EU Cuts to trainee surgeons’ hours threaten patient safety: Royal College of Surgeons

Trainee surgeons are under pressure to falsify their working hours and are operating on days off as hospitals struggle to comply with cuts to working hours, the Royal College of Surgeons has said.

Junior doctors should be allowed to opt out of the European Working Time Directive that limits them to a 48-hour working week from August because the effects on patient care will be ‘disastrous’, John Black, president of the College said.

Patients are being put at risk and the quality of their care is under threat as many hospitals are covering up failures to implement new rotas that comply with the directive, the Royal College has warned.

The College is calling for the Government to agree an opt out to safeguard patient safety and highlighted that in America juniors work an 80-hour week and in Germany a 61-hour week has been agreed.

The College also wants the on-call rule to change so sleeping at hospital does not count towards the working hours as it does currently.

Concerns were raised over junior doctors hours as many were working up to 100 hours a week and were making mistakes because they were so tired. Now the working time directive threatens to cut juniors hours so much that they cannot get enough experience to practice safely, it has been argued.

A survey of over a thousand surgeons by the Association of Surgeons in Training (ASiT) found more than half of trainees felt under pressure to falsify their hours.

Nine in ten were regularly exceeding their rostered hours, 85 per cent were coming in on days off to carry out operations and seven out of ten said the reduction of their hours so far has not improved their worklife balance.

ASiT believe 65 hours a week is required to gain the necessary training opportunities and 80 per cent of respondents would support an opt-out of the European Working Time Regulation to protect training.

Only a quarter of junior surgeons felt that the records of their working hours held by their trust’s human resources department accurately reflected their actual hours.

A further survey of almost 500 surgeons found unsafe levels of staffing because there are not enough surgeons available to fill rotas and gaps are appearing.

Over half of those questioned had experienced gaps on their rota. NHS Trusts are now routinely re-employing their own trainee surgeons out of hours as “internal locums” to cover gaps in shifts – with over two thirds of rota gaps filled in this way.

Two thirds of trainees working with rota gaps feel that patient care has suffered as a result.

“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 when every doctor’s hours are cut to a 48 hour per week maximum. 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?”

Alastair Henderson, joint director, NHS Employers, said: “Increasing junior surgeons’ hours would be a backward step.

“NHS employers have worked hard to implement the directive and have made good progress. More than half of junior doctors are already compliant and employers are still committed to ensuring that the maximum number of doctors are compliant by August 2009.

“We recognise, however, that there are a small number of services for which compliance may not be possible by August 2009. In those circumstances arrangements which offer a derogation of up to 52 hours work per week for a limited time are being considered, subject to EU approval. In these circumstances there would be rigorous scrutiny of the services affected and these would include plans to achieve compliance as soon as possible.

“We are not aware of any evidence that junior doctors are being asked to falsify their hours. If any doctor is being pressurised or bullied into falsifying their monitoring returns they should raise the issue with their HR department or trade union so that this can be investigated.”


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