Significant changes will be considered so doctors can train and work more flexibly, the Government has announced. These changes will be explored in response to an independent review of the impact and implementation of the European Working Time Directive on the NHS.
Work is now underway to explore options to support doctors who want to access more training opportunities. Former president of the Royal College of Surgeons (RCS), Professor Norman Williams led a taskforce of experts, including the BMA, NHS Employers and Royal Colleges, which reported to the Government in April with a range of recommendations.
Under the Working Time Directive, doctors and trainee doctors are restricted to working a maximum of 48 hours per week on average over a six month period, unless they voluntarily opt-out. Within the NHS this has contributed to overly rigid shift patterns, affecting time for training.
The taskforce report found that the Directive has had a beneficial impact by preventing doctors from working very long hours and jeopardising patient safety.
However, it also found that doctors in certain specialty areas, such as surgery, work longer hours voluntarily to gain the training they need. For example, doctors beginning surgical training today will have 3,000 fewer hours to learn through training – equivalent to 128 whole days. In addition, complex shift patterns can increase handovers between doctors, which can increase the risk of errors, and enforced rest breaks have resulted in cancellation of some clinics.
The Government has accepted all of the review’s recommendations and has committed to explore all options including:
· Identifying training time that is not working time: at present doctors must complete training and regular work within the 48 hour weekly limit of the Directive unless they opt out – Health Education England will explore if and how some training elements could be separated from work related activities, meaning doctors can have more opportunities to train outside of their regular duties and improve their skills.
· Raise awareness of the voluntary opt-out: The Department of Health will consider ways to encourage more widespread use of the individual right to opt-out of the 48 hour restrictions for those who wish to, and where it is safe to do so. This will allow doctors who want to spend extra time on work related training activities to do so. This would be particularly beneficial in some specialities such as surgery.
· Review working patterns and rotas: Health Education England (HEE) is working on a national programme that will provide support to Trusts so they can redesign staff rotas and give doctors more time to access training.
The Government will also ensure that the current contract negotiations for junior doctors and consultants take account of the recommendations of the report, including how training time can form part of working patterns and that doctors have appropriate rest times and breaks.
Secretary of State for Health Jeremy Hunt said: “We share the longstanding concerns about the impact of the implementation of the Working Time Directive on patient care and doctors’ training. Doctors should have the flexibility they need to access the training they want. This would lead to better care.
“We will never go back to the past with tired doctors working long hours, but it is clear that the Directive does have a negative impact on the training of doctors in some specialities. We will now look at how training and working time could be separately identified so we can give doctors the flexibility they need.”
Professor Norman Williams, chair of the independent taskforce, said: “As a taskforce we were clear that the one size fits all approach of the Working Time Directive in medicine is detrimental for training and patient care in some specialties. Our recommendations set out a clear path to getting to much needed solutions. The taskforce, which drew support from across the health service, was unified that action is needed now but solutions should not lead to a return to doctors’ working excessively long hours.
“I am pleased the Government has accepted our report and committed to explore our key recommendations. In particular the separation of training and education of trainee doctors from their work on the wards has the opportunity to strike the right balance between delivering patient care and ensuring that junior doctors have the right knowledge and skills.”
