Work pressure' on junior doctors

Published by: mike 2009-01-09

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'Work pressure' on junior doctors

http://news.bbc.co.uk/2/hi/health/7319272.stm

Junior doctors are being asked to work longer hours, often unpaid, because of staff shortfalls, the British Medical Association has warned.

Its survey suggests three in ten work on teams with at least one vacancy. It warns care could suffer and of possible bullying and harassment of doctors.
The BMA blames problems with a recruitment system introduced in 2007.

The Department of Health acknowledged the problem, saying it was working with NHS Trusts and doctors to solve it.

It's fundamentally wrong for junior doctors to be pressured into working excessive hours
Ram Moorthy
BMA

The BMA has issued guidance to junior doctors asking them to be alert to any changes in their working rotas.

It believes that, in some cases, there is potential for an increase in bullying and harassment as juniors are asked to cover for unfilled posts.

Some doctors who replied to the surveys said that there were as many as five unfilled vacancies in their specialties, increasing their own workload substantially.

Ram Moorthy, chairman of the BMA's Junior Doctors Committee, said: "It's fundamentally wrong for junior doctors to be pressured into working excessive hours.

"This was a problem that employers and the government could and should have foreseen, and it's unfair that doctors are having to prop up rotas without being paid for it. If the problem continues it can only damage the quality of patient care."

The problem has arisen, the BMA believes, because Trusts were given a single opportunity to recruit new juniors last year, and have not been able to fill posts which have become vacant in subsequent months.

Consultant workload

Hospital consultants say they also expect to have to cover extra work as a result.

Dr Jonathan Fielden, chairman of the BMA's Consultants Committee, said: "Consultants in many trusts are working under extreme pressure to hold the service together for patients.

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"Whilst we condemn bullying in any circumstance, consultants and employers must work together constructively to solve this problem and support our junior colleagues at this stressful time."

The Department of Health said it had conducted its own survey of strategic health authorities in February in an effort to gauge the extent of the problem.

A spokesman said: "It is worth bearing in mind that the NHS employs around 120,000 doctors in England and, whilst some Trusts have reported issues, many haven't.

"There have always been some problems staffing some rotas in shortage specialties.

"We understand the theory that the single timetable for specialty training recruitment in 2007 might be a contributor and that is partly why we are moving to a three-phase timetable in 2008, but there may be other factors.
"We are talking to the NHS, to the medical profession and others about potential solutions."

Shadow health secretary Andrew Lansley MP said that it was "unacceptable" that junior doctors were overstretched.

"The measures deployed by the government to try and mitigate the impact of their doctor training shambles are creating more problems."

Doctor hour cuts 'will harm care'

Doctors may see patients less frequently, Professor Pounder warns
Patient care will suffer when junior doctors' hours are cut to conform with the European Working Time Directive, a leading medic has warned.

http://news.bbc.co.uk/2/hi/health/7328448.stm

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From August 2009, a junior will not be able to work more than 48 hours a week, compared with the current limit of 56.

But Professor Roy Pounder, of the Royal College of Physicians, warns it will not be possible to safely implement the change without more doctors.
The Department of Health says the 48-hour-week will be implemented.

It is unlikely [patients] want to trade continuity of care for slightly fresher doctors
Professor Roy Pounder, Royal College of Physicians
Writing in the RCP journal, Clinical Medicine, Professor Pounder says the EWTD will mean all junior doctors working, in effect, eight hours fewer per week - the equivalent of one less shift.

Staffing at night and the weekend is already too lean to make further reductions, so he forecasts the cuts will have to be made in daytime staffing.

Professor Pounder warns this will have a major impact on the training provided to junior doctors, which is delivered during daytime shifts.
But he says the biggest effect will be on patient care.

"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch and learn about the progress of an illness.
"Seeing a patient once or twice before handing over to the next doctor, who then does the same after a short period, means it is difficult to detect a subtle deterioration in a patient's condition."

Fewer investigations
Reducing doctors' working hours is partially aimed at preventing potentially harmful fatigue.

But Professor Pounder adds: "There is no robust evidence concerning patients' attitudes to the effects of the EWTD on their inpatient care but it is unlikely they want to trade continuity of care for slightly fresher doctors."
He cited a pilot at one hospital where hours were cut from 56 to 48 per week, which found there were too few doctors to do the necessary tasks.
"Fewer investigations were ordered, fewer patients examined, poorer continuity notes written, fewer relatives seen and slower discharge drugs or letters."

The NHS is planning for all doctors in training to be working a 48-hour week from 2009 and half already do so
Department of Health spokeswoman
Professor Pounder called for the number of training posts to be increased from the current 34,000 to 46,000 to provide enough doctors to implement the directive.

"It is possible to create legal rotas that are not best for patient care, training or cost effective overall.

"It may be that the solution is to recruit more junior doctors and consultants."

More doctors training
Mr Ram Moorthy, chairman of the BMA Junior Doctors committee, said: "The Department of Health and NHS have had plenty of time to prepare for the 48-hour week.

"It must not be allowed to compromise the quality of doctors' training, which is a massive concern, or the service the NHS provides."

A spokeswoman for the Department of Health said: "The NHS is planning for all doctors in training to be working a 48-hour week from 2009 and half already do so."

She said hospitals in north-west England were working to an implementation date of August 2008 - one year early.

"NHS staff have achieved this progress through reforming outdated working practices and recruitment.

"The number of doctors in training has risen by over 50% since 1997 and the number of medical school graduates has increased by 70%."