Training ‘compromised’ by time directive

Support for opt-out

ASiT believes 65 hours a week is required to gain the necessary training opportunities and 80% of respondents would support an opt-out of the European Working Time Regulation (EWTR) to protect training. The College’s regular monitoring of junior doctor training quality shows that trainee surgeons are not able to get into theatre to learn. Almost half of junior doctors in the first two years of surgical training go to theatre fewer than three times a week and one in 15 does not go at all. “This is a worry for today and tomorrow,” said John Black, president of the Royal College of Surgeons. “On the one hand, the immediate effects on patient care in the NHS are potentially disastrous. There are simply not the surgeons in the UK to fill the gaps. On the other, trainees are telling the college they cannot gain enough experience to progress on the shortened hours. The choice for the nation is clear – do we want patients of the future to be treated by a group of highly skilled and experienced surgeons, or be passed around a wider group of lower-skilled surgeons with less experience?” Ben Cresswell, the president of ASiT, added: “The increased tendency to shift working that we have seen over the past few years has been driven entirely by a desire to reduce hours. That desire has not come from the profession, neither from trainees nor from consultants, and the hours reduction has been universally damaging due to significant fragmentation of the surgical team and a loss of continuity of care. “We now have hard evidence that this fragmentation has harmed both quality of training and patient safety. The Association of Surgeons in Training is offering its full support to the Royal College of Surgeons of England, in its request for an opt-out of the EWTR legislation. We feel that such a concession offers the very best solution, in order to permit a return to excellence in training and to protect high quality patient care.” The College called on the Government to put in place a long-term solution to safeguard patients and the training of future surgeons. Key recommendations include: • The introduction of an opt-out for all the surgical specialties in England, to allow hours to be worked up to the figure defined by the College’s trainee organisations. • The revision of the rest-break legislation. Formal rotas brought in to meet working time legislation have introduced unsafe levels of handovers between doctors and have proved more disruptive to work-life balance than the longer on-call system they replaced. The College pointed out that the US has decided to keep junior hospital doctors’ weekly hours at 80, largely based on patient safety grounds. In Germany, the trade union representing hospital doctors in conjunction with the professional bodies has agreed that 61 hours is appropriate.

Impact on orthopaedics