Time is running out for NHS Trusts and the Department of Health to act
Rhona MacDonald’s article concerning the European Union Working Time
Directive raises important issues concerning the working patterns of the
medical profession.(1) We are rapidly approaching the implementation of
the initial stages of the EU working time directive. In August 2004
doctors in training should work no more than 58 hours per week; from 2009
this must be reduced to 48 hours per week.(2)
There are two main ways to reduce the number of hours in any
particular working pattern. Either the total number of hours must be
reduced (ie some of these hours must be undertaken by non-medically
qualified staff) or the number of people contracted to work these hours
must be increased.
To completely modify a working arrangement for junior staff requires
a great deal of time and managerial skills. The working patterns for
doctors in training must be balanced against the ways in which NHS Trusts
function in order to provide an adequate service for patients.
To change a working pattern for junior staff so radically means that
organisations must urgently consider alternative ways in which they
provide their service. We need to look carefully at tasks which could be
undertaken by staff who are not medically qualified, however the answer to
reducing doctors hours should not be to simply employ more nursing staff.
Roles must be clearly defined within acceptable clinical risk
guidelines. To train staff appropriately and ensure that new working
patterns are robust and cost effective will be difficult as the time in
which to do this is slipping away.
The Department of Health needs to react swiftly to issue practical
guidance to NHS Trusts to advise them about changing working patterns for
doctors in training. In the interim, until organisational change can take
place, recruiting extra doctors may be the only way in which to ensure
compliance with the directives that come into force in August 2004.
Unless action is taken soon to ensure that trusts and the Department
of Health are prepared to meet the demands of the EU Working Time
Directive then the current working patterns for many junior staff will
become unsustainable. Time is rapidly running out for NHS Trusts to act.
1. MacDonald R. More Doctors is not the answer to the EU Working
Time Directive. BMJ 2003;326:68 (11 January)
Competing interests: No competing interests