The following document
was produced by the Psychiatric Trainees' Committee regarding
trainees concerns about the impact of EWTD. The document has been
approved by the Education, Training and Standards Committee.
The impact of the European Working
Time Directive in psychiatry
The European Working
Time Directive (EWTD) was enacted in UK law in October 1998. In
August 2004, junior doctors’ hours were reduced to an average of 58
hours per week, which was effectively 56 hours per week under the
New Deal, and there was an interim reduction to a 56 hour week in
August 2007. A reduction to 48 hour week is planned in August
2009.
Concern has been
raised, particularly by surgical specialties, about the impact of
EWTD on the quality of training and patient safety. There have been
a small number of applications for derogations, so some services
may be able to plan to reduce junior doctors’ hours to 52 hours a
week in August 2009 for a maximum of three years.
The majority of
psychiatry rotas are already compliant with the 48 hour week and
compliance with EWTD may be less problematic compared with other
specialties. However, the implementation of EWTD in psychiatry
presents different training challenges.
In many Trusts, the
solutions implemented to ensure EWTD compliance includes employing
other members of the multi-disciplinary team (MDT) to undertake
work previously carried out by core trainees, particularly out of
hours, which has subsequently reduced trainees’ experience in out
of hours work. The Psychiatric Trainees’ Committee (PTC) feels that
regular, proper exposure to out of hours work is essential
throughout core and higher training as different competencies,
particularly in emergency management and assessment, are achieved
out of hours.1 Although the presence of other MDT
members may be beneficial in assisting with EWTD compliance,
quality specialist training to ensure patient safety and optimal
management remains a key priority. In addition, trainees need to be
able to meet essential curricular competencies and skills out of
hours to develop into independent clinicians.
When a psychiatric
hospital is geographically distant from a general hospital, there
are particular concerns about patient safety if fewer doctors are
available on site through the use of non-resident rotas covering
multiple sites to achieve EWTD compliance. The medical team are
required to assist in the identification, diagnosis and management
of both physical and psychiatric illnesses, and patients require
timely access to a doctor.
In order to minimise the impact of EWTD on
psychiatric training, the PTC propose that the following issues are
addressed:
- Careful consideration
must be given to rota design to ensure that working patterns
provide essential out of hours experience for trainees without
impacting unduly on training during normal working hours.
- All trainees must
have the opportunity to undertake regular emergency assessments out
of hours.
- Handover arrangements
between trainees, their supervising consultants and other members
of the MDT should be improved to optimise patient safety. This
issue was also highlighted by the results of the 2007 PMETB trainee
doctors survey that found handover arrangements in psychiatry to be
inadequate.2
- Trainees should have
increased access to supervision by consultants, which will improve
patient safety and the quality of training. To consolidate learning
from on calls, both clinical supervision whilst on call and
educational supervision in daytime hours are required. Increased
consultant time in job plans should be dedicated to the supervision
and assessment of trainees.
We believe that these measures will
optimise training experiences and ensure that the best quality
doctors are trained for the future.
Clare Oakley
Chair, Psychiatric Trainees’ Committee
February 2009
1)
Psychiatric Trainees’ Committee. Finding the balance: The
psychiatric training value of Out of Hours Working
2)
Postgraduate Medical Education and Training Board. National
Survey of Trainee Doctors results 2007
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Page last updated on 13th April
2009 by E Baker-Glenn