Doctors' Working Lives News
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Tuesday, April 29, 2008
WTD annual conference / RCP concerns over EWTD impact
The Working Time Directive annual conference is taking place on the 2nd July 2008 at the ExCel, London. This is free to NHS staff (though a fee may be charged if you cancel at short notice). For more information and to register visit the booking page on the National Workforce Projects website.
The Department of Health's three-month consultation process on proposals for managing applications from non-EU medical graduates closes on 6th May (Tuesday).
The RCP have expressed concerns over EWTD impact on training and patient care, and suggest that more junior doctors and consultants may need to be recruited. (BBC, Politics.co.uk, OnMedica, Anaesthetics News). Meanwhile, the BMA suggest that 2,000 more consultants are needed to improve patient care and support EWTD hours reductions. (Telegraph) However an OnMedica article challenges the BMA's view, suggesting that only gradual expansion should be pursued. This is echoed in the US by a NEJM article questioning whether expansion of the medical workforce is the right solution to the perceived physician shortage.
A BMA survey finds that 2 in 3 junior doctors fear their training will suffer due to EWTD. (Press Association, HospitalHealthcare.com, STV - includes video report)
The BMA also say that juniors are being pressured to work extra hours unpaid (BBC, Herald, Telegraph, Independent).
In Ireland, the Chair of the EWTD National Implementation Group suggests that only court action can force real implementation of EWTD. (Irish Medical News) Also in Ireland, the Health Service Executive has refused to fund a pilot project in which consultants worked longer hours in order to allow their junior doctors to reduce their hours for EWTD. The HSE's view was that they would be rendered bankrupt if this scheme was extended to other hospitals. (Irish Health)
In Wales, the Western Mail reports that a major shortage of junior doctors has led to the temporary closure of some hospital services. (icWales)
In Sydney, Australia, junior doctors have given evidence to a public hospital inquiry about lack of training, chronic problems accessing test results, and orders not to claim overtime despite working 12-hour days.
Research
An Imperial College study indicates that laparoscopic skills suffer most on the first night shift of a block, and that adequate preparation for night shifts is essential. (Ann Surg 2008;247(3):530-9)
A Yamaguchi University study has found that a simple sleep education program for medical students can improve knowledge, coping methods and sleep. (Nippon Koshu Eisei Zasshi 2008;55(1):3-10)
An article in the Nursing Standard suggests that naps during the night shift may help prevent errors due to fatigue. (Nurs Stand 2008;22(17):20-1) Nursing Management also has a study on the effect of work hours and sleep on ICU patient care. (Nurs Manage 2008;39(4):32A-32F)
EWTD and women in medicine
Finally, the BMJ has a head-to-head debate on the increasing numbers of women in medicine, which makes startling reading. The Guardian, in an article about workplace gender discrimination, refers to Dr Brian McKinstry's argument that the increase in women doctors is a threat to the medical profession. The Guardian suggests that the EWTD should be used to tackle the culture of discrimination against pregnant women.
The Department of Health's three-month consultation process on proposals for managing applications from non-EU medical graduates closes on 6th May (Tuesday).
The RCP have expressed concerns over EWTD impact on training and patient care, and suggest that more junior doctors and consultants may need to be recruited. (BBC, Politics.co.uk, OnMedica, Anaesthetics News). Meanwhile, the BMA suggest that 2,000 more consultants are needed to improve patient care and support EWTD hours reductions. (Telegraph) However an OnMedica article challenges the BMA's view, suggesting that only gradual expansion should be pursued. This is echoed in the US by a NEJM article questioning whether expansion of the medical workforce is the right solution to the perceived physician shortage.
A BMA survey finds that 2 in 3 junior doctors fear their training will suffer due to EWTD. (Press Association, HospitalHealthcare.com, STV - includes video report)
The BMA also say that juniors are being pressured to work extra hours unpaid (BBC, Herald, Telegraph, Independent).
In Ireland, the Chair of the EWTD National Implementation Group suggests that only court action can force real implementation of EWTD. (Irish Medical News) Also in Ireland, the Health Service Executive has refused to fund a pilot project in which consultants worked longer hours in order to allow their junior doctors to reduce their hours for EWTD. The HSE's view was that they would be rendered bankrupt if this scheme was extended to other hospitals. (Irish Health)
In Wales, the Western Mail reports that a major shortage of junior doctors has led to the temporary closure of some hospital services. (icWales)
In Sydney, Australia, junior doctors have given evidence to a public hospital inquiry about lack of training, chronic problems accessing test results, and orders not to claim overtime despite working 12-hour days.
