Cut in doctors' working time 'will leave UK short of skilled surgeons'

Published on Sunday 1 August 2010 15:53

EUROPEAN laws limiting the hours doctors can work have "failed spectacularly" and damaged patient safety, surgeons have claimed.

•Picture: Getty

The European Working Time Directive (EWTD), which was fully implemented a year ago, means junior doctors across the UK are not supposed to work more than 48 hours a week.

But a new survey has revealed concerns among consultants and their trainees over reductions in the amount of practical training they now receive and the impact on patients of repeated change-overs in medics looking after them.

Royal College of Surgeons (RCS) president John Black said: "To say the European working time regulations have failed spectacularly would be a massive understatement."

One consultant surgeon described the EWTD as a "training disaster", adding: "We are raising a generation of demotivated, demoralised and poorly trained surgeons. The UK will pay for this and regret it for at least 30 years."

The Scottish Government said patient safety was a priority and that NHS boards were being helped to comply with the regulations, but opposition parties expressed concern about the findings of the survey.

The limits imposed by the EWTD were designed to stop doctors working excessive hours, putting themselves and patients at risk.

But the Royal College of Surgeons of England, which surveyed 980 surgeons across the UK, said that, since the regulations were introduced, patients in NHS hospitals were less safe.

In the survey, 80 per cent of consultants and 66 per cent of surgeon trainees said patient care had deteriorated under the directive. This compares with 72 per cent of consultants and 59 per cent of trainees consulted last October - just a few months after the EWTD came into force.

Some 65 per cent said their training time had decreased - up from 41 per cent last year.

Two-thirds of trainees also reported a decline in training time in the operating theatre, and 61 per cent of consultants said they were operating without trainee assistance more frequently.

Concerns were also raised about what happened when doctors had to change shifts and pass on information about patients to those starting work. The number of such handovers has increased as doctors are working fewer hours. The poll found 41 per cent of consultants and 37 per cent of trainees reported "inadequate handovers".

The concerns remained even though many medics were working longer than the 48-hour limit. Seventy-two per cent of trainees and 61 per cent of consultants were consistently working more than that. More than half of trainees said they covered rota gaps, which resulted in them working in excess of their contracted hours.The RCS said the survey painted "a picture of an NHS that, one year on, is still is totally overstretched due an arbitrary hours regulation".

It said patients were increasingly being assessed only by junior members of staff or routinely passed between many different doctors with varying levels of experience, often with unsafe, inadequate or no handover procedure.

Senior surgeons, under pressure to get through patient lists, were now operating alone, while their juniors managed wards without support and guidance because working rotas were so stretched.

The RCS said the lack of exposure to "vital hands-on training alongside experienced colleagues is rapidly eroding NHS care and causing a critical shortage of capable, skilled surgeons in the future".

Mr Black said: "Despite previous denial by the (Westminster] department of health that there was a problem, surgeons at all levels are telling us that not only is patient safety worse than it was before the directive, but their work and home lives are poorer for it.

"The new government have indicated they share our concerns, but there is not a moment to lose in implementing a better system, which would enable surgeons to work in teams, with fewer handovers and with the back-up of senior colleagues."

Surgical groups have called for a working week of up to 65 hours, including time spent on-call, to balance training opportunities for surgeons, provide good patient care and ensure an adequate work-life balance.

Dr Alan Robertson, a member of the British Medical Association's Scottish junior doctors committee, said: "The results of this survey are concerning and suggest that more doctors are required to ensure that patients receive the quality healthcare that is expected of the NHS.

"The BMA has long advocated a consultant-led service, which would assure a high quality of care for patients as well as allowing junior doctors the time to train. The challenge now is to work towards this by investing in consultant expertise to deliver high quality care."

Jackie Baillie, Scottish Labour health spokeswoman, said there was a shortage of junior doctors in Scotland, with many vacancies unfilled.

She highlighted the case of the Victoria Hospital in Kirkcaldy, which has been forced on several occasions to close its A&E service overnight because it has been unable to fill staff rotas. The health board said this was partly due to the EWTD restrictions.

"I have also heard reports that there are concerns some junior doctors are not receiving sufficient training and contact time with patients," Ms Baillie said.

"That is something that should concern us all and we should review the situation to make sure that those who are newly qualified are as experienced as required."

Ms Baillie said the situation needed to be reviewed to make sure trainees were given enough time with patients. But she said this did not mean doctors had to return to working very long hours, which she termed "a feat of endurance".

A Scottish Government spokesman said: "Patient safety and care is our number one priority. The Scottish Government's working time regulation adviser continues to work closely with all NHS boards on the design of rotas to ensure high-quality patient care and in order to comply with the working times regulation. We will continue to assist health boards in meeting these requirements."