Locum Staffing and Medical Staffing

European Working Time Directive and me

Heather Harris gives a trainee’s verdict on what it is like working under the European Working Time Directive’s 48 hour week

The start of the new European Working Time Directive (EWTD) 48 hour working week in August 2009 has meant that hospitals throughout the country have been redesigning on-call rotas for junior doctors.[1] Radiology is considered a service specialty within medicine, providing specialist imaging services for all hospital departments. Because certification under the Ionising Radiation (Medical Exposures) Regulations is required to work within radiology, and because there are no junior doctors below specialist registrar or specialist trainee grade, radiologists are not in a position to take part in the hospital at night scheme. The new 48 hour working week has therefore been difficult to achieve, but Sheffield has risen to the challenge, and a new compliant working pattern for specialist registrars (SpRs) began in October 2008.

Changes to out of hours cover

Before 2004, when the EWTD 56 hour maximum working week became mandatory in the United Kingdom, radiology SpR out of hours cover in Sheffield comprised a 1 in 6 non-resident 24 hour on call, covering either the central campus hospitals (the Royal Hallamshire Hospital, the Jessop Wing, Weston Park Hospital, and the Sheffield Children’s Hospital), or the Northern General Hospital.[1] From August 2004, this was changed to a shift pattern. Specialist registrars continued to gain supervised training during normal working days (9 am to 5 pm), with out of hours work covered by working long day shifts (9 am to 10 pm) and night shifts (9 30 pm to 9 am). Attendance at one multidisciplinary meeting a week, starting at 8 am, was also incorporated into the rota, to allow the SpRs legally to continue attending these important training opportunities. The long day shifts were based either centrally or at the Northern General Hospital, and the night shift SpR was based at the Northern General, covering all of the Sheffield hospitals. The rota required a minimum of 12 SpRs, and over 12 weeks each SpR worked eight weekday long days, two whole weekends of long days (Friday to Sunday), and one set of seven consecutive nights, starting Friday night, with the associated loss of six days of consultant supervised daytime training. The effect of this was to maintain a 1 in 6 rota commitment for day shifts including weekend days, but to reduce the overnight commitment to a 1 in 12.

Because of a temporary expansion of the training scheme, the number of SpRs available for the on-call rota rose to 18. Calculation of the average weekly hours over an 18 week rota cycle, however, was still not compliant with the new 48 hour limit, and therefore the rota was redesigned. The general feeling among the SpRs was that shifts worked well for the department, particularly since a local audit had demonstrated considerable increases in the number of out of hours investigations taking place throughout the city. One of the SpRs (HH), voluntarily took on the task of redesigning the rota, and after many meetings with the programme director for the training scheme and the EWTD project manager for Sheffield Teaching Hospitals NHS Foundation Trust, a suitable rota was produced, requiring 16 full time equivalent SpRs to be compliant. In order to reduce average hours to less than 48, with no increase in SpR numbers, specified days off were added to the rota (a full day off timetabled for every two long weekday shifts worked), with a small adjustment in the length of the shifts (nights becoming longer, and long days becoming shorter), dividing night shifts to either weekends or Monday to Thursday, and incorporating a short handover. This has had the effect of retaining as many useful training opportunities as possible, while maintaining out of hours cover and maximising compensatory time off to the advantage of SpRs and the radiology department.

The new rota was started in October 2008, and after allowing for a settling in period, we have been able to reflect on the good and the bad aspects that have occurred.

Effect on training

In a recent Career Focus article on 48 hour working at the Homerton Hospital, it seems that these doctors’ experience is that loss of training has been minimal with their new working pattern.[2] A recent statement about the directive, however, by the president of the Royal College of Radiologists, Professor Andy Adam, says “An informal survey carried out by the Faculty of Clinical Radiology suggests that most training departments are having difficulties with the directive and are anticipating that its full implementation next August would result in major problems with both training and service work.”

Our experience would agree with that. Over a 16 week rota, the number of training days missed owing to night shifts and days off totals 14. Over a year, this equates to six weeks, and is in addition to six weeks’ annual leave and 10 days’ study leave. Also, rostered days off have led to a reduction in SpRs within the department to cover the departmental duties. This has led to SpRs having to miss training sessions to meet the commitment and has the knock on effect that there are less senior SpRs available to cover consultant absence. Consultants feel that trainees are not around, and computed tomography and ultrasound lists have to go uncovered instead of giving more senior SpRs the chance to take on the responsibility of reporting solo.

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