Trainees asked to opt-out of EWTD

TRAINEE doctors will be encouraged to increase their training time by voluntarily opting-out of the European Working Time Directive.

The Department of Health in England said opting-out could benefit junior doctors in specialties such as surgery where “overly rigid shift patterns” have reduced training opportunities.

The move follows an independent review of the directive’s impact on the NHS. The Government has accepted six recommendations made by the review taskforce and said “significant changes will be considered so doctors can train and work more flexibly”.

This includes encouraging “more widespread use of the individual right to opt-out of the 48 hour restrictions for those who wish to, and where it is safe to do so. This will allow doctors who want to spend extra time on work related training activities to do so.”

The EWTD came into effect in 2009 and limits the average working week for doctors to 48 hours. It has come in for sustained criticism, with concerns that it restricts the amount of time available for training.

The taskforce, led by former Royal College of Surgeons president Professor Norman Williams, found the directive had been beneficial in preventing doctors from working very long hours.

However, it also highlighted its impact on training. Doctors beginning surgical training today will have 3,000 fewer hours to learn through training – the equivalent of 128 whole days. Complex shift patterns have also been blamed for a greater number of handovers which can increase the risk of mistakes. The report noted that enforced rest breaks have led to the cancellation of some clinics.

The Government has outlined a number of other proposed measures to improve the way the EWTD works including separating training from work-related activities. Currently, doctors must complete training and normal work within the 48-hour limit of the directive unless they opt-out. Health Education England will look at separating the two which would give more doctors opportunities to train outside of their regular duties.

The report’s recommendations will also be taken into account in the ongoing contractual negotiations with junior doctors.

The BMA has raised concerns about the proposal to separate work and training.

BMA Council chairman Mark Porter said: “We have to remember that the work and training of junior doctors are inseparable. This leads to unique pressures that can’t be resolved just by increasing working hours. Having the right degree of flexibility in the system is important, but we must not create a culture in which doctors feel pressured into opting out of the 48 hour weekly limit that protects patients.”