As Chairman of the Independent Working Time Regulations Taskforce which reported its findings to the Department of Health in March 2014, I was particularly interested in two articles related to the subject in the 13th December 2014 issue of the BMJ . The debate entitled “Can doctors be trained in a 48 hour working week?” was naturally polarised (pp 16-17). Whilst this may be considered attractive journalism it simplifies the argument. The findings of the Taskforce (which had representatives from all the key medical bodies including the BMA) recognised that in present circumstances one size does not fit all. Whereas the rigid application of EWTD with the need for a fixed shift system may be beneficial for some specialties, for others, particularly the procedurally based ones, it has proved deleterious both for patient care and training. True, it is possible to mitigate some of these deleterious effects by utilising better rota design and enhancing training opportunities but in our present NHS this cannot possibly solve all the problems. For this reason the Taskforce made certain recommendations designed to introduce greater flexibility into the system for those specialties that require it. One of these, which has attracted particular controversy, is to encourage greater use of the “opt out”. I was therefore intrigued to read Matthew Limb’s article which examined the Norwegian system (BMJ Careers section pages 4-5).
Norway remains outside the EU but nevertheless has had working time regulations in place for doctors since 1994 limiting hours to 45-46 hours per week for juniors and 46-47 on average for seniors. Norwegian employment law, however, allows opt outs where the workload is substantial and permitted by agreement. The Norwegian Medical Association has a national agreement with employers’ organisations that extends working time for doctors in all hospitals up to 60 hours. Limb also notes that “doctors frequently work more than scheduled, both registered and non-registered overtime”. The point is made that doctors in technical specialties work more than others often motivated by the need to develop their technical skills. This echoes the findings of our Taskforce.
More liberal use of the opt out was just one of the Taskforce’s six recommendations. We also urged that “more work should be undertaken to identify ‘service’ and ‘education’ elements in the work of doctors in training. This will include how the possibility of separate agreements may contribute to resolving some of the difficulties identified by this review”
Until it is accepted that in our NHS trainees in certain specialties require more “hands on” training and hence time on the job than in others and that flexibility in the application of EWTD is required, we are in serious danger of continuing to undermine what was once considered to be one of the finest post-graduate medical training systems in the world. No amount of time on simulators can replicate the real life clinical situation.
Our recommendations were submitted to the Department of Health nine months ago and despite being received favourably have yet to be acted upon. So, as we enter 2015, I urge those in a position to initiate the changes required to act with an urgency which has been absent for far too long.
Yours sincerely
Professor Sir Norman Williams
Chairman of The Independent Working Time Regulations Taskforce to The Department of Health, March 2014
Immediate Past President, The Royal College of Surgeons of England (2011-14)
Competing interests:
No competing interests
14 January 2015
Norman S Williams
Professor of Surgery
Queen Mary, University of London Barts & The London SMD
Rapid Response:
Dear Editor
As Chairman of the Independent Working Time Regulations Taskforce which reported its findings to the Department of Health in March 2014, I was particularly interested in two articles related to the subject in the 13th December 2014 issue of the BMJ . The debate entitled “Can doctors be trained in a 48 hour working week?” was naturally polarised (pp 16-17). Whilst this may be considered attractive journalism it simplifies the argument. The findings of the Taskforce (which had representatives from all the key medical bodies including the BMA) recognised that in present circumstances one size does not fit all. Whereas the rigid application of EWTD with the need for a fixed shift system may be beneficial for some specialties, for others, particularly the procedurally based ones, it has proved deleterious both for patient care and training. True, it is possible to mitigate some of these deleterious effects by utilising better rota design and enhancing training opportunities but in our present NHS this cannot possibly solve all the problems. For this reason the Taskforce made certain recommendations designed to introduce greater flexibility into the system for those specialties that require it. One of these, which has attracted particular controversy, is to encourage greater use of the “opt out”. I was therefore intrigued to read Matthew Limb’s article which examined the Norwegian system (BMJ Careers section pages 4-5).
Norway remains outside the EU but nevertheless has had working time regulations in place for doctors since 1994 limiting hours to 45-46 hours per week for juniors and 46-47 on average for seniors. Norwegian employment law, however, allows opt outs where the workload is substantial and permitted by agreement. The Norwegian Medical Association has a national agreement with employers’ organisations that extends working time for doctors in all hospitals up to 60 hours. Limb also notes that “doctors frequently work more than scheduled, both registered and non-registered overtime”. The point is made that doctors in technical specialties work more than others often motivated by the need to develop their technical skills. This echoes the findings of our Taskforce.
More liberal use of the opt out was just one of the Taskforce’s six recommendations. We also urged that “more work should be undertaken to identify ‘service’ and ‘education’ elements in the work of doctors in training. This will include how the possibility of separate agreements may contribute to resolving some of the difficulties identified by this review”
Until it is accepted that in our NHS trainees in certain specialties require more “hands on” training and hence time on the job than in others and that flexibility in the application of EWTD is required, we are in serious danger of continuing to undermine what was once considered to be one of the finest post-graduate medical training systems in the world. No amount of time on simulators can replicate the real life clinical situation.
Our recommendations were submitted to the Department of Health nine months ago and despite being received favourably have yet to be acted upon. So, as we enter 2015, I urge those in a position to initiate the changes required to act with an urgency which has been absent for far too long.
Yours sincerely
Professor Sir Norman Williams
Chairman of The Independent Working Time Regulations Taskforce to The Department of Health, March 2014
Immediate Past President, The Royal College of Surgeons of England (2011-14)
Competing interests: No competing interests