With less than 250 days to go until all junior doctors in Scotland will be restricted to working a maximum of 48 hours a week, British Medical Association (BMA) Scotland has warned that Scotland’s Health Boards are not ready.
The deadline for full compliance with the European Working Time Directive for doctors in training is August 2009.
However, 49 per cent of Scotland’s junior doctors are currently employed on rotas that exceed the 48-hour limit.
BMA Scotland is concerned that Scotland’s Health Boards are still not prepared for this change and urges them to take action now, rather than compromise patient care by breaching health and safety legislation next year.
Dr Alan Robertson, Chair of the BMA’s Scottish Junior Doctor Committee said: ‘The BMA is calling on the Scottish Government to ensure that Health Boards have plans in place to deal with the changes coming into effect in August 2009.
‘Despite having had eight years to formulate a plan, they are still not ready and now have less than 250 days left.
‘Plans must be tested in advance of the deadline to guarantee that they are robust and effective.
‘This will allow any service gaps to be detected and filled prior to the start of the new limit being introduced, ensuring that patient care is not compromised.’
The BMA is also campaigning to ensure that training quality is not damaged by Health Boards in their preparations for the changes.
With reduced working hours, junior doctors need sufficient time for ‘hands-on’ training to ensure that they have the skills and experience to become fully trained consultants and GPs.
If the standard of training is not maintained it will be to the detriment of patient care, and this is not acceptable.
Dr Robertson added: ‘The 48-hour working limit is going to have a massive impact on training and service delivery and the NHS is not yet prepared.
‘In less than 250 days, there will be a dramatic reduction in the availability of junior doctors to deliver patient care and that gap must be filled.
‘In order to do this effectively, NHS Boards must develop plans in partnership with the profession.
‘This must not be tackled at the last minute.’
The European Working Time Directive (EWTD) is designed to protect the health and safety of workers by restricting the number of hours an individual can work and imposing minimum rest requirements on all workers.
The EWTD dictates how many hours an employee can work and how much rest they should take.
It is enshrined in UK and European law and is therefore a legal requirement.
It was agreed that the EWTD for junior doctors would be implemented gradually over five years.
This meant that the limitation to 48 hours work per week would only be introduced in August 2009.
An interim 58-hour week was applicable from August 2004 – this reduced further to a 56 hour week in August 2007.
However, doctors in training were already restricted, under the New Deal contract, to no more than 56 hours a week.
A BMA Scotland Briefing: The European Working Time Directive, says: ‘Two in three junior doctors believe compliance with the 48-hour working week will have a negative effect on their training, but most think that extending training and improving working patterns will help address these concerns.’
The briefing notes: ‘The EWTD states that employees (with few exceptions) should not work more than an average of 48 hours a week over a reference period and that the following rest requirements should be met:
• a minimum of 11 hours continuous rest in every 24 hour period
• a minimum rest break of 20 minutes after every six hours worked
• a minimum period of 24 hours continuous rest in each seven day period (or 48 hours in a 14-day period)
• a minimum of four weeks paid annual leave
• a maximum of eight hours work in each 24 hours for night workers.
Junior doctors are unlikely to be classed as night workers.
Under the EWTD, night workers are defined as those who work at least three hours of their daily working time during the night.
This cannot be assumed for junior doctors.
The EWTD became part of British law and applicable to the majority of workers on 1 October 1998 through the Working Time Regulations.
Consultants and other career grade hospital doctors were included in this initial legislation although some changes were applied through a collective UK agreement.
However, junior doctors were excluded.
The Directive states that the 48-hour limit must be implemented in full for all employed doctors, including doctors in training, no later than 1 August 2009.
Furthermore, all time spent at a workplace at the request of an employer must count as working time and the only inactive time on-call should be when the doctor is available for work, but not required to be within the workplace, performing work or preparing for work.
The European Commission is currently considering this with a view to make inactive on-call time neither work nor rest.
Any employee can choose to opt out of the hours limits.
However, for junior doctors this is not straightforward because they work in teams on a rota.
Junior doctors don’t have control over their own working patterns and as a result, opting out individually will be complicated.
The BMA’s view is that only those junior doctors who have independent control over their working hours should be able to consider opting out.
A number of different authorities are responsible for enforcing the EWTD.
These include the Health and Safety Executive, which can fine organisations who breach the rules.
The entitlements to rest and leave are enforced through employment tribunals.
The briefing adds that the BMA knows that health boards are beginning to work on implementation of the directive but BMA Scotland is concerned that they have not devoted enough time on preparation for the EWTD despite having had eight years to formulate a plan.
It stresses that it is essential that boards consider the implications of changing junior rotas to comply with the regulations otherwise there could be chaos as hospitals rush to meet the deadline and patient safety could be compromised.
The BMA is concerned that training opportunities for junior doctors will be dramatically reduced once the regulations are in force.
In February 2008, the BMA undertook two separate UK-wide surveys, one of junior doctors, the other of the wider membership, to find out what members’ views were on the European Working Time Directive (EWTD) and the effect of the Directive on junior doctors’ working hours and training.
Two in three (64 per cent) junior doctors surveyed by the BMA believed compliance with the 48-hour working week would have a negative overall effect on their training.
When asked what concerned them most about the 48-hour limit, a third (33 per cent) said it was the impact on the quality of training, and a further third (32 per cent) identified its impact on their ability to gain the skills necessary to practise safely.
However, most juniors felt that there were ways of addressing these concerns.
68 per cent agreed that there was a need to extend training to enable them to learn their role within the 48-hour limit.
59 per cent of those expressing a view believed that improved working patterns to protect training time should enable them to train within the hours limit.
The second survey, of BMA members at all levels, suggested that junior doctors’ fears are shared by the wider medical profession.
Over half (57 per cent) did not think it would be possible to train a doctor adequately in any specialty whilst complying with the limits.
Two in five junior doctors (41 per cent) reported they had already experienced a need to undertake training during their time off and three in five (60 per cent) reported that their ability to provide safe medical care to patients had been compromised by pressures to work excessive hours.
The BMA believes it is important to ensure that training is deliverable within a 48-hour week.
One possibility would be to extend the training period to maintain standards and comply with the 48-hour week.
This would ensure that trainees in procedural based specialties such as surgery and cardiology had enough exposure to theatre to ensure they are fully experienced and skilled to treat patients.
Improved working patterns would also help.
The BMA is calling on governments to ensure that Health Boards have plans in place to deal with the changes coming into effect in August 2009.
Not only should they be prepared, but it is essential that any plan is tested prior to the deadline to guarantee that it is robust and effective.
This will ensure that patient care will be protected as any service gaps will be detected and filled prior to the start of the new limit being introduced.
The number of consultants should also be increased.
The BMA is also campaigning to ensure that training quality is not compromised by Health Boards in their preparations for the changes.