More doctors is not the answer to the EU Working Time Directive

Recruiting extra doctors in order to comply with the European Working Time Directive is not the most effective use of financial and human resources, warns the Department of Health in guidance issued last week.

Instead, it suggests that “creative redesign” of working patterns is needed, including changing the working patterns of consultants and specialist registrars, to avoid the big increases in staffing that would otherwise be needed.

From August 2004 doctors in training, who had previously been excluded from the directive, will come within its remit. This means they should work for a maximum 58 hours a week, with a further reduction to 48 hours a week by 2009. At the moment many such doctors would be working as many as 72 hours in the NHS.

Other recommended solutions include reducing the number of rotas and stopping the practice of doctors snatching a few hours' sleep between shifts while in a hospital, as this counts as being on duty under the directive. Doctors will be expected to work more intensive resident rotas, supported by on-call cover from home.

This will be achieved by the sharing of cover between specialties and developing the roles of other staff. For example, one pilot project, covering acute medical and orthopaedic departments in Birmingham Heartlands and Solihull NHS Trust, will introduce senior nurses to replace doctors in training between 1700 and 0900 on weekdays and all day at weekends.

Jo Hilborne, who chairs the BMA's junior doctors' negotiating committee, said: “In the absence of any robust and practical guidance from the Department of Health, it is likely that many trusts will introduce a shift system for their junior doctors, as this is much simpler to operate.”

She continued: “Hospital mergers may be inevitable in order to produce the critical mass of doctors required to ensure patient safety.”