Here is a collation of invaluable tips from experts on achieving the European working time directive

Homerton University Hospital foundation trust

  • Know your hospital. One model does not fit all, so gather as much background information as possible: number of emergency attendances, time of arrival, numbers and types of admission, length of stay, numbers of emergency operations
  • Consider all potential solutions and ideas, but innovate your own
  • Try getting everyone to agree change that needs to be made
  • Don’t underestimate the amount of time required to make change happen
  • Numbers, information and data can be very persuasive
  • Speak to each consultant team individually to show how the changes will affect them
  • Improvements can always be made


Getting junior doctors on board

  • Barrier

Junior doctors want to engage and take ownership of their working practices. They just need an avenue to do so.

  • Solutions

Lord Darzi’s next stage review has highlighted the importance of engaging clinicians in management issues and roles. Frontline staff who implement change increase the likelihood of a sustained positive transformation, improving the quality of patient care.

NHS North West has recognised these issues and has sought to fully engage junior doctors in designing their working conditions and looking at the means to remove non-clinical work pressures. They strived to achieve a balance between service provision and maintaining high standards of training and education.

Junior doctors have had the opportunity to consult directly with EWTD project managers within trusts in order to design their working patterns and accept new working practices.

The key to success within the North West has been giving junior doctors ownership of their working conditions and empowering them with the ability to take part in their rota design.

The creation of EWTD compliant rotas in the North West has been achieved through managed change, which is transparent and auditable.

Edited from: Signposting European Working Time Directive Solutions

Top tips for EWTD rota design

  • Consult all key stakeholders before planning any changes: junior doctors, senior doctors, and senior nursing staff
  • Identify local workload and match medical staffing levels appropriately
  • Set realistic start and finish times in the normal working day
  • Minimise impact upon attendance at formal teaching sessions
  • Include appropriate handover period
  • Include appropriate prospective cover allowance and room for leave to be taken
  • Ensure New Deal and EWTD requirements are all met
  • Ensure rotas are IWL friendly, for example by maximising the number of free weekends
  • Plan rotas with flexibility, ie not 47.9 hours
  • Thirteen hour shifts are likely to overrun so aim for a maximum of 12.5 hours
  • Group weekend nights together
  • Match doctors in pairs/consider daytime ward cover
  • Match rotas at different grades within specialties to allow joint handover/Hospital at Night/team working
  • Use software like DRS or Zircadian to analyse rotas and ensure that staff using software have been trained appropriately
  • Where possible, take senior surgical trainees off night shifts, or consider having non-residents on call, to consolidate learning and maximise daytime training opportunities and “cutting time”.


Royal College of Anaesthetists and Royal College of Surgeons

  • Ensure senior board level leadership
  • Encourage junior doctor involvement
  • Establish an EWTD steering group
  • Use IT solutions
  • Redesign services if needed
  • Implement as soon as possible to ensure solutions are monitored, embedded and implemented

Source: WTD - Implications and Practical Suggestions to Achieve Compliance