Talking Point: The mysterious side-effects of the EWTD

12 November 2009

By Joanne Curran, associate editor, MDDUS

IT’S hard to know what to make of the new rules on the European Working Time Directive. In the space of a few weeks, two reports have been published suggesting that restricting junior doctors’ working hours could be both helpful and harmful. One report suggests patients are “at increased risk of dying” because of the directive while another indicates that medical errors linked to overwork are “more likely in posts that are not EWTD compliant”.

A survey by the Royal College of Surgeons of England has reported that patients are “much less safe” since the new 48-hour working rules came into force. It claims services are being held together by a “grey market” of doctors who are willing to break the rules to maintain patient care. The college surveyed hundreds of consultants and trainees and found a worrying 64 per cent thought quality of care had suffered under the directive. Too many shift changeovers left doctors little time for a proper handover, it reports, while juniors work extra unpaid hours to make sure patients are cared for. And hospitals, the report claims, “couldn’t stay open” without the goodwill of staff.

President of the Royal College of Surgeons, John Black, said the survey sent a “clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care”.

Meanwhile, the National Training Surveys Key Findings 2008-2009 – from the Postgraduate Medical Education and Training Board – seems to offer a more positive view. A direct comparison with the RCSEng survey isn’t quite possible as the PMETB survey was carried out in the months before the 48-hour week was imposed in August, when the 56-hour week was in force. But the study shows that junior doctors who are in posts that comply with the EWTD were less likely to report errors than those who were not.

The key findings noted: “Medical errors linked to overwork are more likely in posts that are not EWTD compliant.” Trainees who blamed mistakes on overwork had 64 per cent EWTD compliance compared to 77 per cent EWTD compliance amongst those who did not blame mistakes on overwork. Other interesting results showed that juniors in posts that complied with shorter working hours felt they had a better experience of training. They were also more likely to report being encouraged to take study leave and less likely to report leaving local study sessions. Trainers also reported changing the way they taught in response to the shorter hours.

One area of concern that emerged from the survey was the falsification of working hours, with almost 4500 doctors admitting to doing this. This, in combination with the increasing number of hospital rotas applying to opt-out of the EWTD, seems to indicate real problems with shorter hours. But as the Department of Health continues to back reduced hours, it may take more surveys and studies into the EWTD’s impact before the government will consider any real changes.

Links:

National Training Surveys: Key Findings 2009-2009

Patients being harmed by working time limits, RCSEng