conference focus

Published: 30/05/2002, Volume II2, No. 5807 Page 12 13

Hospitals may be spared the need to provide junior doctors with an 11-hour break for every 24-hour working day, senior medical adviser for the Department of Health Dr Deborah McInerny said.

In 2004, junior doctors are due to be given a maximum 58-hour week and the right to an 11-hour continuous break in every 24hour working period, under a timetable drawn up in the wake of the European working time directive.

Since the agreement was struck, the DoH has been in talks with the British Medical Association about the best regulations.

'Our aim is to give maximum flexibility to trusts, ' said Dr McInerny.

She added that one of the most important issues was to review the way services where delivered, 'particularly at night'. Too often up to four clinicians needed to see or discuss inpatients suffering problems after midnight, before a decision could be reached on the best course of action. 'Patients need to be seen by someone who can make a decision, ' she said.

She flagged up some possible models of working: 'The Central Middlesex solution is to concentrate all of your emergency teams in one place in the hospital. You have one emergency team that deals with all critical problems during the night, rather having one senior house officer for every specialism.'

Dr McInerny also said that 'the tribal barriers' had to be broken down, with the royal colleges needing to review cross cover.

The working-time directive requires junior doctors to have a maximum 58-hour working week by 2004, falling to 56 hours in 2007 and 48 (or 52 in exceptional circumstances) in 2009.

Dr McInerny also suggested that inching towards the target may not be the best strategy: 'The advice we are getting is that a big bang would be better - but that it would need to be carefully managed.'