Intended for healthcare professionals

Rapid response to:


Trainees' attitudes to shift work depend on grade and specialty

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:48

Rapid Response:

Shift working is an inevitable consequence of the European Working Time Directive


Aitken and Paice have shown that trainees’ attitudes to shift work
depend on grade and specialty.(1) With the implementation of the European
Working Time Directive in August 2004 (2), working patterns for many
doctors in training will have to radically change. The organisation of
such changes will present a major challenge to NHS Trusts and the
Department of Health.

The European Working Time Directive will enforce stringent
requirements on doctors and employing trusts. As part of health and safety
legislation, its implementation cannot be avoided. From August 2004 there
will be a reduction in the maximum number of hours worked by doctors in
training to 58 per week; from 2009 this will be reduced further to 48.
Furthermore the directive spells out stringent rest requirements so that
continuous working is limited to no more than 13 hours in 24.

Given the SiMAP judgement of the European Court of Justice, all hours
spent on the hospital premises whilst on call will be classed as work.(3)
This will have major implications for the working patterns of doctors in

Aitken and Paice(1) discussed some of the negative attitudes to shift
working patterns including a perceived disruption to social or family life
as well as concerns about training experience especially in some of the
surgical specialties. Apart from specialties in which on call commitments
are extremely low, shift-based working patterns will be an inevitable
consequence of the implementation of the EU Working Time Directive and
planning needs to take place at an early stage to deal with this reality.

The reduction in the number of hours doctors are allowed to work will
mean that either more doctors need to be recruited per trust or that tasks
normally undertaken by medically qualified staff must be redistributed to
other staff and that new healthcare practitioner roles may need to be
developed to take on this work.

Without doubt, many specialities require on-site 24 hour availability
of medical staff, however any shift-based working patterns will reduce the
availability of junior medical staff during the normal working day.
Changing working patterns within any organisation will take time and until
this is achieved the recruitment of more doctors may be the only way in
which to ensure adequate day-time cover as well as compliance with the
stringent requirements of the EU Working Time Directive.

The Department of Health and NHS Trusts have little over one year to
ensure that robust mechanisms exist to deal with the changing working
patterns of doctors in training and that these changes are approved by
Royal Colleges and Postgraduate Deans as well as the junior medical staff

The time to act is now to implement a system to deliver a high
quality, cost-effective method of patient care before the legal reality of
the EU Working Time Directive is upon us and it is too late to respond,
other than in a court of law.

1. Aikten M, Paice E. Trainees’ attitudes to shift work depend on
grade and specialty. BMJ 2003;326:48 (4 January 2003)



Competing interests:  
AR is the Junior Doctor Representative for Royal Manchester Children's Hospital and is involved in negotiation with the trust concerning changing working patterns. Opinions expressed are entriely personal.

Competing interests: No competing interests

10 February 2003
Andrew G Rowland
Senior House Officer in Paediatrics
Royal Manchester Children's Hospital, Hospital Road, Pendlebury, Manchester, M27 4HA, UK