Time is running out on the August ’09 48-hour week, and a consensus appears to be evolving in the profession. It doesn't work. This week it is starting to hit the media. Surveys from two trainee groups ASiT and BOTA have rung the alarm bells, the Royal College of Surgeons have admitted they are

Widespread concerns have been flagged up as to the readiness of the NHS for these changes in August 2009 including the risk of system failure.

• High-demand acute specialties such as Trauma, Surgery, Paediatrics, Intensive Care are most likely to fail, due to the intensity of their work rotas.
• Hospitals in ‘remote’ areas with a less readily available supply of replacement doctors to ‘plug gaps’ are most likely to be negatively impacted.
• Government plans have been base around ‘idealised’ rotas which may not take account of ‘real’ factors such as annual leave, sickness and other doctor shortages.

The shorter week is not popular amongst doctors. The majority of doctors favour a maximum limit of 56 hours per week. A recent survey by the Royal College of Physicians showed that 58% of doctors thought that patient care was worse under the EWTD limit of 48 hours. The Royal College of Surgeons and surgical trainee organisations want an opt-out for all surgeons.

In a pilot study in Galway all the trainee surgeons reported a deterioration in quantity or quality of training, and 81% of them thought patient care had deteriorated. In a survey of BMA members in April 2008 60% of respondents agreed that junior doctors should be able to opt out of a maximum average working week collectively or individually. A survey conducted by Remedy members in October 2008 showed that 81% of respondents felt the Working Time Directive and New Deal were significant impediments to adequate training

In view of the difficult circumstances, the UK Government has applied to Brussels using a process called ‘derogation’. This would, if ratified by Europe, allow some trusts to apply for an extra four hours per doctor per week until 2011. It would still lose 100 working days per week in the ‘typical’ trust example above, and has been described as a ‘sticking plaster solution’ by the President of the Royal College of Surgeons.

One option which is open to all would free up any doctor to work a 56-hour week. It uses an ‘individual opt-out’ which all UK workers currently have free access to. It is a strictly voluntary written agreement by an individual doctor with her or his Trust to waive the 48-hour rule. The minority of doctors who prefer to work 48 hours would retain the right to do so, with no pressure to opt-out.

The individual opt out has been rejected in the past as being too difficult to implement, and relies on doctors volunteering to work the extra 8 hours – it cannot be made mandatory. This presents problems, but they are not insoluble. Many Trusts already cope with part-time doctors working variable hours

Lobby your MP

Lobby the BMA

The BMA Divisional meetings are happening over the next few weeks. BMA Divisions are based on geography, not specialty or grade, and are open to all members. At Divisional meetings policies can be proposed which can be taken to the Annual Representative Meeting in the summer to formulate policy.

We would encourage BMA members to find out when their local Divisions are meeting and lobby for a change.

Lobby the Press