Staff shortages on the wards: some solutions

I agree that implementing the EU working-time directive would cause the NHS problems, but I have little sympathy for your arguments against its adoption (comment, 18 November).

This has been an issue for at least 20 years, but the government and NHS managers have shown little inclination to find a solution.

Waiting for more doctors to be available following the planned increase in medical student numbers may not be an answer either.

Doctor availability depends on retention as well as recruitment.

There are plenty of naive and innocent school-leavers willing to sign up for medical school, who do not yet know what they are letting themselves in for.

One in five medical graduates, however, is not practising in the NHS five years after qualification.

This may get even worse. Sixty per cent of the current medical school intake is female (and for good reason, as women make excellent doctors). Women doctors appear to be less likely than their male predecessors to put up with the appalling working conditions expected by the NHS, and their male colleagues are increasingly following their example.

The bottom line is pay and conditions. The public will get the NHS it deserves and pays for. If we are to forgo competitive and safe working practices, this should be compensated by punitive pay rates for the excessive hours (perhaps up to three or five times the basic rate).

Since the junior doctors would be helping the NHS out of something of a fix, at the expense of their own health, personal lives and professional reputations (tiredness and disillusionment are no defence in a negligence case), NHS managers should welcome this approach.

Punitive costs should provide a suitable incentive to develop alternative solutions, which could involve further work shifting to other groups, such as nurses and clerks.

Many doctors suspect that the status quo has been maintained for so long only because they were so cheap.

Dr Rowan Harwood Consultant geriatrician Nottingham