Description

As of August 2004, a further development
of the European Working Time Directive
comes into law. This against the back drop of
the New Deal has led to many changing
working patterns. These changes have led to
a reduction in training hours,1 less continuity
of care and intolerable night shifts.

Following a recent ruling in the European
Court of Justice (SiMAP) “work” is defined as
all the time that an employee spends in the
workplace, irrespective of the amount of any
time spent resting. A further ruling
(Jaegger), the implications of which stated
that you are working even if you are available
to be called from home has thrown more
problems into the current system although
we are currently unclear as to its long term
implications in our health care system.

NHS trusts keen to comply with new
laws are making changes to the management
of acute services, these include a hub and
spoke approach and developing allied
professional roles. However, combining
departments in a hub and spoke approach can
lead to patient and relatives travelling long
distances and deskilling of smaller units.

The use of clinical nurse specialists is
being trialled by the NHS Modernisation
Agency “Hospital at Night Project”.2 This
would allow ENT SHOs to be non resident
on call. Northwick Park Hospital ENT
department have successfully implemented
this scheme, with the use of nurse specialists
first on call and strict protocols for patient
management. Our own department has
carried out an out of hours audit which
shows that a similar scheme could apply here.

Urgent attention is needed to ensure that
patient continuity of care and junior doctor
training is not hampered. With little time
remaining action must be taken, but even if
SHO training is not further harmed, it is
difficult to believe that the quality of patient
care will improve as a result of these changes.

 

References
1. The European working time directive- interim report and
guidance from the royal college of surgeons of England working part chaired by Mr Hugh Phillips.

2. NHS Modernisation Agency, www.modernnhs.nhs.uk