Consultants under fire over wards left to NHS trainees

Too many junior doctors are left unsupervised on wards overnight and are missing out on vital training, a damning report has warned.

The NHS is "too reliant" on trainees to provide out-of-hours care for patients, including at weekends and during the night, the Government review said.

Some older consultants are reluctant to work outside normal day shifts according to the review's author Professor Sir John Temple.

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Sir John examined the impact on medical training of the European Working Time Directive (EWTD), which cut the maximum number of hours doctors could work to 48.

He concluded that trainees could still receive high-quality training in a 48-hour week but not if they continue to provide out-of-hours care.

Trainees are poorly supervised, and their training during the day suffers because they have to fill gaps in rotas, he said.

In a study critical of the way consultants arrange their hours, Sir John said the service would need to be redesigned so consultants work more flexibly and are more "directly responsible" for patient care.

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It would cut costs in the long term due to shorter patient stays in hospital, better decision-making, better diagnosis and increased safety, he said.

He said "a number of people will never want to change what they are doing" but they tended to be older and would retire. Younger people who were on track to be consultants had a different view, he said.

Professor Ian Gilmore, president of the Royal College of Physicians, said there had been improvements in consultants' hours in recent years.

But he added: "I think part of the problem is the older consultants still want to turn up at 8am and go home at 6pm, Monday to Friday."

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The review was ordered by former Health Secretary Alan Johnson. The report said the change in hours implemented in the NHS last year, had caused gaps in rotas which were often filled by trainees.

"When gaps appear, the system is breaking down," Sir John said. "It's breaking down more now than it was two years ago."

Although rotas are often "compliant on paper", some doctors are

falsifying records to hide gaps.

"Where there are gaps in rotas these are often in the evenings or at night and offer minimal supervision or training opportunities," the review said.

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Sir John said junior doctors "can be left feeling exposed without proper supervision out-of-hours" and such a reliance on trainees to cover night and weekend work did not happen in most of Europe.

The report called on consultants to work more flexibly, saying their contracts are "not being used to the benefit of training".

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