NHS Unprepared For Drop In Doctors' Hours In 2009, British Medical Association Warns

Main Category: Public Health
Article Date: 02 Jan 2009 - 1:00 PST

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Many hospitals in England are insufficiently prepared for a major drop in doctors' hours in 2009, and government funding to help them is not reaching the front line, the BMA said on Tuesday 30 December, 2008.

On 1 August 2009, the European Working Time Directive (EWTD) will cap junior doctors' working weeks at 48 hours, a significant drop from the current limit of 56. However, the most recent figures show that in 2008 almost half (46%) of junior doctors in England were on rotas which would be unlikely to comply*(1), potentially leaving trusts open to fines of up to £5000 per breach.

While it welcomes an end to the days of exhausted doctors treating patients, the BMA is concerned about the effect the change could have on the quality of medical training, and on services in areas where trusts that have not addressed the relevant workforce issues.

The Department of Health in England has stated that £100 million was made available in 2008 to help trusts comply with the EWTD, with £300 million available in 2009. Examples of ways in which the money can be spent include employing extra staff and investing in "intelligent bleep systems" which can increase efficiency by allowing doctors to prioritise calls.

However, the BMA is increasingly concerned that hospitals do not know how to access the funding from Primary Care Trusts, or are not receiving it. The BMA has written to health minister Ann Keen asking her why the funding is not reaching the front line, and calling for it to be ringfenced next year.

Dr Jonathan Fielden, Chairman of the BMA's Consultants Committee, says:

"This major change to junior doctors' hours is probably the biggest challenge hospitals will face in 2009. It will need focused consultant expansion and change towards consultant based care. Hospitals need to be fully prepared as early as possible to minimise disruption to services and maintain high quality patient care. It's crucial that funding to help them is protected, and that it reaches the front line."

The BMA is also calling for urgent solutions to ensure that the EWTD does not reduce the quality of training doctors receive. In particular, it believes, there is strong evidence of the need for a planned expansion in numbers of consultants. Recent BMA surveys* (2) show that two thirds of junior doctors believe the EWTD will have a negative effect on the quality of their training.

Dr Andy Thornley, Chairman of the BMA's Junior Doctors Committee, says:

"The 48-hour limit will have a big impact on both patients and junior doctors. It is vital that trusts are properly resourced to ensure that changes don't have a negative impact on either the quality of care, or on training."

*Notes

1) According to the latest data from NHS employers in England (April 2008) 46% of junior doctors were working on rotas where they are likely to be working between 48 and 56 hours per week:
http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm

2) View full results of BMA surveys on concerns about the EWTD and training at:
http://web2.bma.org.uk/pressrel.nsf/wlu/SGOY-7DJCNF

Full text of letter to Health minister follows:

1 December 2008

Dear Ms Keen

With less than eight months to go the full implementation of the EWTD is a challenge to all employers and doctors. The BMA is keen to ensure that the disruptive impact on NHS service delivery is kept to a minimum and patient care protected, whilst maximising training opportunities. As you know this is not a new development and a significant amount of work has been done to prepare those involved for the changes. Despite this many trusts are a long way from being compliant.

We understand that, earlier this year, the Department of Health allocated £100m to PCTs to support compliance with the EWTD. These additional funds are necessary and very welcome but we are concerned, that these funds are not reaching the appropriate places in the NHS. There is a certain amount of anecdotal evidence that acute trusts are unaware of this additional funding, and those that are aware have found it difficult to secure. As these funds were not ring-fenced there are suspicions that the funding has been spent on other initiatives.

Given these concerns and the timing, we think it is essential to establish some clarity around this funding and believe it would be of benefit to all. It would be useful for the Department to clarify where this funding has gone, and why it is not being seen at trust level. We could perhaps use this information and areas of best practice to show how best to utilise this funding for those in difficulties.

We are also aware that further funding is being made available for 2009. We would be grateful if you could clarify this, and take up our offer to aid developing an assurance system to show how these funds are clearly channelled to EWTD solutions, rather than lost in translation.

We would be happy to meet with you to discuss how we can work together to achieve this challenging timetable for EWTD implementation whilst maintaining educational opportunities and high quality patient care.

Yours sincerely

Jonathan Fielden
Chairman, CCSC

Andrew Thornley
Chairman, JDC

British Medical Association http://www.bma.org.uk