Patients at risk from trainees’ long hours

SOME trainee doctors are still working nearly 100 hours a week which could be putting patients at risk, the General Medical Council has warned.

Long working hours are leaving some doctors tired and stressed, increasing the potential for mistakes.

The findings were revealed in research commissioned by the GMC looking at the impact of Working Time Regulations set by the European Union.

The survey gathered the views of 82 trainees and found that while the regulations had led to fewer hours, it had also led to more shift work meaning some doctors were tired and sometimes performing poorly. Many of the doctors surveyed welcomed regulations for improving their work-life balance but others said they had less time to manage their workload because of badly designed and understaffed rotas.

The European Working Time Directive (EWTD), introduced in 2009, limits the average working week for doctors to 48 hours in a bid to improve health and safety. Working hours are also limited by the UK government’s New Deal regulations.

Limits on doctors’ working hours have been criticised and this was echoed in the GMC survey where some respondents said the shorter working week was responsible for a lack of continuity in out-of-hours care and meant they had access to fewer training opportunities.

The study also found that most trainees felt unable to challenge bad rotas and working practice while some reported being unable to take rest breaks or eat or drink during long shifts. Researchers stressed that Working Time Regulations were not the sole cause of fatigue and that changes to medical training and the NHS were also factors.

A range of views emerged from the GMC survey with one doctor commenting: “I've got no problems with the fact that I work a little bit over and take the extra time to get training opportunities and that increases my hours to get better at my job. That’s personal sacrifice and personal advancement to get a better job - to become a consultant.”

Another said: “I think when you are getting to the end of a 13-hour shift you find that your technical skills certainly decrease. It gets a lot harder to do things that require more concentration but I think you’re also quite aware of that, so patient safety wise you are aware that you are not at your best so you often check more of your decisions with other people.”

The study also supported other evidence suggesting too many hospitals rely on trainees to provide care without adequate supervision.

GMC chief executive Niall Dickson said: “It is clear the current system is not working as it should – in some cases doctors are still too tired and there are issues around continuity and training opportunities.

“We must never go back to the ridiculous hours worked in the past when patients were routinely put at risk by exhausted young doctors, but the current system is too complex and the way it is implemented far from satisfactory.”

He said the GMC would continue to work to address the issue.

Professor Terence Stephenson, Chair of the Academy of Medical Royal Colleges welcomed the research, adding: “While there are different views on the Working Time Regulations, there is general agreement that their relationship with the New Deal contract - which also limits the hours that trainee doctors work - makes it unnecessarily complex when designing rotas and this needs to be addressed.

“We would back a move to introduce greater flexibility into the WTR so rotas can support both service and patient safety while enhancing training.”