48-hour limit on junior doctors’ weekly working hours takes effect
From August 2009, as a result of regulations reflecting the requirements of the EU Working Time Directive, trainee doctors are now covered by the statutory 48-hour limit on average weekly working hours. Some doctor organisations have expressed concern that the National Health Service is ill-prepared for the change. They argue that, without adequate preparation, reduced working hours could adversely affect training for junior doctors and patient care.
On 1 August 2009, the phased reduction of trainee doctors’ working hours culminated in the introduction of a 48-hour limit on their average working week, in line with the provisions of EU legislation. The move has raised concerns that reduced working hours may leave too little time to provide training for junior doctors and that patient care may be adversely affected. There have also been concerns that the time limit could hamper the ability of the National Health Service (NHS) to respond effectively to the swine flu pandemic.
Trainee doctors were exempt from the provisions of the original 1993 Working Time Directive (93/104/EC), but were brought within its scope as a result of an amending directive adopted in 2000 (2000/34/EC). Reflecting the provisions of the 2000 directive, the UK government introduced the Working Time (Amendment) Regulations 2003 (UK0404105F). In respect of junior doctors, the regulations provided for the phased introduction of the 48-hour limit on average weekly working hours. From August 2004, the weekly working time limit for doctors in training was 58 hours. This was reduced to 56 hours in August 2007 and to 48 hours as of 1 August 2009. The move will affect about 60,000 junior doctors. Weekly working hours may be averaged out over a reference period of 26 weeks.
The Department of Health (DH) has reportedly stated that 97% of NHS workers already meet the new requirements, with no effect on training, but that the Secretary of State, Andy Burnham, had asked Medical Education England to review the quality of training in the light of the directive to see whether any adjustments need to be made. The department also pointed out that, where a service needs additional hours of cover, individual doctors can voluntarily opt out of the 48-hour limit to provide the required service.
Views of doctors’ organisations
The doctors’ professional association, the British Medical Association (BMA), stated that evidence on the ground contradicted the claim that the NHS was ready for the change. Chair of the BMA’s junior doctors’ committee, Dr Andy Thornley, commented: ‘It is clear to those of us who work in the NHS that many trusts have not properly prepared for this change. We are not reassured by government reports that the NHS is 97% compliant with the new working time regulation as we fear many junior doctors are being pressured to lie about their hours’. The BMA said that junior doctors were worried that the quality of their training had suffered as working hours had been reduced, and were also ‘deeply concerned that patient services could be affected in trusts that have not properly prepared for the working time directive’.
Similar concerns have been expressed by the Royal College of Surgeons (RCS). Its President, John Black, highlighted that ‘the College and the vast majority of surgeons believe that a 48-hour week for surgeons in the NHS is a major threat to safe patient care which will result in very thin medical cover with multiple handovers, and will devastate standards of training’. Moreover, the organisation believes that rotas that are compliant with the working time limits are ‘not deliverable’ because of insufficient numbers of doctors, estimating that ‘fewer than half of all rotas will be truly compliant’. The organisation has suggested to the government that there should be a ‘surgical opt-out to a maximum of 65 hours’, which it believes would ‘solve the problem permanently, allowing a safe service, good training and an optimum lifestyle for trainee surgeons’.
Response of NHS employers
However, according to NHS Employers, the body that represents NHS trusts in England on employment relations issues: ‘NHS organisations have told us consistently that they are ready for implementation of the European Working Time Directive for junior doctors [...] Where a service needs additional hours of cover, individual doctors can voluntarily opt out of the 48-hour limit to provide this. NHS organisations have already been advised to discuss use of the opt-out with key staff where that might be needed as part of their flu pandemic preparations.’
However, the employer body stressed that, outside exceptional or emergency circumstances, ‘doctors, like other health professionals, and their patients should be protected by the reasonable controls on working hours set out in the Working Time Regulations’.
Mark Hall, IRRU, University of Warwick