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A British perspective
The European working time directive (EWTD) is a directive of the European Union within the umbrella of health and safety legislation. The directive was enacted in UK law, from 1 October 1998.1 The main features of the legislation relate to the average maximum numbers of hours that could in law be worked in a week, the duration and timing of rest periods, days off, and paid leave.
The EWTD applied to all medical staff, except doctors in training—that is, the house officer and specialist registrar grades. It is not widely appreciated that all other grades of medical staff are bound by this legislation unless they specifically, and individually “opt out.”
An amending directive was issued in 2000,2 removing the exemption of doctors in training from the EWTD, to take initial effect in August 2004, when the average weekly working time had to be reduced to 58 hours. Thereafter, in August 2007, this should be reduced to 56 hours per week, and in 2009 to 48 hours. This was not optional, but was a legal requirement and breaches of this legislation are subject to significant financial penalties, to be imposed on the employing trusts. Compliance is checked by continual monitoring.
Not surprisingly, there was a flurry of activity, and a plethora of documents, guiding and advising trusts on how to deal with this issue, both from the Department of Health, and the royal colleges. Crucial to determining how trusts would respond to this was the definition of work, when the resident was on call—that is, was asleep, doing on-call work, or resting. Luckily for us all, help was at hand in the shape of a specific challenge to the directive, known as the “Simapp” case. This ruled that “resident on-call” was work, whether engaged in clinical …