Doctors' Working Lives News


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Improving Doctors' Working Lives

Tuesday, July 01, 2008

Changes to EWTD - European Social and Affairs Council agrees revisions, but they still have to get through the European Parliament 
EU social policy and employment ministers have agreed by a qualified majority on a proposal to amend the Working Time Directive. This is only one stage of the agreement process, and this still has to be agreed by the European Parliament. The main points of the proposal are:

* "Inactive time", ie time spent resident but not working, has been accepted as a new category in between work and rest. It will not count as work for the purposes of the 48 hour limit (unless otherwise agreed by collective agreement or national legislation - some countries have already said they will legislate for it to remain as work). However, whilst this time will not count as "work", it won't count as "rest" under EWTD either. This means that 24 hour resident on call will still be impossible as it will not meet the 11 hour rest requirement. However, doctors who are required to be resident on shifts, but who are resting for much of the night period, may be able to increase their daytime activity.

* The opt-out will be retained, but capped - at 65 hours per week in countries where all duty counts as work, and at 60 hours per week if inactive duty is not counted as work. There will also be heavier restrictions and provisions as to the use of the opt out - workers cannot opt out during their first month, will not be penalised for refusing to opt out, and employers must keep records of opted-out workers' hours.

* Compensatory rest may be taken within a reasonable period, to be determined by legislation, convention or collective agreement.

NHS Employers has a good summary of the proposed revision. However, note that this has been strongly opposed by the unions and has yet to get through the European Parliament, so it is by no means certain that this latest effort will resolve the situation. For more details check out reports in EIRO, the Guardian, the Independent and the BMJ amongst others. Also note the press release from the Standing Committee of European Doctors (CPME) which opposes the proposed amendments.

Thursday, June 05, 2008

NCEPOD: Heart surgery's safer at night - because it's done by consultants 

The new NCEPOD report says that heart surgery is actually safer at night - but only because you're more likely to see a consultant out of hours than you are during the day. According to the Independent, 17 per cent of in-hours operations were carried out by junior doctors compared with under 1 per cent at night, and this has led to better quality of care out of hours. However, the report also notes that mortality is more related to poor assessment and inadequate handover than lack of technical skill.

The BMJ looks at widening participation in medicine to include those from different backgrounds who had not managed to achieve top grades. However, the accompanying editorial, which takes a critical view of the push to increase diversity in medicine, has raised eyebrows and ire. "Shame the smug doctors", demanded the Daily Mirror, while a subsequent BMJ article here wondered whether the Mirror had just misunderstood the statistics in the original editorial.

A report by the King's Fund and the Royal College of Physicians suggests that doctors should be able to choose a career pathway in both medicine and management, reports the BMJ.


In New Zealand, junior doctors have been on strike due to an ongoing pay dispute. Stuff.co.nz has a thorough article on the dispute - and the comments below the article by clinical staff are well worth reading for alternative insights into the situation.

A pilot study at Bradford Teaching Hospitals suggests that interruptions and distractions are the main reasons for drug errors, reports the BMJ.

Wednesday, May 07, 2008

House of Lords rules against government restriction on overseas doctors 
The House of Lords has ruled against government guidance which restricts overseas' doctors entry into medical training via the Highly Skilled Migrant Programme. The British Association for Physicians of Indian Origin (BAPIO) had taken the case to judicial review. The Department of Health will have to withdraw the guidance although they will be able to publish revised guidance in the future. In the meantime, the BMA have published their official response to the consultation on this issue, which suggests that "removing the pool of international medical graduates from the UK altogether will destabilise rotas” and “ultimately place patients at risk”. (BMJ, Anaesthesia UK, OnMedica) For a copy of the full House of Lords judgement click here.

A&E services in South Staffordshire are having to limit their services and send patients to clinics and GPs as the the current A&E service was described as "unsustainable" due to junior doctors' working hours limits (Express & Star).

The Health Service Journal asks:
Did racism delay the SAS contract?


The BMJ asks: Does it matter that medical graduates don’t get jobs as doctors? and examines the arguments for and against.

And a US research study looks at effects of call on sleep and mood in internal medicine residents, noting that frequent on call can affect mood significantly even when the doctor is off duty.

Tuesday, April 29, 2008

WTD annual conference / RCP concerns over EWTD impact 
The Working Time Directive annual conference is taking place on the 2nd July 2008 at the ExCel, London. This is free to NHS staff (though a fee may be charged if you cancel at short notice). For more information and to register visit the booking page on the National Workforce Projects website.

The Department of Health's three-month consultation process on proposals for managing applications from non-EU medical graduates closes on 6th May (Tuesday).

The RCP have expressed concerns over EWTD impact on training and patient care, and suggest that more junior doctors and consultants may need to be recruited. (BBC, Politics.co.uk, OnMedica, Anaesthetics News). Meanwhile, the BMA suggest that 2,000 more consultants are needed to improve patient care and support EWTD hours reductions. (Telegraph) However an OnMedica article challenges the BMA's view, suggesting that only gradual expansion should be pursued. This is echoed in the US by a NEJM article questioning whether expansion of the medical workforce is the right solution to the perceived physician shortage.

A BMA survey finds that 2 in 3 junior doctors fear their training will suffer due to EWTD. (Press Association, HospitalHealthcare.com, STV - includes video report)

The BMA also say that juniors are being pressured to work extra hours unpaid (BBC, Herald, Telegraph, Independent).

In Ireland, the Chair of the EWTD National Implementation Group suggests that only court action can force real implementation of EWTD. (Irish Medical News) Also in Ireland, the Health Service Executive has refused to fund a pilot project in which consultants worked longer hours in order to allow their junior doctors to reduce their hours for EWTD. The HSE's view was that they would be rendered bankrupt if this scheme was extended to other hospitals. (Irish Health)

In Wales, the Western Mail reports that a major shortage of junior doctors has led to the temporary closure of some hospital services. (icWales)

In Sydney, Australia, junior doctors have given evidence to a public hospital inquiry about lack of training, chronic problems accessing test results, and orders not to claim overtime despite working 12-hour days.

