RCOG Release: Royal Colleges Release Report On Working Time Directive (WTD) 2009 Compliance

Main Category: Women's Health / Gynecology
Also Included In: Pregnancy / Obstetrics
Article Date: 02 Jul 2008 - 2:00 PDT

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Some medical specialties have expressed concern over the effects of the decrease in junior doctors' working hours as a result of the Working Time Directive (WTD). The WTD will restrict junior doctors' work hours to 48 hours each week from 2009.

The report Children's and Maternity' Services in 2009: Working Time Solutions, released today by the Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Paediatrics and Child Health (RCPCH) examines current provisions to meet with the 2009 WTD requirement and offers recommendations to assist Trusts in their workforce planning.

A voluntary survey of all O&G and paediatric units in England was undertaken and the response rate was 53% and 71% respectively. The findings reveal that although there has been significant progress in WTD 2009 compliance at the junior grades in both specialties, more needs to be done at the middle and consultant grades. Only 48% of units were compliant in terms of their work patterns and job plans in both specialties at consultant level.

For trusts that were working towards compliance with WTD 2009, this was being achieved through a mix of initiatives, mainly increasing staff and redesigning rotas.

The survey was followed-up with visits to nine O&G and 11 paediatric units that reported compliance with the WTD 2009 requirement. Interviews were conducted with key clinical staff. All the units visited (obstetrics and gynaecology, and paediatrics) had used rota redesign as one of their solutions. The next most common solution for the obstetrics and gynaecology units was increased medical staff (67%) and for the paediatric units, role substitution (80%). The project group also found that units which scored well in patient safety and training were associated with greater consultant numbers.

Visits were also made to non-compliant units to gather data and information about why some units were having difficulties achieving compliance with WTD 2009.

Other findings include:

- There were marked discrepancies between the intended use of certain solutions with the actual use of compliance solutions in O&G.

- There is concern that approximately 50% of all units with non-compliant rotas do not have plans to achieve compliance by 2009.

- For those units that have plans to achieve compliant rotas, few have costed their plans.

Based on the findings from the survey and visits, expert panels for each specialty were assembled and issues were analysed. Key recommendations were developed from these discussions.

The main recommendations are:

- There is no single solution for the restructuring of services to comply with the WTD 2008 48 hour requirement. Each individual unit will need to look creatively at a mix of solutions based around the characteristics of their unit and the needs of the population they provide services to.

- Patient safety is paramount and no doctor should be expected to be on seven consecutive nights as this results in sleep deprivation and fatigue.

- Formal hand-overs are required and dedicated time should be set aside in rotas to ensure the appropriate hand-over of medical teams.

- Cross-cover (doctors providing cover for one or more specialties during out-of-office hours alongside their own) between paediatrics and O&G should only be practiced at junior grade and restricted in the smaller neonatal units. Units must demonstrate there is no risk of a doctor being required in two places at once.

- The middle grade is the major problem. Trusts must concentrate on achieving compliance in the middle grades and ensure that these doctors receive adequate training, since specific clinical skills are required at this level in both specialties.

- Reconfiguration of services will impact on service provision across all specialties and a Trust-wide approach is needed when developing solutions.

The Project Steering Group has devised a mechanism whereby Trusts are able to assess their deficiencies in working towards compliance. This is found in Appendix 10 - 'Criteria assessment process for WTD 2009 solutions'.

Professor Sabaratnam Arulkumaran, RCOG President said, "It is important for us to ensure that all trusts meet with the WTD so that doctors, especially trainees, are not overworked and have a good work-life balance."

"We are duty-bound to ensure that our trainees receive adequate levels of training and supervision so that they are prepared for the challenges ahead.

"In order to meet up with the WTD requirements, we need more consultant presence in our labour wards. This ensures safety and continuity of care since junior doctors are supervised during the odd-hours and have the support they need to progress on to the next level."

Dr Patricia Hamilton, RCPCH President, said, "Although reducing hours worked by doctors in training has been important and is central to the Working Time Directive, it is also very important that any change in the working practices of these trainees does not adversely affect patient safety or the doctor's work-life balance and training opportunities.

"This report will be of benefit to the units that have achieved compliance, and would like to evaluate the effects that this has had on their patients and doctors, and also to those units that are currently developing plans for the service and would like to learn from the experiences gained by others."

Reference

Royal College of Obstetricians and Gynaecologists/Royal College of Paediatrics and Child Health. Children's and Maternity Services in 2009: Working Time Solutions. NHS National Workforce Projects, July 2008.

Royal College of Obstetricians and Gynaecologists