Doctors caring for up to 400 patients at night

21 April 2010

SOME doctors are responsible for as many as 400 hospital patients at night, a new report has claimed.

There are wide variations in the provision of medical cover at night, according to research from the Royal College of Physicians (RCP). It found doctors were caring for an average of 61 night patients – but the number varied from just one patient to as high as 400 in some cases.

A junior doctor was often the most senior doctor in charge of a ward in 63 of the 887 medical teams in England and Wales who responded to the survey. Consultants were involved in the direct delivery of overnight care in only six per cent of teams.

The staffing issues have arisen since junior doctors’ working hours were restricted to 48 per week under the European Working Time Directive last August. The RCP said there was now "overwhelming evidence that safe and effective hospital cover, especially at night, cannot be sustained" under the new European rules.

Dr Andrew Goddard, director of RCP’s Medical Workforce Unit, said: “The very low number of doctors per patient at night in some hospitals raises serious concerns for patient safety and there are also worrying reports of very junior doctors being left unsupported, which urgently require further investigation.”

Day cover on wards also varied considerably, from two to 65 patients per junior doctor with the highest ratio in Wales and the lowest in London, reflecting the city’s higher number of trainees.

Other key findings highlighted issues over junior doctors’ welfare, with 58 per cent of consultants reporting an increase in sickness rates of juniors working under them, compared to before the EWTD. There were also higher than expected vacancy rates amongst foundation level trainees, which varied from one per cent to 8.6 per cent of specialist trainees.

Dr Goddard criticised the EWTD, saying: “The apparent rise in sickness rates of junior doctors since the introduction of the European Working Time Directive highlights the additional stresses that are being put upon trainees by new rotas. Far from benefiting their welfare, the poor implementation of the directive means that juniors are missing out on crucial support and valuable training opportunities, and patient care is being spread too thinly.”

The study - to be published later this year in Clinical Medicine - asked consultants to record the membership of their team and the number of patients they were responsible for at 11am and 11pm on one day in November in order to create a snapshot of staffing levels.

A Department of Health spokesman said: "Employers are responsible to ensure that service rotas are designed and staffed appropriately, in accordance with the working time regulations. The Department of Health's overriding priority will continue to be ensuring that patients are safe; and experience, high quality and effective care in the NHS."