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:

 

 

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