Research

An Imperial College study indicates that laparoscopic skills suffer most on the first night shift of a block, and that adequate preparation for night shifts is essential. (Ann Surg 2008;247(3):530-9)

A Yamaguchi University study has found that a simple sleep education program for medical students can improve knowledge, coping methods and sleep. (Nippon Koshu Eisei Zasshi 2008;55(1):3-10)

An article in the Nursing Standard suggests that naps during the night shift may help prevent errors due to fatigue. (Nurs Stand 2008;22(17):20-1) Nursing Management also has a study on the effect of work hours and sleep on ICU patient care. (Nurs Manage 2008;39(4):32A-32F)

EWTD and women in medicine

Finally, the BMJ has a head-to-head debate on the increasing numbers of women in medicine, which makes startling reading. The Guardian, in an article about workplace gender discrimination, refers to Dr Brian McKinstry's argument that the increase in women doctors is a threat to the medical profession. The Guardian suggests that the EWTD should be used to tackle the culture of discrimination against pregnant women.


Monday, January 14, 2008

Tooke final report on Modernising Medical Careers 
The final Tooke report following the inquiry into Modernising Medical Careers has concluded that the original principles of the recruitment process were "well-conceived" but "lost in translation", resulting in "an inflexible structure that does not encourage excellence". The recommendations include:

* A new body, NHS Medical Education England, to manage postgraduate medical training
* A ring-fenced budget to prevent money intended for education and training from being used to plug hospital deficits
* A more flexible approach to the 48 hour working time limit (for instance by separating education and service time) if possible, and an examination of how changes to training can compensate for the EWTD's impact

On the EWTD issue, the report concludes that:
"....the current interpretation in UK legislation impedes the acquisition of experience, of confidence and the ability to shoulder responsibility. This promotes further the 'trainee mentality' over and above a recognition of the trainee's service contribution. In the interest of patient safety, no one would wish to see a return to hours of duty that impact on adequate rest and relaxation, but few other professions in the UK, nor medical career structures in Europe embrace the Directive in the same way that it has been embraced in the UK...

The Panel recommends that urgent attention should address whether there are ways in which a more flexible approach to EWTD could be legitimately embraced (e.g. separation of service and educational contracts). Due regard should also be given to whether additional compensatory mechanisms (which have been the subject of valuable but as yet unpublished scoping studies) could offset any reduction in clinical experience. DH should explore the potential for contractual solutions."

The full report can be found here. The BMJ has an audio interview with Sir John Tooke about the report. You can also access a full transcript here.

The report is so far being warmly welcomed by everyone, apparently. Click for responses from:
BMA
Remedy UK
Department of Health spokesperson
Royal College of Physicians
Royal College of Surgeons
Royal College of General Practitioners
Royal College of Radiologists
Royal College of Anaesthetists
Medical Schools Council
Academy of Medical Sciences

See also reports from the BBC, Telegraph, Times, Guardian, etc.

Wednesday, October 10, 2007

Doctors' recruitment to be done locally from 2008; start dates to be staggered; consultation out on prioritising UK graduates 
Doctors' recruitment to specialist training from 2008 will be done locally by deaneries, and start dates will be staggered, it has been announced. (Personnel Today) This follows the findings of the Tooke independent inquiry, which found that the MMC/MTAS changes were "rushed and poorly communicated" and that warnings about system risks were overlooked by the government. Health Minister Ben Bradshaw has said that although "a national electronic application process is a good idea" for the future, it would need to be secure, and the scoring process and the shortlisting process should be understood by candidates. (Guardian, E-Health Insider)

There is also a consultation on whether to give priority to EU graduates. The deadline for responses to this consultation is 22nd October 2007. The document notes that few non-UK EU graduates apply to the UK and that the within-EU competition is "manageable" - ie this discussion is effectively about whether we should prioritise UK graduates. (Click the link for the consultation document.)

Meanwhile, BMJ Career Focus looks at the ethical and legal implications of HIV testing for junior doctors.

Tuesday, August 28, 2007

Off hiatus 
As we emerge through the last days of August, blinking at the light, a few pieces of IDWL news (even non-MMC news!) begin to take shape....

Hospitals report that the massive August changeover went relatively well despite recruitment continuing right up to the wire - and beyond. Doctors and Trusts had to deal with considerable uncertainty and anxiety before and during changeover, although most hospitals appear to have minimised the impact of this uncertainty on patients by a planned reduction in service. Health service leaders have suggested that the decision to have all doctors change over on the same day may be reviewed for next year (Guardian).

Foundation Year 1s have lost their statutory right to on-site accommodation as of August 1st 2007, due to the repeal of ss10-13 of the Medical Act 1983 and the insertion of s10A, as announced on the NHS Employers website on 26th July. However, as most trusts had already agreed to provide this accommodation to the current intake, F1s will retain their tax exemption on this benefit until 31 July 2008, after which it will be taxable based on its cost to the Trust.

A study in the Emergency Medicine Journal suggests that doctors feel they are getting less experience in performing common procedures, due both to hours reductions and to changes in training. (Telegraph)

Women medical graduates are now outnumbering men by almost three to two, according to a BMA study. This is likely to have significant implications for flexible training and the BMA is urging the NHS to "wake up to the needs of its staff". (Independent)



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This site is maintained by Ellie Pattinson. All rights reserved. This website is maintained independently of the NHS and the views expressed are not necessarily a reflection of the views of that organisation. For any queries, contributions or amendments, please email me here.