Fears for safety of patients with too few doctors

Each doctor cares for an average of 61 patients but it ranges from one to 400, research from 670 medical teams in England and Wales showed.

In comparison, a doctor cares for just 11 patients on average during the day.

The data revealed junior doctors with fewer than two years' experience on NHS wards can often be the most senior person on duty at night.

Dr Andrew Goddard, director of the medical workforce unit at the Royal College of Physicians, which carried out the survey, described the results as "worrying".

"The very low number of doctors per patient at night in some hospitals raises serious concerns for patient safety and there are also worrying reports of very junior doctors being left unsupported, which urgently require further investigation."

The figures came in response to an anonymous survey sent to all consultants in England and Wales asking them to record the make-up of their team and how many patients were being cared for.

The snapshot survey was carried out at 11am and 11pm on November 5 last year.

Data was collected from 887 hospital teams at 11am, including 4,004 junior doctors caring for 18,854 patients, and from 670 teams at 11pm, including 2,263 junior doctors caring for 97,561 patients.

At 11pm, 63 teams had a junior doctor in their first two years of training as their most senior medical cover. In comparison, only 6 per cent of teams said consultants were involved in the direct delivery of overnight care.

The study, to be published in the journal Clinical Medicine, was carried out to assess the impact of the European Working Time Directive (EWTD), which limits the number of hours a trainee doctor can work to 48 per week. It found day cover on wards ranged from two to 65 patients per junior doctor, with the highest ratio per doctor in Wales and the lowest in London, where there is a higher number of trainees.

The average number of patients per doctor also varied considerably between specialties, the research found.

Almost six in 10 consultants (58 per cent) reported high sickness rates among their trainees since the introduction of the EWTD in 2009.

The highest rates were among second year trainees, "possibly reflecting a loss of team working and sense of belonging in doctors a year into their training,", the college said.

Dr Goddard, who led the study, said: "In the daytime, care for many patients is carried out by junior doctors, which limits their time shadowing more senior doctors and improving their knowledge and skills.

"Far from benefiting their welfare, the poor implementation of the directive means that juniors are missing out on crucial support and valuable training opportunities, and patient care is being spread too thinly."

Dr Shree Datta, chairman of the junior doctor committee at the British Medical Association (BMA), said: "It is appalling that some hospitals are so understaffed that one doctor can be responsible for 400 patients.

"This situation needs addressing as a matter of urgency. Patients must have confidence that their hospitals are properly staffed at night and that experienced doctors are available when required."

John Black, president of the Royal College of Surgeons, said: "We have overwhelming evidence from the frontline that safe and effective hospital cover, especially at night, cannot be sustained under EWTD."

A spokesman for the Department of Health said: "Employers are responsible to ensure that service rotas are designed and staffed appropriately, in accordance with the working time regulations."