Writers at Medical Educator have watched the news coverage with interest of this introduction of a 48 hour working week.* The asterisk is an important one. For example, junior doctors will still be working more than 48 hours in one week (it’s an averaged figure over several weeks), and it doesn’t do much to inspire non medical readers!
Listening to BBC reports of the introduction will lead to “serious accusations” being made by junior doctors that they were essentially instructed to falsify monitoring data. True? It remains an indisputable fact that hospital trusts continue to practice inappropriate monitoring practices which fall short of the accepted published standards. A quick poll of junior doctors shows that 0 of our sample of 10 understood the monitoring basics (how hospitals should practice the process of monitoring), however 9 out of 10 knew it was a contractual obligation! We suspect that is because of the keenness of monitoring bodies to point this out to us. One junior doctor recounts his own experiences of monitoring to us:
The trust essentially conducted the monitoring without due warning. The results were not disseminated in the required way. The management was reluctant to allow the process of monitoring to be transparent. Junior Doctors who should not have been monitored as working the full shift rota actively colluded to distort the monitoring figures. Annual leave and holidays were not properly accounted for. Legal action via the BMA was threatened.
Another told us the following
Only until an employment tribunal was threatened by the junior doctor representatives did the trust acknowledge that the rota was not compliant. It was not an argument over break times, rest, sleep patterns or any other caveats. It was simply that the number of hours was outside of the banding which we were being paid (and not by a small amount). The trust went to the extent of claiming typographical errors on the published rota.
On balance the hospitals have a very difficult job in managing rotas: no one doubts that the overall interest remains patient care despite all the potential wrangling. That said, the new cohort of junior doctors starting work in the UK and the European Union will not just be struggling with acute pulmonary oedema in the early hours, they will be grappling with complicated employment and payment issues that has dogged the training of juniors over the past decade.
We call for a no nonsense guide to the hours that doctors can work in the EU, and that all rotas distributed to juniors should include average hours worked per week, and a clear breakdown of how the rota has been applied to the British banding system. We’d be interested to hear the views of students and qualified doctors here about how their new jobs shape up over the coming weeks, and months. We’re particularly interested to hear how interns from the US, Canada and Australia cope with working patterns, and doctors from India and Pakistan on how they contrast their own working conditions with those described here.
Please do not name organisations or individuals, for legal reasons we will not publish such comments.
Links to National organisations representing junior doctors and students below.