Rules aimed at ensuring doctors do not work long hours are leading to cancelled operations and clinics for patients, a government-ordered review has found.
The report into the impact of the European Working Time Directive (EWTD) found that mandatory rest periods for doctors providing out-of-hours emergency hospital care were impacting on the following day’s work.
The EWTD limits doctors to a 48-hour week and was brought in to put a stop to long working weeks of 70 or 80 hours or more in the NHS.
But several royal colleges have said the limits mean doctors cannot always get involved in all aspects of patient care, while the quality of training for medical students has gone down.
In its submission to the task force examining the issue, the Royal College of Physicians said many consultants take part in on-call rotas and are required to attend out-of-hours to provide emergency procedures.
“To comply with the directive, compensatory rest to make up for missed rest periods must be taken the following morning, something that has resulted in clinics and outpatient or inpatient procedure lists being cancelled,” the report said.
“The RCP suggests that the cancellation of such appointments can have a detrimental effect on patient care, as it delays vital consultations between patient and doctor, where diagnoses are made and new courses of treatment are determined.
“The Royal College of Radiologists also highlighted in their evidence that for clinical radiologists, lists are ‘frequently cancelled or transferred to colleagues due to the legal restrictions of the EWTD and compensatory leave pre and post on-call periods’.”
The latest report said the EWTD has “had an adverse impact on the training in certain medical specialities, including surgeons and doctors working in acute medicine”.
The task force made several recommendations, including the creation of “protected education and training time” for junior doctors.
More consideration should also be given to encourage wider use of the right for individual doctors to opt out of the EWTD.
Professor Norman Williams, president of the Royal College of Surgeons and chairman of the task force, said: “We are all committed to providing excellent training, fair employment practices and the highest quality of patient care. We also agree that it would be undesirable to return to the old days when doctors worked excessively long hours.
“However, the inflexibility of the directive is having deleterious effects on training and patient care in some specialties and there is a need for solutions.
“One option which deserves further exploration might be to separate the training and education of trainee doctors from their work on the wards.
“This will help strike the right balance between delivering patient care and ensuring that junior doctors are able to acquire the knowledge and skills they need to become specialists of the future.”
Health secretary Jeremy Hunt said: “The government commissioned this important work because we share the long-standing concerns of doctors and patients about the impact of the implementation of the directive on patient care and doctors’ training.
“I am very grateful to the Royal College of Surgeons and other members of the expert panel for the way they have explored these issues and presented constructive solutions to address them. We look forward to working with doctors and patient groups to take them forward.”
Dr Mark Porter, chair of the British Medical Association, said: “While the BMA remains strongly supportive of the working time directive, the report is right to highlight the importance of sharing best practice in rota design and working patterns.
“This is key because, where problems around continuity of care and education and training have arisen, they have largely been due to poor implementation.
“As part of ongoing contract discussions, the BMA and NHS Employers are examining how to ensure all doctors have enough time for training.
“For junior doctors this means ensuring they receive sufficient training opportunities during their placements so they acquire the knowledge and skills they need to become specialists of the future. For consultants this means having protected time to supervise junior doctors and assure quality of patient care.”