Published: 17/04/2003, Volume II3, No. 5851 Page 10 11

Trust managers are becoming increasingly anxious over whether they will be able to reduce junior doctors' hours in compliance with the European working-time directive deadline next year.

Many trusts say they have already made radical changes in work practices as they struggle to cut junior doctors' weekly working hours to 56 by August 2003 under the New Deal. But with next year's August directive deadline to cut working hours to 58 a week including on-call time, they say they are up against the wall.

Newcastle upon Tyne Hospitals trust personnel manager David Levy said: 'Our compliance rate with the New Deal was 94 per cent at the beginning of the year. But the directive will mean a reduction in junior doctors' hours of about 20 per cent.'

The trust is already building directive requirements into contracts for junior doctors, he added.

'It is a combination of investment and reform.'

Royal Liverpool and Broadgreen University Hospitals trust medical working-time compliance manager Kay Carter said: 'The financial implications are serious.

The government is giving out more specialist registrar posts, but is not giving out the money to pay for them.'

Her trust is moving more doctors onto full shift patterns to cope with the change. She said: 'The change from residential oncall working patterns to full shift patterns has been enormous. We employ 300 junior doctors; 18 months ago we had 30 doctors on full shift patterns and, by 1 August 2003, we will have 133.'

North Bristol trust medical workforce development manager Claudia Grigereit said an additional 56 clinical fellow posts had been funded, but this did not resolve training issues. 'For every shift a doctor does at night, he/she cannot do a day shift the day before or after. All these hybrids and partial shifts will go out of the window as we progress towards full compliance with the directive.'

Both the Institute of Healthcare Management and the Association of Healthcare Human Resources Management agreed the target may not be achievable. Their members were predicting difficulties despite a variety of new schemes and initiatives led by the Department of Health.

IHM acting chief executive Rosey Foster said: 'We feel there will be a real difficulty in meeting the August target...Recruitment still remains a problem and therefore the reality is that the target may not be achievable.'

AHHRM executive officer Peter King added: 'In order to meet it we need more doctors and it will not be possible without that.'

The medical establishment is equally worried. The Royal College of Physicians wants a postponement of three to six years, saying there are insufficient trained doctors to provide full cover at present. 'Without this delay we believe there is a substantial risk to the safety of many hospital patients with medical illnesses, ' the college warned.

Hospital Consultants and Specialists'Association chief executive Stephen Campion warned of the impact on emergency cover. 'Our scenario planning suggests that only the largest teaching and district general hospitals will be able to commit a full shift of consultant and junior anaesthetic staff. This will reduce the number of hospitals in the UK giving emergency cover from 350 to about 120.'

British Medical Association lead negotiator for junior doctors Jo Hilborne said training was a serious issue as moves to full shift patterns will make it difficult for doctors to meet their training requirements. 'It could still all go horribly wrong, ' she said.

The NHS Confederation was upbeat. Policy manager Alistair Henderson said: 'Generally, the picture is of trusts beginning to get to grips with the issues and I am reasonably confident that trusts will be compliant with the directive by the deadline of August 2004.'