Intended for healthcare professionals

Rapid response to:

Feature European Working Time Directive

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BMJ 2009; 338 doi: (Published 14 April 2009) Cite this as: BMJ 2009;338:b1507

Rapid Response:

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Dear Sir

Tessa Richard’s article sums up the conflicting views that exist in
Europe, the UK medical profession and the Department of Health (DH) about
the potential impact of the EWTD.

Several surveys have shown that the majority of consultants and
trainees believe the EWTD will have a significant negative effect on
medical training, quality of patient care and the way consultants will
work in the future. However many Strategic Health Authorities (SHAs) don’t
share this viewpoint, and monthly SHA returns on the readiness for EWTD
seem at direct odds with the view from the medical frontline. The DH, to
its credit, is aware of this discrepancy and is working with the Royal
Colleges to carefully check these returns on an individual trust basis.
The outcome of these reviews should be available well before the deadline
for derogation.

Furthermore, whilst many trusts may have 48 hour compliant rotas on
paper, there is huge concern about the practicality of these rotas. Our
survey (1) showed that UK medical registrars usually work 4 hours more
than their contracted hours. Keeping rotas EWTD compliant will therefore
be quite a challenge, and some ‘compliant’ rotas need to be taken with a
large health warning.

Tessa quotes me on the ‘inconclusive’ evidence of the effects of
EWTD. Parliament has shown little sympathy for health professionals’ views
on EWTD because of lack of evidence of the negative effects of EWTD beyond
surveys of opinion. The profession needs to provide such evidence, and
quickly, to get any support for change in legislation from MPs.

Importantly though, MPs do support the opt-out for UK doctors from
EWTD. The opt-out gives additional flexibility both for the provision of
service and for training opportunities. The opt-out, though, must not be
seen as the only solution to EWTD.

Finally, doctors may not be aware of the large amount of recurrent
money the DH has given trusts to support EWTD, for example by employing
additional acute physicians. This amounts to 0.2% of tariff income which
equates to £300k p.a. for a typical acute trust. Some trusts may have kept
this funding quiet to allow the money to be used elsewhere, but it is
urgently needed if EWTD is not to be the disaster we fear.

1. Royal College of Physicians. Implementation of the European Working
Time Directive in 2009 – implications for UK clinical service provision
and training for the medical specialties.

Competing interests:
None declared

Competing interests: No competing interests

20 April 2009
Andrew F Goddard
Director, Medical Workforce Unit and EWTD lead
Royal College of Physicians, 11 St Andrew's Place, Regent's Park, London, NW1 4LE