James Gubb, 10 April 2008

The British Medical Association (BMA) have just released a survey today confirming a point I remember being made in no uncertain terms to me last year by one of the figureheads of the junior doctor pressure group, Remedy UK. The European Working Time Directive (EWTD) coming into effect next year will cut junior doctors’ maximum week to 48 hours; a fact, he said to me, risks serious shortcomings in patient care. It seems his colleagues agree. Two in three (64 percent) believe the EWTD will have a “negative overall effect” on their training.

And so do the consultants. A second survey revealed that 57 per cent of the BMA’s members did not believe it would be possible to train a doctor adequately in any specialism in a 48-hour week. Whereas today’s orthopaedic consultant has probably done around 22,000 hours of training in their specialty, our current junior doctors anticipate receiving around 7,000 hours.
A further problem is that the EWTD also mandates rota work. Junior doctors must clock in and clock out at a set time. Not a problem if you’re doing simple stuff, but a big problem if you’re doing more complex operations. Again this is picked up in the survey; many worried the new limit will see them working “bizarre and complex” rotas for less pay.
Of course, tiredness and the excessively long hours junior doctors have historically worked may well have had a negative impact on patient care. As one junior doctor, David Macklin, told the BBC a few years ago: ‘You wouldn’t want to be in a plane flown by a pilot who hadn’t slept for days.’
But then again, you wouldn’t want to be flown in a Boeing 747 by a pilot only trained adequately to fly a by-plane. We seem to have gone too far the other way. “Who would you want to replace your hip?” asks a blogging junior doctor today. Two in five junior doctors (41 percent) in the survey said they regularly needed to undertake training in their time off; 33 per cent feared an impact on the quality of their training, while a further 32 per cent were concerned about the impact on their ability to learn the skills needed to practice safely.
An expert in the field, Professor Roy Pounder, concurs. Writing in the RCP journal, Clinical Medicine, he details the results of a pilot in one hospital that had already implemented the cut in training hours. He found that “fewer investigations were ordered, fewer patients examined, poorer continuity notes written, fewer relatives seen and slower discharge drugs or letters.”
“One less day in hospital every week means it will be virtually impossible for a junior doctor to watch and learn about the progress of an illness”, he argues. “Seeing a patient once or twice before handing over to the next doctor, who then does the same after a short period, means it is difficult to detect a subtle deterioration in a patient’s condition.”
In other words patient care is likely to suffer unless the NHS can find a way of eliminating inefficiency and adopting lean management techniques to drive performance; or going on yet another recruitment binge.
What is remarkable, however, is that the imposition of the EWTD, a tonic for all social democrats, has upset its very own constituent: a trade union.