I’m working too many hours, what should I do?BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2110 (Published 04 May 2017) Cite this as: BMJ 2017;357:j2110
Abi Rimmer asks what steps doctors should take if they think their hours are excessive and pose a threat to patient safety or their own wellbeing
Sally Old, medicolegal adviser, Medical Defence Union
“Specifically, it says: ‘If patients are at risk because of inadequate premises, equipment, or other resources, policies, or systems, you should put the matter right if that is possible. You must raise your concern in line with our guidance and your workplace policy. You should also make a record of the steps you have taken.
“Usually you should raise your concern with your manager or an appropriate officer of the organisation that employs you—such as the consultant in charge of the team, the clinical or medical director, or a practice partner.
“Be clear, honest, and objective. Focus on patient safety and acknowledge any personal grievance that may arise. Keep a record of the steps that you have taken.
“If raising the concern locally is not appropriate or does not resolve matters then it may be necessary to contact a regulatory body. In some circumstances it may be necessary to consider making the concern public, but the GMC advises caution regarding patient confidentiality and suggests that you seek advice, for instance from a senior colleague, the GMC, a defence organisation, the BMA, or the charity Public Concern at Work (www.pcaw.org.uk).”
Jeeves Wijesuriya, chair, BMA Junior Doctors Committee
“If you think you’re working too many hours, first of all, remember you’re not alone. That doesn’t mean, however, that you have to put up with it. Working to exhaustion isn’t a badge of honour.
“For trainees on the 2002 contract, a system of rota monitoring can be asked for to see if a rota is causing trainees to be worked beyond their hours.
“For those on the 2016 contract there is exception reporting. Exception reporting lets us easily flag the differences between our actual work and our agreed work schedules. You should submit an exception report as soon as possible after the exception takes place or within 14 days.
“Collated exception reporting data are used to demonstrate to senior staff and trust boards where the problems are. The information helps the BMA and organisations like Health Education England and the Care Quality Commission [to] hold trusts to account.
“If you continue to feel overworked you can contact the BMA’s employment advisers on 0300 1231233, or by email or web-chat. If you’re feeling overwhelmed and want to speak to another doctor for advice, you can contact the BMA’s Doctors for Doctors service on 0330 1231245.”
Michael Farquhar, paediatric sleep consultant, Evelina London Children’s Hospital
“With current NHS pressures, members of the team feeling unable to take their breaks is not unusual. Many doctors and nurses think that the needs of their patients are more important than their own.
“The problem with this attitude is that it ignores why breaks are so important in the first place. Breaks are not there just for you—they’re also there to protect your patients from the consequences of you being tired and stressed. This is when you are more likely to miss things, to make mistakes, to take longer to do simple tasks, and to find it more difficult to empathise with others.
“The new contract states what breaks you should get, what facilities you should have access to, and what to do when it’s not working. It explicitly links your working conditions and breaks to your ability to safely care for your patients.
“We all occasionally miss breaks—that’s how it goes sometimes. If it’s happening consistently though, you need to flag it up.
“Junior doctors can use exception reporting with the new contract to tell their guardian of safe working. The guardian then has to work with you and your department to tackle the problem and correct it.
“Remember: missing breaks is a patient safety issue.”