involvement
in management but I have never met anyone who relished the task.
Has the amount of lost clinical time ever been measured? Has the
whole management edifice been audited on cost effectiveness or time
management efficacy? If not, why not or can someone direct me to the
results or papers discussing the issue?
Steven Ford
Competing interests:
None declared
Competing interests: No competing interests
Here in Australia, we have a 36 hour week. Nevertheless, training
occurs to a high standard. Yes, there is a doctor shortage, particularly
at my level. Luckily, our ranks are swelled by increasing numbers of UK
doctors escaping from the ridiculous hours of the NHS. Perhaps if the
conditions there - especially the hours of work - approximated the
conditions here, some could be enticed back?
Competing interests:
None declared
Competing interests: No competing interests
It is true that the need for an increase in the number of junior
doctors will be significant. However there are innovative ways of tackling
the issues that are being piloted around the country.
Various steps such as shift patterns, boundary spanning roles for other
clinical staff (increase in the prescription list for nurses) and
appointment of trust doctors or staff grades are but a few.
Though true that the financial burden will increase on the health economy,
it is not unknown for various authorities to get their sums wrong and I
wonder if some cost savings have been taken into account. To give a few
examples, reduction in the hours of juniors will mean that no band
payments will be necessitated. Payment to nurses has been traditionally
less than that received by the doctors and boundary spanning roles in
itself will result in direct savings.
Besides if consultants take over some of the junior doctor on-call work as
is being trialled in some places, it would be a cost efficient way of
treating patients (as the patient will not require to rebook for a morning
clinic for consultant opinion!).
But then we are only looking at the tip of the iceberg. The real issues
will come up when the EWTD will be applicable to consultants (forty
hours).
Where will the NHS find so many consultants from and in such a short time
to fill the gap? (with the training hours reduced will we have 'competent'
consultants rolling out in the time that has been set as adequate for
training now?)
Will the consultants be willing for shift patterns?
Will this affect the continuity of care and responsibility issues?
Most importantly how will the consultants manage to work in the private
sector beyond the forty hour limit?
I believe that currently if an employee can show that they work for two
separate employers, they are able to get around the 40 hour limit and
continue to work longer.
However, how will the profession convince the general public that they are
safe to practice privately after their 40 hours in the NHS; when we have
ourselves clamoured for a reduction in hours?
An example often quoted in the press is; would we be happy to fly with a
pilot who has completed his statutory flying hours with airline X and is
now flying for airline Y in his own private time?
In fact if the consultants manage to get around the issue of 40 hours, so
can the administration with regards to the juniors. Why not name the
training hours as those 'worked' for the deanery and in their own private
time? and the forty hours of service time for the NHS?
The NHS and the medical profession has tremendous challenges ahead and
finding the money is the least of them. More important will be the change
in attitudes and culture within the NHS.
Competing interests:
None declared
Competing interests: No competing interests
Re: So much to do, so little time...
Dr Mendelson may be working a 36 hour week but this is very far from
the Australian norm, unfortunately. Particularly at more senior levels,
most surveys show that >50 hour weeks are typical and >70 hour weeks
are not uncommon. Australian hospitals have been forced to reduce the
working hours for junior staff because of a system of award wages which
makes paying overtime very expensive. It is very much cheaper to pay two
resident medical officers to work 36 hour weeks, even in a shift system,
than it is to pay one to work 72 hours - quite different from the UK
system of paying less for overtime than for standard hours. But at more
senior levels, a lot of senior training positions and almost all staff
consultant posts are paid at a flat rate, with no extra pay for after
hours work. Private practitioners (visiting medical officers) generally
get paid more the more they work, but they also bring in more revenue for
the hospital the more they work. Either way, there is no incentive at all
for the hospital to limit the hours senior doctors work - the reverse is
true, in fact. And most GPs are not exactly putting their feet up and
wondering what to do with all that extra time they have on their hands -
like other small businessmen and women they are working long and hard, by
and large. So Dr Mendelson should make the most of her free time while she
can!
Competing interests:
None declared
Competing interests: No competing interests