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. 2003 Apr 26;326(7395):929. doi: 10.1136/bmj.326.7395.929/a

EU working time directive

More doctors is truly not the answer

Alan R Berry 1
PMCID: PMC1125833  PMID: 12714479

Editor—In its statement that the European working time directive should be implemented for doctors in training without simultaneously increasing numbers of doctors,1 the Department of Health is revealing a tacit acceptance of lower standards of care for patients. Its recommended alternatives to increasing medical staffing serve only to make the reduction in hours affordable.

Over the past 10 years, since the first initiative to reduce junior doctors' hours of duty, medical cover on wards has been progressively reduced and the standards of care provided have consequently declined, particularly postoperatively. Consequently problems are detected late, sometimes when corrective action is no longer possible.

The merit of reducing further the hours of work is for debate elsewhere, but if it is believed to be necessary it is folly to suggest that it can be done without replacing the doctors taken from the wards with others of equal standing. A football team playing with only 10 men is not the same effective unit as the full side. It may make do, by extra effort, for a short while, but it will not be able to sustain performance throughout the season.

The statement of the chairperson of the junior doctors' negotiating committee, that hospital mergers may be inevitable to produce the critical mass of doctors required to ensure patient safety, suggests humble expectations. We should surely be offering more to hospital patients than basic safety.

Footnotes

Competing interests: None declared.

References

  • 1.Macdonald R. More doctors in not the answer to the EU working time directive. BMJ. 2003;326:68. doi: 10.1136/bmj.326.7380.68/b. . (11 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2003 Apr 26;326(7395):929.

Directive will be biggest driver for change in delivery of medical care

Michael S Molloy 1

Editor—The working time directive will herald a major change in the delivery of medical care in hospitals.1-1 Avoiding recruitment of extra doctors, and consultants in particular, in the early phases of implementation will make any plan unmanageable.

Shift work will be a solution only in some areas with a requirement for staff in a specialty to be on site for 24 hours. To staff a rota over 24 hours, seven days a week, that incorporates prospective cover for annual leave, continuing professional development, commitments to continuing medical education, and a contingency for unplanned events such as illness will require a minimum of nine or 10 doctors for one to be available, with a built in handover period for patients undergoing treatment. graphic file with name bmjlett.f2r.jpg

Senior doctors in many countries are already covered by the working time directive and will therefore not be in a position directly to increase their hours to compensate for reduced working hours for junior doctors. If work is to be redirected to other new grades of technical staff they will have to be trained. Reducing working hours for junior doctors should not result in an expansion of this grade as this will not enhance quality of care for patients, who will be even less likely than now to be treated by a consultant in the early stages of their illness. It will also affect the career progression of this group.

In the Republic of Ireland initiatives have been taken by the training bodies which will remove training accreditation from emergency departments that do not have an eight session consultant commitment in emergency medicine.

The directive is inevitable; we should do what we can to encourage early implementation locally, improving junior doctors' working and training conditions and making the hard decisions for those politicians unwilling to do so.

Footnotes

Competing interests: MSM is a past president of the Irish Medical Organisation.

References

  • 1-1.Macdonald R. More doctors is not the answer to the EU working time directive. BMJ. 2003;326:68. doi: 10.1136/bmj.326.7380.68/b. . (11 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]

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