Research
An Imperial College study indicates that laparoscopic skills suffer most on the first night shift of a block, and that adequate preparation for night shifts is essential. (Ann Surg 2008;247(3):530-9)
A Yamaguchi University study has found that a simple sleep education program for medical students can improve knowledge, coping methods and sleep. (Nippon Koshu Eisei Zasshi 2008;55(1):3-10)
An article in the Nursing Standard suggests that naps during the night shift may help prevent errors due to fatigue. (Nurs Stand 2008;22(17):20-1) Nursing Management also has a study on the effect of work hours and sleep on ICU patient care. (Nurs Manage 2008;39(4):32A-32F)
EWTD and women in medicine
Finally, the BMJ has a head-to-head debate on the increasing numbers of women in medicine, which makes startling reading. The Guardian, in an article about workplace gender discrimination, refers to Dr Brian McKinstry's argument that the increase in women doctors is a threat to the medical profession. The Guardian suggests that the EWTD should be used to tackle the culture of discrimination against pregnant women.
Monday, January 14, 2008
Tooke final report on Modernising Medical Careers
The final Tooke report following the inquiry into Modernising Medical Careers has concluded that the original principles of the recruitment process were "well-conceived" but "lost in translation", resulting in "an inflexible structure that does not encourage excellence". The recommendations include:
* A new body, NHS Medical Education England, to manage postgraduate medical training
* A ring-fenced budget to prevent money intended for education and training from being used to plug hospital deficits
* A more flexible approach to the 48 hour working time limit (for instance by separating education and service time) if possible, and an examination of how changes to training can compensate for the EWTD's impact
On the EWTD issue, the report concludes that:
"....the current interpretation in UK legislation impedes the acquisition of experience, of confidence and the ability to shoulder responsibility. This promotes further the 'trainee mentality' over and above a recognition of the trainee's service contribution. In the interest of patient safety, no one would wish to see a return to hours of duty that impact on adequate rest and relaxation, but few other professions in the UK, nor medical career structures in Europe embrace the Directive in the same way that it has been embraced in the UK...
The Panel recommends that urgent attention should address whether there are ways in which a more flexible approach to EWTD could be legitimately embraced (e.g. separation of service and educational contracts). Due regard should also be given to whether additional compensatory mechanisms (which have been the subject of valuable but as yet unpublished scoping studies) could offset any reduction in clinical experience. DH should explore the potential for contractual solutions."
The full report can be found here. The BMJ has an audio interview with Sir John Tooke about the report. You can also access a full transcript here.
The report is so far being warmly welcomed by everyone, apparently. Click for responses from:
BMA
Remedy UK
Department of Health spokesperson
Royal College of Physicians
Royal College of Surgeons
Royal College of General Practitioners
Royal College of Radiologists
Royal College of Anaesthetists
Medical Schools Council
Academy of Medical Sciences
See also reports from the BBC, Telegraph, Times, Guardian, etc.
* A new body, NHS Medical Education England, to manage postgraduate medical training
* A ring-fenced budget to prevent money intended for education and training from being used to plug hospital deficits
* A more flexible approach to the 48 hour working time limit (for instance by separating education and service time) if possible, and an examination of how changes to training can compensate for the EWTD's impact
On the EWTD issue, the report concludes that:
"....the current interpretation in UK legislation impedes the acquisition of experience, of confidence and the ability to shoulder responsibility. This promotes further the 'trainee mentality' over and above a recognition of the trainee's service contribution. In the interest of patient safety, no one would wish to see a return to hours of duty that impact on adequate rest and relaxation, but few other professions in the UK, nor medical career structures in Europe embrace the Directive in the same way that it has been embraced in the UK...
The Panel recommends that urgent attention should address whether there are ways in which a more flexible approach to EWTD could be legitimately embraced (e.g. separation of service and educational contracts). Due regard should also be given to whether additional compensatory mechanisms (which have been the subject of valuable but as yet unpublished scoping studies) could offset any reduction in clinical experience. DH should explore the potential for contractual solutions."
The full report can be found here. The BMJ has an audio interview with Sir John Tooke about the report. You can also access a full transcript here.
The report is so far being warmly welcomed by everyone, apparently. Click for responses from:
BMA
Remedy UK
Department of Health spokesperson
Royal College of Physicians
Royal College of Surgeons
Royal College of General Practitioners
Royal College of Radiologists
Royal College of Anaesthetists
Medical Schools Council
Academy of Medical Sciences
See also reports from the BBC, Telegraph, Times, Guardian, etc.
