At the Work and Health Research Centre (WHRC), Loughborough University, we have conducted a series of studies to examine junior doctors’ views on the EWTD. Using a mixed methods research design, we have explored psychosocial working conditions of EWTD rotas and assessed the perceived impact of the Directive on junior doctors’ quality of working life and training opportunities.
The WHRC is concerned with protecting employee health and safety whilst facilitating work performance and job satisfaction. We have a number of projects running in the Centre which focus on changing legislation and its impact on employees. One such project includes ‘Working Late’, which is exploring age legislation and identifying solutions to improve health and quality of working life of older people. As an applied research centre, we were aware that the legislative changes introduced by the EWTD represented a unique epoch for medicine. Consequently, we sought to explore these changes and develop sustainable solutions for the challenges presented by the Directive.
Working with the support of the East Midlands Healthcare Workforce Deanery we conducted a series of interviews, focus groups, a questionnaire and an expert panel. The findings of the four research phases consistently highlighted a number of key themes. The first theme concerned myths and misconceptions associated with the EWTD. Many doctors reported a general lack of information and clarity regarding the remit of EWTD.
In particular, the Directive was viewed as synonymous with cutting out of hours experiences, with doctors being ill informed of its provisions for rest requirements.
A second theme concerned work intensity and the extremes between day and out of hours shifts. Whilst day shift work was viewed as heavily administrative, out of hours, although providing more opportunities for autonomy and hands on skills experience, were regarded as excessively stressful and demanding. This was linked to the increased demands on staffing resulting from EWTD and thin layers of cover during the out of hours period. Consequently, the data indicates that whilst junior doctors work fewer hours than previous cohorts, work intensity has, in some instances, increased. As such, junior doctors have questioned whether EWTD has addressed what is was intended to.
In terms of developing recommendations from the data, one suggestion involves addressing work intensity. One way to achieve this is to look at more multiprofessional ways of working, such as the Hospital at Night programme, and reducing the traditional silo working such that appropriate cross cover and support can be provided. Additionally, there needs to be greater clarity and information regarding what EWTD is and how it affects doctors and healthcare professionals alike. To achieve this, we welcome further engagement with medical schools who can play a role in educating upcoming cohorts of junior doctors on the EWTD such that clearer expectations are established.
For further details on the research please contact
Myanna Duncan: M.Duncan@lboro.ac.uk
Working Time Directive 2009 
