Scalpel Time Directive

As most people know, I have a soft spot for all things surgical. That is probably because I spent one year in Stanmore with orthopaedic surgeons [ lucky me]. Actually, secretly, I am of the view that surgeons are the dishiest doctors in hospital medicine. Anyway, I spotted the results of an interesting study featured by Remedy UK. Sadly, no dishy surgeons accompanied the study results. This is the problem with Remedy UK, its all very well being all intellectual but there isn't any eye candy on their website. If they are going to write about surgical spirit, they need some serious anatomy features. Anyhow, I do think the findings below should also apply to other specialities such as general medicine. It should also be interesting to monitor patient continuity of care before and after the change to the shift system and the Working Time Directive. When it was first brought into force, North Staffordshire NHS Trust commenced it. The fears though were always that continuity of care and training would suffer. Mind you, I am from the days where 110 hours a week was the norm. In my case, I did that plus locums. Thats probably part of the reason I have always slept for about 2.5 hours a night. Thats been the case since North Staffordshire NHS Trust. It was said that the Working Time Directive would solve the problem of exhaustion and tired doctors but I am of the view that better clinicians with stamina with a view to good quality care existed about 10 or so years ago. These days, juniors are not attached to their team, the system is rather normadic and patients do suffer RE continuity of care. It is also an impossible task to ensure good quality training on the job during shift systems. Good training comes with good teamwork. I don't think the teams actually see very much of their juniors these days. Anyhow, here is the study......

Remedy UK have featured an interesting issue regarding the Working Time Directive.

The Association of Surgeons in Training (ASiT) has released details of their survey on the Working Time Directive and its impact on Training. We have reproduced below the Executive Summary below - the full results can be viewed on the ASiT Website

"Results from the ASiT survey confirm that there is significant underreporting of hours worked by surgeons in training. As a result, the number of non-compliant posts is far higher than previously thought, making achievement of EWTD targets unlikely. Within units purporting to be EWTD compliant, a significant problem has been identified whereby “rota gaps” (created by a failure to recruit non-training doctors) have been filled by rearranging internal cover so that hours may appear compliant “on-paper”.

The reality of such solutions however is that individuals are working in excess of the reported 48 hours. Shift working has been shown to lead to more fatigue and increased medical errors when compared to 24 hour on-call rotas. Those working full shift rotas have reported a deterioration in the quality of training over the last two years. The ASiT survey suggests that surgical trainees wish to continue working out-ofhours on-call rotas and that the majority would welcome the opportunity to work beyond the 48 hours imposed by EWTD.

Overall 80% favoured either an individual or a specialty opt-out. ASiT suggest that to ensure optimal training, with adequate time for exposure and high quality patient care with increased continuity, it is necessary to return to a working week of approximately 65 hours. For higher specialty trainees (ST3 and above), on-call rotas rather than shift working would best protect training opportunities, and would be the optimal arrangement where workload permits"