Wednesday, October 10, 2007
Doctors' recruitment to be done locally from 2008; start dates to be staggered; consultation out on prioritising UK graduates
Doctors' recruitment to specialist training from 2008 will be done locally by deaneries, and start dates will be staggered, it has been announced. (Personnel Today) This follows the findings of the Tooke independent inquiry, which found that the MMC/MTAS changes were "rushed and poorly communicated" and that warnings about system risks were overlooked by the government. Health Minister Ben Bradshaw has said that although "a national electronic application process is a good idea" for the future, it would need to be secure, and the scoring process and the shortlisting process should be understood by candidates. (Guardian, E-Health Insider)
There is also a consultation on whether to give priority to EU graduates. The deadline for responses to this consultation is 22nd October 2007. The document notes that few non-UK EU graduates apply to the UK and that the within-EU competition is "manageable" - ie this discussion is effectively about whether we should prioritise UK graduates. (Click the link for the consultation document.)
Meanwhile, BMJ Career Focus looks at the ethical and legal implications of HIV testing for junior doctors.
There is also a consultation on whether to give priority to EU graduates. The deadline for responses to this consultation is 22nd October 2007. The document notes that few non-UK EU graduates apply to the UK and that the within-EU competition is "manageable" - ie this discussion is effectively about whether we should prioritise UK graduates. (Click the link for the consultation document.)
Meanwhile, BMJ Career Focus looks at the ethical and legal implications of HIV testing for junior doctors.
Tuesday, August 28, 2007
Off hiatus
As we emerge through the last days of August, blinking at the light, a few pieces of IDWL news (even non-MMC news!) begin to take shape....
Hospitals report that the massive August changeover went relatively well despite recruitment continuing right up to the wire - and beyond. Doctors and Trusts had to deal with considerable uncertainty and anxiety before and during changeover, although most hospitals appear to have minimised the impact of this uncertainty on patients by a planned reduction in service. Health service leaders have suggested that the decision to have all doctors change over on the same day may be reviewed for next year (Guardian).
Foundation Year 1s have lost their statutory right to on-site accommodation as of August 1st 2007, due to the repeal of ss10-13 of the Medical Act 1983 and the insertion of s10A, as announced on the NHS Employers website on 26th July. However, as most trusts had already agreed to provide this accommodation to the current intake, F1s will retain their tax exemption on this benefit until 31 July 2008, after which it will be taxable based on its cost to the Trust.
A study in the Emergency Medicine Journal suggests that doctors feel they are getting less experience in performing common procedures, due both to hours reductions and to changes in training. (Telegraph)
Women medical graduates are now outnumbering men by almost three to two, according to a BMA study. This is likely to have significant implications for flexible training and the BMA is urging the NHS to "wake up to the needs of its staff". (Independent)
Hospitals report that the massive August changeover went relatively well despite recruitment continuing right up to the wire - and beyond. Doctors and Trusts had to deal with considerable uncertainty and anxiety before and during changeover, although most hospitals appear to have minimised the impact of this uncertainty on patients by a planned reduction in service. Health service leaders have suggested that the decision to have all doctors change over on the same day may be reviewed for next year (Guardian).
Foundation Year 1s have lost their statutory right to on-site accommodation as of August 1st 2007, due to the repeal of ss10-13 of the Medical Act 1983 and the insertion of s10A, as announced on the NHS Employers website on 26th July. However, as most trusts had already agreed to provide this accommodation to the current intake, F1s will retain their tax exemption on this benefit until 31 July 2008, after which it will be taxable based on its cost to the Trust.
A study in the Emergency Medicine Journal suggests that doctors feel they are getting less experience in performing common procedures, due both to hours reductions and to changes in training. (Telegraph)
Women medical graduates are now outnumbering men by almost three to two, according to a BMA study. This is likely to have significant implications for flexible training and the BMA is urging the NHS to "wake up to the needs of its staff". (Independent)
Friday, July 27, 2007
Hiatus
This news page is currently on hiatus while we all deal with the MMC situation. More news if and when things quieten down...
Friday, June 15, 2007
Alan Watkins
Many of you will have heard about the tragic death of Alan Watkins and his young son Arun last weekend. Alan was a much valued colleague during his role with NHS London and our thoughts are with his wife and family.
