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Trainees still working nearly 100 hours a week

Working Time Regulations have not solved problem

Jo Carlowe

Friday, 15 February 2013

Some doctors are still working nearly 100 hours a week increasing their likelihood of making mistakes and putting patients at risk.

This is the finding from the General Medical Council which commissioned research aimed at understanding the impact of the Working Time Regulations which is designed to promote health and safety by restricting the hours that doctors work.

The study, based on the views of 82 trainee doctors, found that while the regulations had led to fewer hours, it had also produced more shift work, leaving some doctors suffering fatigue and acknowledging that there were times when they performed poorly.

Under the Working Time Regulations the UK's 55,000 doctors in training should not be working more than 48-hours a week, averaged over 26 weeks. They are also bound by the New Deal contract which was also designed to limit the hours they can work

While many of the doctors in the study welcomed the regulations for improving their work-life balance, others said they had less time to manage their workload because of badly designed and understaffed rotas.

Some also said that the shorter working week was responsible for a lack of continuity in out-of-hours care and meant they had access to fewer training opportunities.

Many respondents also complained of not being able to take rest breaks or eat or drink during long shifts and most said they felt unable to challenge bad rotas and working practices.

The GMC states that the study builds on evidence that too many hospitals are relying on doctors in training to provide care and treatment without adequate supervision from senior colleagues.

The GMC's State of Medical Education and Practice report 2012 recommended that hospitals should urgently look at access to consultants seven-days a week to bolster cover during anti-social hours.

Niall Dickson, Chief Executive of the GMC, said: “It is clear the current system is not working as it should – in some cases doctors are still too tired and there are issues around continuity and training opportunities.

“We must never go back to the ridiculous hours worked in the past when patients were routinely put at risk by exhausted young doctors, but the current system is too complex and the way it is implemented far from satisfactory.”

He said the GMC would continue to work with the NHS, medical royal colleges and postgraduate deaneries to help address these problems.

Professor Terence Stephenson, Chair of the Academy of Medical Royal Colleges, welcomed the report.

“While there are different views on the Working Time Regulations, there is general agreement that their relationship with the New Deal contract - which also limits the hours that trainee doctors work - makes it unnecessarily complex when designing rotas and this needs to be addressed,” he said.

He added: “We would back a move to introduce greater flexibility into the WTR so rotas can support both service and patient safety while enhancing training.”

Responding to the publication of the GMC research, Dr Ben Molyneux, Chair of the British Medical Association’s junior doctor committee said poor implementation of the WTR had left some junior doctors working potentially “dangerous working patterns”.

“The solution does not lie in increasing working hours. There is clear evidence that long working hours increase the potential for doctors to make mistakes. We must learn from the GMC research and the recommendations of the Time for Training review to ensure working patterns deliver on education and do not threaten patient safety,” he said.

“Hospitals must not continue to rely on the outdated working practices of junior doctors. We need to move to a consultant based system of delivering healthcare service to patients and ensure that high quality patient care and high quality training go hand in hand.”

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