John Garner: Double whammy could leave us with less skilled doctors

Published on Monday 8 June 2009 19:08

WE ARE only six weeks away from the final phase of the implementation of the European Working Time Directive, which will enforce a reduction of the maximum hours a junior doctor can work in an average week from the current 56 hours down to 48 hours.

This loss of eight hours a week per doctor will have a number of serious implications.

For employers, it stretches cover so that they may require more doctors to ensure a minimum cover for patients in hospital. Extra budgets have apparently been allocated but not enough to ensure all additional staff are funded.

For patients in hospital, it means more faces to remember, and greater uncertainty as to which doctor is looking after you. In addition, with a greater number of "handovers," as one doctor goes off shift and another starts, there is an increased risk of communication breakdown.

I'm not against the reduced hours, but it behoves everyone to work hard to minimise the risks that this change will certainly create.

One of my biggest concerns is the training of junior doctors. When I and doctors of my generation trained, the long hours were an accepted part of career progression.

I recall one job I did for six months in Leith, where we were working, or on call, for 124 hours a week. All the team was dog tired and probably unsafe, but we saw and learnt an awful lot of medicine and surgery.

It gave us confidence in our patient assessments and we quickly mastered many practical procedures.

Future generations of junior doctors won't have the opportunities of being constantly on the wards, so other methods need to be employed to ensure they have the knowledge and skills to be our future consultants and GPs.

This, to my mind, can be achieved only by the creation of protected time, so that they can learn and hence develop the necessary skills.

These junior doctors will need consultants to impart that knowledge and experience and to demonstrate the kind of care that we aspire to in the Scottish health service. Here, though, is the rub: future consultants may be less able to dedicate the time needed to undertake the teaching and supervision of junior doctors.

Let me explain.

When the new consultant contract was negotiated five or six years ago, provision was made in the contracts for sessions to support professional activity. These sessions, known as "SPAs" offered time when the consultant was not seeing patients, and were meant for such activities as administration, teaching medical students, postgraduate doctors and other health staff, supervision of junior doctors, research, educational activities to keep up to date, and so on.

It was agreed between management and doctors that two and a half sessions out of a ten-session week was an appropriate figure, and job plans were drawn up accordingly.

Recently, health boards in Scotland have been trying to sign up the new generation of consultants to a contract that only allows one SPA.

This would perhaps help to reduce waiting times in the short term but would also create a double whammy – junior doctors who need more intensive and concentrated teaching due to their reduced hours, and yet a workforce of consultants who are unable to deliver because of insufficient time allocated to deliver the education.

There is a real risk that, unless we address this problem now, future generations of consultants will be less skilled and less experienced than our current cohort – and those who will suffer will be the patients.

So, as August approaches and the hours of junior doctors are reduced, we need to be confident that patients will not be put at risk by these changes.

In addition, both junior doctors and consultants need adequate protected time to ensure education and practical skills are imparted and acquired. If that means extra doctors, so be it.

I want to be sure that, when I need a consultant or GP, he or she has the necessary skills (and time) to sort out my medical problems.

&#149 Dr John Garner is a member of the British Medical Association's Scottish council and a practising GP.