Wednesday, May 23, 2007
Remedy UK loses High Court battle over MTAS
The High Court has ruled against Remedy UK's claim that the Medical Training Application Service (MTAS) and the subsequent decisions of the Review Group were "so conspicuously unfair as to amount to an abuse of power".
In his judgement, Mr Justice Goldring said that "although far from ideal", the Review Group's decision was "within the range of reasonable responses" and that the Review Group was "entitled to reach the decision it did given the circumstances facing it at the time".
However, he also concluded that "The fact that the claimant has failed in what was accepted to be an unprecedented application so far as the law is concerned does not mean that many junior doctors do not have an entirely justifiable sense of grievance. The premature introduction of MTAS has had disastrous consequences. It was a flawed system in the ways I have indicated." He indicated that the junior doctors could still appeal over job allocations or take their case to tribunal.
Remedy UK have ruled out an appeal, "as the lives of 34,000 doctors have been subject to enough uncertainty in recent months". In a statement they said that "This is a sad day for doctors and the NHS. The judge has recognised that we have challenged an inherently unfair system, but at this late stage he is powerless to act."
Remedy UK have a copy of the full judgement here.
The BMA have issued a response stating: "We hope the Department of Health will not claim this as a victory when the careers of thousands of doctors remain in doubt because of government failures. The High Court is absolutely right to criticise their handling of this mess, and to point out that our concerns about it were ignored...We have demanded that the government guarantee that no doctor will be unemployed as a result of this process and called for funding for extra training posts. We now hope that doctors will unite to fight for these aims. The past week has been incredibly painful for the medical profession. It’s time for us to start healing the wounds and move on." As reported yesterday, the BMA have written to Patricia Hewitt suggesting urgent steps to be taken to resolve the MTAS situation, including employment guarantees, resources (e.g. bursaries), a more transparent process, a doctor-led group to design training, and greater training flexibility.
Further reports and comment are available at the Guardian, Telegraph, Daily Mail, and elsewhere.
Health Secretary Patricia Hewitt is facing a vote of no confidence in the House of Commons today over her handling of MTAS. (Guardian and others)
Following James Johnson's resignation, a Channel 4 News report examines doctors' concerns over the BMA's representation of their views on MTAS and looks at the role of Doctors.net.uk.
In his judgement, Mr Justice Goldring said that "although far from ideal", the Review Group's decision was "within the range of reasonable responses" and that the Review Group was "entitled to reach the decision it did given the circumstances facing it at the time".
However, he also concluded that "The fact that the claimant has failed in what was accepted to be an unprecedented application so far as the law is concerned does not mean that many junior doctors do not have an entirely justifiable sense of grievance. The premature introduction of MTAS has had disastrous consequences. It was a flawed system in the ways I have indicated." He indicated that the junior doctors could still appeal over job allocations or take their case to tribunal.
Remedy UK have ruled out an appeal, "as the lives of 34,000 doctors have been subject to enough uncertainty in recent months". In a statement they said that "This is a sad day for doctors and the NHS. The judge has recognised that we have challenged an inherently unfair system, but at this late stage he is powerless to act."
Remedy UK have a copy of the full judgement here.
The BMA have issued a response stating: "We hope the Department of Health will not claim this as a victory when the careers of thousands of doctors remain in doubt because of government failures. The High Court is absolutely right to criticise their handling of this mess, and to point out that our concerns about it were ignored...We have demanded that the government guarantee that no doctor will be unemployed as a result of this process and called for funding for extra training posts. We now hope that doctors will unite to fight for these aims. The past week has been incredibly painful for the medical profession. It’s time for us to start healing the wounds and move on." As reported yesterday, the BMA have written to Patricia Hewitt suggesting urgent steps to be taken to resolve the MTAS situation, including employment guarantees, resources (e.g. bursaries), a more transparent process, a doctor-led group to design training, and greater training flexibility.
Further reports and comment are available at the Guardian, Telegraph, Daily Mail, and elsewhere.
Health Secretary Patricia Hewitt is facing a vote of no confidence in the House of Commons today over her handling of MTAS. (Guardian and others)
Following James Johnson's resignation, a Channel 4 News report examines doctors' concerns over the BMA's representation of their views on MTAS and looks at the role of Doctors.net.uk.
This site is maintained by Ellie Pattinson. All rights reserved. This website is maintained independently of the NHS and the views expressed are not necessarily a reflection of the views of that organisation. For any queries, contributions or amendments, please email me on admin@idwl.info.
