Changes to working regulations in the UK are failing doctors and patients

Jul 31 2008

Recent changes to working regulations in the UK are seriously damaging the working life and education of junior doctors and patients are also suffering, warn senior doctors on BMJ.com.

The British government must relax the regulations of the European Working Time Directive (EWTD) or it could spell disaster for medicine in the UK, say the authors.

"British medicine is highly respected worldwide because of the training provided and the breadth of experience and clinical expertise of most consultants and GPs", write Hugh Cairns and colleagues from King's College Hospital in London. But the EWTD is threatening this reputation by having a negative effect on medical training and taking doctors away from direct patient care. No amount of teaching can substitute for this practical experience, they add.

Introduced to improve workers' safety and protection, the directive changed the maximum working week to 56 hours in 2007, with a planned further reduction to 48 hours in 2009, and a minimum requirement of 11 hours rest in any 24 hour period.

According to the authors, these changes have posed considerable problems for medicine in the UK because of the need for junior medical staff to work long hours to fulfil training requirements and to provide a 24 hour service to patients.

They point out that the EWTD has dramatically changed working patterns in hospitals. Junior doctors are spending an increasing amount of their time "handing over" to incoming staff, reducing the time available to provide patient care. In addition, they say, a large part of junior doctors' working weeks are spent on solitary out-of-hours shifts with "little or no training value", which will only get worse with the introduction of a 48 hour week.

Furthermore, they say, many specialities are having to share junior staff because of insufficient numbers of juniors to provide a legal "rota", resulting in poorer continuity of care, and many patients receiving almost no routine care at night and at weekends.

The directive "is not achieving any of its presumed aims for junior medical staff—quality of life has not improved, training has deteriorated, and, for most patients, medical care is not safer", claim the authors.

They propose that the government abandon the further reduction of the working week from 56 to 48 hours and call for the minimum daily rest to be changed from 11 to eight hours. At the very least, they conclude, hospitals and medical staff should be exempt from the 48 hour limit.