August change-over for NHS doctors puts patients at risk

The majority of doctors believe patient safety in Scotland is compromised in August as medical trainees start their new posts all on the same day, research shows.

August has long been considered a difficult time for the NHS as 50,000 doctors across the UK change to new roles on the first Wednesday of the month.

Now a survey of doctors has found that 90 per cent believe the change-over happening on the same day has a negative impact on patient safety.

The research, by the Royal College of Physicians of Edinburgh (RCPE) and the Society of Acute Medicine, also found 93 per cent thought it negatively affected patient care, and 58 per cent said it was bad for their training.

Traditionally, would-be doctors take up training posts in the first week of August and those already in training rotate to other positions on the same day.

In recent years, growing evidence has emerged to suggest patients admitted to hospital around this time of transition, when young doctors are still getting used to their new roles, have higher early death rates than those admitted at other times.

The latest research, published in the journal Clinical Medicine, suggests the situation could be improved by changes to the starting dates, with 80 per cent of 763 doctors questioned backing a staggered transition of trainees to new roles over a period of a month.

Medics also suggested moving the switch-over to another time of year to avoid clashing with the holiday period, when senior doctors, who could help supervise trainees, are away. One doctor said: "August is always a nightmare."

Dr Louella Vaughan, the study's lead author, said: "The results add to the emerging evidence base which indicates that the August change-over system increases a number of risks for patients, including an increased early death rate for patients admitted to hospital at this time.

"Over 90 per cent of doctors who responded to the survey believe patient safety is compromised every year in August by this outdated system. When considered along with other related evidence, it is clear the current system is in urgent need of reform."

Dr Neil Dewhurst, RCPE president, added: "For many years doctors have been aware of practical problems caused by this annual change-over. Formal evidence has now reached the level where it should not be ignored.

"Other changes to established systems within healthcare have been shown to deliver real improvements for patients and similar consideration must be given to making the change-over in training safer. We would urge (government] to review this matter as a matter of urgency." Dr Alan Robertson, from the British Medical Association's Scottish junior doctors committee, said: "The fixed change-over date in August does give the NHS a clear date for which to plan services and ensure sufficient supervision is in place to provide support to those new in the job.

"However, there could be scope for some of the suggestions posed by the RCPE."

Margaret Watt, chair of the Scotland Patients' Association, said: "We have to make the transition as smooth as possible for doctors and patients because if the doctors don't get it right the patients are the losers."

Deadly effect

RESEARCH has confirmed that the change-over period of junior doctors has a destabilising effect on patient care.

A 2009 study of almost 300,000 patients in English hospitals found death rates for emergency cases arriving on the first Wednesday in August were 6 per cent higher than for those arriving a week earlier.

The effect has been seen in other countries, with a study of 700 US hospitals showing a small increase in mortality early in the academic year.