BMA Survey

Hospital doctors think that WTD will have a positive effect on their personal health and safety

“The 48 hour working week is a positive thing that requires a ‘whole systems change’ in the NHS” Wendy Reid

For many organisations within the NHS this will require a massive shift in culture and change to the working week. It will mean that training is met within this new limited hour week and patient safety is kept paramount.

In April, the British Medical Association (BMA) published the findings of its survey of junior doctors about the impact the directive was likely to have on their lives, jobs and training. Whilst over half of the 470 respondents felt that it would have a negative effect on their training, there were other more positive responses to the directive in general.

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Notably only 30 percent of those surveyed wanted the BMA to lobby for the 48 hour limit to be delayed, and 66 percent believed that doctors should be protected from working excessive hours. 60 percent also reported that their ability to provide safe medical care to patients had been compromised by pressures to work excessive hours.

Wendy Reid a postgraduate dean and national clinical director for the NHS Hospital at Night program says that a 48 hour working week is a positive thing that requires a ‘whole systems change’ in the NHS. “Tired doctors are dangerous, doctors are only human beings, they have not got different DNA, I have seen doctors of my generation pay a huge personal price in terms of marriages and relationships for working in many cases sometimes up to 100 hours a week, we have to ensure training, and the 48 hour week may help to ensure that doctors are working within their competencies,” she says.

The BMA survey shows that hospital doctors think that the new directive will have a positive effect on their personal health and safety as well as a positive impact on their quality of life.

Three in five respondents admitted that in their experience, their ability to provide safe medical care to patients had been compromised by working excessive hours. One respondent sums up the positive effect they hope it will have on their working lives: “Doctors are also human beings who need to sleep, eat, use the toilet, socialise and live their lives as well as work. No other disciplines expect people to work without breaks as we do. In their race to succeed juniors risk putting patients lives in jeopardy. It’s quality not quantity that counts.”

Miss Reid agrees. As clinical director of the Hospitals at Night programme she believes that organisations need to get organised to both meet the directive and ensure that appropriate training can be delivered within the new times. Miss Reid says that the programme is one way to achieve this but admits that it is not a ‘panacea’ for the NHS to deliver good training for junior doctors.

“We really, really need to have safer doctors and there is evidence out there that shows that this (48 hour week) can work, we need to look at this because it also shows that trainees and trainers are happier,” she says.

Dr Yasmin Ahmed-Little, project director for the implementation of the directive in the North West, says that although there was a mixed response from those surveyed about work life balance she is increasingly finding that once junior doctors have tried the 48 hour work week and different shift patterns they do not want to go back.

“There is a view that still lingers that it is better to get their night shifts out of the way in one go, but once they have tried it and split their night shifts they don’t go back and they realise how dangerously they have been working,” she says.

“There is definitely a fear of the unknown and we need to communicate the benefits to trainees.” Dr Ahmed-Little says that the responses to the survey were also very encouraging because of the strength of understanding about the directive and about what it means. She says that it is now important to build on this to ensure that junior doctors understand that they need to take ownership of the new pattern of working.

Dr Ahmed-Little says “to achieve this successfully it comes down to partnership, junior doctors working with the deaneries and engaging the clinical leads, the Royal Colleges and Modernising Medical Careers colleagues.”

“It is important that the Royal Colleges are setting standards nationally which allow for local flexibilities, the workforce must think creatively in order to implement this,” she adds.

However, for the time being there does remain a question mark over whether adequate training for junior doctors can be provided within the 48 hours they will be obliged to work. Of those surveyed two in three (64 percent) of junior doctors said that they believed compliance with the 48 hour working week would have a negative impact on their training. Mr Ram Moorthy, chairman of the BMA Junior Doctors Committee says training must improve to meet the directive properly, “The 48 hour limit is coming, and it will have a massive impact,” he admits. “Our training has to get far better if we’re going to continue to produce the best quality of doctors. We need to look at the possibility of lengthening the amount of time it takes to qualify as a consultant,” he says.

But Miss Reid thinks that these issues can and will be resolved, “We are striving for excellence across the board in the NHS in terms of training and patient safety. This is not about a little bit of change this is about a whole systems change,” she says. As Miss Reid says, the directive ‘is the law’ and ultimately the NHS has to meet it.

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