Juniors’ training can be saved by consultants, report says

24 June 2010

A GREATER input from consultants is the key to saving junior doctors’ training under the European Working Time Directive, a Government report has concluded.

Senior medics must work more evening shifts if trainees are to get the training they need. Currently, the health service is “too reliant” on junior doctors to provide out-of-hours patient care, according to the Time for Training report by Professor Sir John Temple.

The former president of the Royal College of Surgeons in Edinburgh warned: “Training is patient safety for the next 30 years. What is very clear is that the status quo cannot continue if we are to train... the professionals of tomorrow for continued high quality healthcare delivery and patient safety."

The report found that the EWTD – which limits doctors’ hours to an average of 48 per week – has led to junior doctors spending more time covering gaps in shifts, especially overnight, which means less time to carry out operations and other vital training.

The review heard from junior doctors who had been taken out of training courses and outpatient clinics and told to cover nightshifts, where they would learn less. The report found that working at night also gave juniors less opportunity to learn from senior doctors.

The report stopped short of calling for the EWTD to be scrapped, saying that high quality training can be delivered within reduced hours if hospitals move to a consultant-delivered service. It said consultants need to work more flexibly and be more directly responsible for care around the clock, leading to better quality of diagnosis, better decision making and better patient outcomes and safety.

But Sir John accepted that a major culture change was needed within the NHS. “A number of people will never want to change what they are doing" but they tended to be older and would retire, he said.

Dr Shree Datta, chair of the British Medical Association’s Junior Doctors’ Committee said: “The report makes it clear that high quality training can be delivered within the constraints of the 48-hour working week, however, this is dependent on implementing the recommendations in full. It cannot simply be put on a shelf to gather dust and to do so would not be in the interests of junior doctors or our patients."

And Dr Mark Porter, chair of the BMA’s Consultants’ Committee, said the BMA had long been in favour of a consultant-delivered service. “It will assure a high quality of care for patients as and when they are in the greatest need,” he said. “The challenge now is to work towards it in a systematic fashion instead of the current piecemeal approach, investing in consultant expertise to deliver high quality care.”

Health secretary Andrew Lansley hinted the new Government may look at how the EWTD is implemented, adding: “We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe.”