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European Working Time Directive (EWTD)

Comment 8th July 2010

The introduction of the EWTD for UK doctors has been a costly disaster for patient safety and trainee education.

  1. The regulations were designed for Spanish lorry-drivers and are very inflexible.
  2. Although very long hours (>80/week) are associated with patient harms there is no evidence that reducing hours below, say, 56 hours per week are associated with improved outcomes.
  3. Cross-cover arrangements introduced on the back of EWTD mean that the doctor has very little knowledge of the patients he is looking after, a recipe for error.
  4. There is insufficient time for adequate patient handover, particularly during busy winter months.
  5. The direct exposure of trainee doctors to learning opportunities is greatly reduced as the same learning opportunities are divided between more doctors.
  6. Knowledge of trainees by supervising senior doctors is greatly reduced because of shiftwork patterns and the loss of the clinical team.
  7. Shiftwork patterns are known to be associated with increased rates of depression. Anyone with experience of jet-lag knows that it takes several days to recover afterwards.
  8. This lack of experience, expertise and knowledge of the patient by junior doctors means that more senior grades are becoming over-committed for routine activity.
  9. Most shifts have gaps, which are covered by locums of variable quality (c.f. Dr Ubani).
  10. The drop in income of junior doctors means that many are 'moonlighting' in neighbouring trusts as locums. This means that their hours are much the same as before, but they have to travel to and work in a strange unit. Both increase patient risk.
  11. The cost of locums has shot up. An average middle grade locum pre-EWTD cost around £40 per hour. Now it is £70 with a sign on fee of up to £20,000 for any medium-term locum. This is costing the health service a fortune.
  12. The change in designation of on call to mean that anyone resident (even if asleep) is paid as if working is very costly and not good value-for-money.
  13. The number of doctors in the NHS has trebled since 1979. On retirement from the NHS doctors in those days survived an average 18 months, so pensions could be generous. Now, with reduced hours and increased longevity, I would predict survivals of an average of 15 years. The pension bill will therefore increase by 30 fold (compound).

Why does this matter?

This would:

  1. Save the NHS and Exchequer a fortune
  2. Greatly improve patient care delivery
  3. Greatly improve training for doctors
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