Quarter of hospitals unlikely to comply safely with European Working Time Directive

The latest survey of acute hospitals in England and Wales shows that 23% will probably or definitely be unable to comply with the European Working Time Directive in August 2004. The Directive rules that junior doctors must not work more than 56 hours per week; must not work more than 13 hours in any 24; and must have an 11-hour break before and after a similar shift. This will require resident junior doctors to switch to 13 hour ‘full shifts’. The RCP advises that each hospital needs a ‘cell’ of 10 junior doctors (optimally) or 8 (as a minimum) working 13 hour full shifts to provide safe and effective 24 hour cover, at the appropriate grades.* 

The latest survey shows that 47% of hospitals have Specialist Registrars in acute medicine working traditional ‘on-call rotas’. Only 40% of hospitals had 10 or more experienced ‘middle-grade’ doctors (Specialist Registrars or Staff Grade doctors), and 38% had 7 or fewer. Although this situation has improved since 2002, many hospitals may feel obliged to introduce full shifts with insufficient staff (6 or 7), to comply with the Directive. 

The survey shows that most Specialist Registrars on full shifts have been consigned to weeks of 7 nights (63%), or ‘half week’ blocks of 3 or 4 nights but twice as often (25%). Previous surveys have shown that these serial night duties are deeply unpopular, because of their adverse impact on training and quality of life, especially since about 40% are female and almost half are parents. There are further concerns that imposing these working patterns on all resident trainees may seriously damage recruitment into acute specialties.

Although employing non-medical helps to reduce junior doctor workload, this measure has not generally allowed a reduction in the numbers of juniors required; and there is little prospect of any skill-mix alleviating the need for experienced middle-grade cover. 

The survey also covers staffing levels in different sizes of hospitals; variations between hospitals; participation of other medical specialties in the acute medicine take-rota; hospitals with separate residential rotas for specialist units such as cardiology, renal medicine and neurology; and use of non-medical staff to cover gaps in medical workforce. 

Replies came from RCP College Tutors, Trust Medical Directors, Clinical Directors of Medicine and other consultant physicians or staff from HR departments, representing 195 (86%) of the 226 acute hospital trusts in England and Wales.