Trusts are ill prepared for 58 hour week for junior doctors
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《英国医生杂志》
Trusts may be ill prepared for new limits on junior doctors?working hours because of a lack of government support and confusion over the legislative details, a parliamentary inquiry has heard.
Doctors?leaders have informed the House of Lords inquiry that national guidance has failed to materialise on how trusts can cut junior doctors?weekly hours to 58梛ust months away from the deadline.
From August 2004 the European Working Time Directive will be extended to include junior doctors. The cut in hours is equivalent to about a 10% drop in the total hours worked by such trainees. But the BMA has told the inquiry that the working time directive pilots taking place throughout England probably won抰 report in time to help trusts meet the August deadline.
"The Department of Health has been very late on the uptake," said Simon Eccles, chairman of the BMA抯 Junior Doctors Committee, which has persuaded the department to run four "hospitals at night" pilots. These pilots aim to redefine how medical cover is provided in hospitals at night and to predict how a whole hospital can comply with the directive while retaining a safe and acceptable service for patients.
"But the project is not going to report until April, which is going to give other trusts very little time," said Dr Eccles, who was one of the BMA leaders called to appear before the inquiry last Wednesday. "It抯 far from ideal and should have been done two years ago really. But it wasn抰 until we got this close to the deadline that the Department of Health woke up."
The BMA also told the inquiry that certain aspects of the directive are unworkable and confusing. The European Court of Justice recently ruled that doctors who are disturbed while on call should be able to lie in on the next day to compensate for their broken sleep. This so called Jaeger judgment would make it hard for managers to plan doctors?rotas, the BMA says, because such compensatory rest must be taken before the doctor starts their next shift.
The BMA has described the requirement as "unworkable and in most cases unnecessary," as it would stop doctors from doing on-call duty from home if they have work the next day.
The BMA called for a commonsense approach whereby a doctor can claw back their compensatory rest as two half days off, or an hour here or there might be aggregated into a whole day off in lieu.
The House of Commons Social and Consumer Affairs Select Committee had called this short inquiry into the directive as part of its response to a European Commission consultation.
The European Commission has asked member states to report back by 31 March on what periods should be used to calculate average working weeks, how employees are opting out of the limit on hours worked, and how working hours should be defined, in the light of recent court cases involving hospital doctors working while on call (BMJ 2000:321;918; 2002;324:1235).
Policy makers in Brussels are concerned that some unscrupulous employers may be coercing staff into signing away their rights to a maximum working week under the 48 hour rule for most employees. But the BMA points out it has no evidence that NHS employers are abusing such opt outs, so consultants梬ho already have the right to work more than 48 hours a week if they wish梥hould continue to be allowed to do so.(London Katherine Burke)
Doctors?leaders have informed the House of Lords inquiry that national guidance has failed to materialise on how trusts can cut junior doctors?weekly hours to 58梛ust months away from the deadline.
From August 2004 the European Working Time Directive will be extended to include junior doctors. The cut in hours is equivalent to about a 10% drop in the total hours worked by such trainees. But the BMA has told the inquiry that the working time directive pilots taking place throughout England probably won抰 report in time to help trusts meet the August deadline.
"The Department of Health has been very late on the uptake," said Simon Eccles, chairman of the BMA抯 Junior Doctors Committee, which has persuaded the department to run four "hospitals at night" pilots. These pilots aim to redefine how medical cover is provided in hospitals at night and to predict how a whole hospital can comply with the directive while retaining a safe and acceptable service for patients.
"But the project is not going to report until April, which is going to give other trusts very little time," said Dr Eccles, who was one of the BMA leaders called to appear before the inquiry last Wednesday. "It抯 far from ideal and should have been done two years ago really. But it wasn抰 until we got this close to the deadline that the Department of Health woke up."
The BMA also told the inquiry that certain aspects of the directive are unworkable and confusing. The European Court of Justice recently ruled that doctors who are disturbed while on call should be able to lie in on the next day to compensate for their broken sleep. This so called Jaeger judgment would make it hard for managers to plan doctors?rotas, the BMA says, because such compensatory rest must be taken before the doctor starts their next shift.
The BMA has described the requirement as "unworkable and in most cases unnecessary," as it would stop doctors from doing on-call duty from home if they have work the next day.
The BMA called for a commonsense approach whereby a doctor can claw back their compensatory rest as two half days off, or an hour here or there might be aggregated into a whole day off in lieu.
The House of Commons Social and Consumer Affairs Select Committee had called this short inquiry into the directive as part of its response to a European Commission consultation.
The European Commission has asked member states to report back by 31 March on what periods should be used to calculate average working weeks, how employees are opting out of the limit on hours worked, and how working hours should be defined, in the light of recent court cases involving hospital doctors working while on call (BMJ 2000:321;918; 2002;324:1235).
Policy makers in Brussels are concerned that some unscrupulous employers may be coercing staff into signing away their rights to a maximum working week under the 48 hour rule for most employees. But the BMA points out it has no evidence that NHS employers are abusing such opt outs, so consultants梬ho already have the right to work more than 48 hours a week if they wish梥hould continue to be allowed to do so.(London Katherine Burke)