The European working time directive scrutiny panel has recommended a further 73 acute medical rotas be granted derogation from compliance with the 48 hour week, bringing the total to 273.

TThis second round of rotas - across 38 trusts - follows the 200 rotas recommended for derogation by the advisory panel in June. Around 4 per cent of acute rotas have now been granted derogation until August 2011.

National clinical adviser for the working time directive Wendy Reid said: “We have always said we would keep the situation under close review and where there is a genuine need for extra time to safely implement the directive we would allow derogation.

However, the Royal College of Surgeons claimed earlier this month that services in trusts reporting compliance with the directive were “being held together by a ‘grey market’ of doctors willing to covertly break the legislation to maintain care for patients”.

A highly publicised survey by the college suggested 43 per cent of surgeons were covering rota gaps in other areas of their trust to keep services running.