Published: 02/09/2004, Volume II4, No. 5921 Page 20 21

Your article on the European working-time directive (page 2425, 8 July) raises some interesting points.However, I would question the overall premise that 'however it is done, creative redesign will have problems'.

The EWTD, in conjunction with other drivers for change, offers an opportunity to give greater recognition and emphasis to training, not less. This opportunity should be grasped and moulded to the needs of every specialty.

Medical training for too long has relied upon waiting for interesting cases. This reactive approach to training should be replaced by a proactive, planned scheme where opportunities are identified and used.

This in itself is not easy:

consultants need new skills in training; they need time to prepare and, most of all, the capacity within the system to allow teaching during the normal working day.

Many of the specific issues mentioned in the article support the existing on-call model, where every specialty has their own team covering their own patient.

Rather than deal with each scenario, I would challenge it by asking two questions.

First, who is the best person to deal with the surgical patient who develops chest pain at night - the surgical senior house officer for that ward or the medical specialist registrar on the hospital at night team?

Second, do the dichotomies raised not suggest current medical training needs reviewing, as it is deficient in basic management skills?

These skills can be learnt and with the learning will, hopefully, come the realisation that a team approach to healthcare is the most efficient model, not teams based solely upon doctors.

Neil Pumford Central (team) doctor Implementation support group Scottish Executive Health Department