Transcript European Working Time Directive and Operative exposure

European Working Time Directive
and Operative exposure
Mr MS Baguneid
Treasurer
Association of Surgeons in Training
Modernising Medical Careers
Entry into specialist register
Government
Manifesto
PMETB
Reconfiguration of the SAS grade
New Deal
CCT / “Generalists”
“Changes”
EWTD
Public
Expectations
Unfinished business
Independent sector
treatment centres
Seamless training
EWTD
Nov 1993 Component of EU health and safety
legislation (Directive 93/104/EC)
Oct 1998
Enacted into UK law (Doctors in training
excluded)
Aug 2000 Doctors in training included (Directive 2000/34/EC)
April 2002 19 Pilot projects funded by DOH
Implementation
Aug 2004 Aug 2007 Aug 2009 -
58 hours
56 hours
48 hours
Rest Periods
11 hours' continuous rest in every 24-hour period
Minimum 20-minute break when shift exceeds 6hrs
Minimum 24-hour rest in every 7 days or
Minimum 48-hour rest in every 14 days
Minimum 4 weeks' annual leave
Maximum 8 hours' work in 24 for night workers
SiMap (Oct 2000)
Doctors who are resident on-call at the hospital are
deemed to be working, even if they are sleeping.
Non-resident: “work begins when disturbed from
rest and ends when resumed”
The problem is huge!
Aug 2004 (58 hrs)
213,000 hrs/week lost
Equivalent to 3700 Juniors (compliant)
Aug 2009 (48 hrs)
208,296 - 476,638 hrs/week lost
Equivalent to 4,300 - 9,900 Juniors
“Inquiry into the European Working Time Directive (EWTD) evidence from the BMA". Feb 2004
Derogation
No derogation for overall hours limit
Derogations for rest periods
Compensatory rest
JAEGER Ruling (Sept 2003)
The Jaeger ruling on compensatory rest means
that a rest period must be taken immediately
after the period of work which generated it
Various strategies
1) Reducing inappropriate duties and enhancing
support for appropriate ones
2) Diverting workload geographically
3) Delegation of doctors workload to others?
4) Generating and allocating additional resources
5) Changing working patterns
6) Development of Night teams
7) Expansion of numbers
Enhancing training
1)
2)
3)
4)
5)
Separation of service/ training
Wet labs and skills workstations
Virtual Reality models
Fresh Cadaveric work / Use of animal models
Recognition of trainers who train (Silver Scalpel
Award)
6) Competence based assessment
7) Use of ISTC for training (Role needs to be
clarified)
8) Training lists (Cases to be tailored)
Survey (Countess of Chester)
Operative time (Trainer vs Trainee)
Inguinal hernia
Varicose vein surgery
Lap Cholecystecomy
Carotid endarterectomy
45%
29%
38%
28%
Working patterns
“One size does not fit all!”
Current on-call rotas are mostly non-compliant
Non-resident on-call not feasible for many
Trusts not keen to pay for “being available”
Large regions make travelling difficult
“Off site residence” is a legal “fudge”
Shifts are largely inevitable
Full shift requires 8 – 10 middle grades ( + needs
at least 10 consultants?)
Shift work - downside
Lack of continuity
Loss of operative exposure 30-50%
Edinburgh SpR survey:
Over 50% considered < 72hours/ week inadequate
90% prefer to work longer week (even 90hrs)
Full shift + 48hrs = Daytime activities reduced by 79%
*29.5hrs/week to 6.15hrs/week*
The European Working Time Directive – interim report and guidance from The Royal College of Surgeons of
England Working Party. Jan 2003
Operations by Trainees
1.3.2002 – 28.2.2003
Total Number of Operations = 87824
Total Number of Trainees = 456
90
83
82
80
70
70
Number of
Trainees
54
60
58
47
50
35
40
27
30
20
10
0
1-50
51-100
101-150
151-200
201-250
251-300
301-350
Number of Operations (in bands of 50)
351-400
Impact on training
1993
2004
Near future
30,000 hours
8000 hours
6000 hours
Genius
Improvement in quality of training
Reduced standards
US stand:
The American College of Surgeons published an
official statement of its views on resident work
hours (Public health law: < 80 hours/ week!)
“It is illogical to make specific time-work
recommendations without considering the effect
on education”
“lack of familiarity with a patient, not fatigue, is
the major cause of errors of judgement”
RCSEng stand:
“very concerned that the time frame of the
European Working Time Directive, as applied to
doctors in training, may compromise safety of
surgical care and the training of surgeons”
Brussels/ UK Gov Stand:
Trusts which do not comply by August 2004 could
be fined for non-compliance.
Fines of up to £5,000 per breach could be levied, as
well as imprisonment.
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