A new study published today in Clinical Medicine, the journal of the Royal College of Physicians, shows that the European Working Time Directive (EWTD) may be failing in its primary objective – to improve the welfare of employees. A group of doctors have found a link between the introduction of rotas compliant with a 48-hour working week and increased prevalence and longer periods of sick leave in junior doctors.
The study at a district general hospital in East Sussex reviewed sick leave data for all junior doctors in the year prior to, and following, the reduced hours working week. Although mortality rates and length of stays did not alter significantly during the study period, episodes of sick leave among junior doctors more than doubled with just over 1 in 3 taking leave in the year before implementation to nearly 3 in 4 the following year.
EWTD-compliant rotas have reduced the number of doctors on the ward, a problem that is compounded by difficulties in arranging locum cover and the shortfall in trainee recruitment that has occurred in some areas. As a result, rising sickness levels have a proportionately greater effect on the ward cover – potentially putting patient care at risk.
Doctors’ leaders have argued that increased shift work and reduced working and training hours, in part in response to the new working time regulations, have led to a breakdown of the traditional medical team, which offered much support to trainees.
These factors may exert a cumulative effect although only a tightening of the existing shift rotas and a rearrangement of the ward working specifically separate the 2 years studied.
Dr Hugh McIntyre, lead author of the study commented:
While not associated with any major effect on patient care, the changes in working practice necessary to comply with the EWTD were associated with, and may have contributed to, a detrimental effect on the welfare of doctors in training. The directive may have failed in its primary purpose: that of promoting the welfare of employees.
Dr Andrew Goddard, Director of the RCP’s Medical Workforce Unit, added:
Research carried out by the RCP supports these findings such as high sickness and vacancies levels across England and Wales. We are concerned that this has significant implications for patient safety and the quality of medical training in the UK.
- The aim of the EWTD was to promote welfare of employees by protecting rest periods and by placing a 48 hour limit on the working week. The study in question chose sick leave as a measure of junior doctor welfare as other indicators are not easily measured.
- The study examined data from August 2007 to July 2008, and August 2008 to July 2009. In the first year the number of non-elective medical admissions was 8,457 and the second year it was 8,517.