While managers may be losing sleep over the European working time directive the solution, as with so many of the 'big issues' in the NHS, is for them to work in close collaboration with their clinical colleagues, particularly consultants. Imposed solutions will damage doctors' morale and patient care.

Many organisations will need more doctors. The British Medical Association would urge them to seriously consider the beneficial, and evidence-based positive impact of expanding their consultant numbers as a solution to both the directive and quality patient care issues. We also urge all groups to think innovatively towards alternative solutions and ways of working to deliver the demands of the directive. Ignoring the health and safety requirements of the directive and using "opt-out" or derogation are not practical or ultimately safe ways of dealing with this complex issue.

A critical problem is that the increased funding made available to PCTs in the 2008-09 allocation is not coming down to many trusts, so the funding to effect change is not there. There is an urgent need for SHAs and the Department of Health to ensure that this money is not "lost" but used for the purpose it was designed for.

The BMA's recent survey shows that doctors do not want this legislation-driven change delayed. We must all work collaboratively to enable innovative and safe solutions for junior doctors, consultants and most importantly our patients.

Dr Jonathan Fielden, chairman, BMA consultants committee

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