Patient safety worries as college urges change in doctor training

The Royal College of Surgeons claims the European Working Time Directive restricting junior doctors to 48-hour weeks has "failed spectacularly" and patients are less safe than they were a year ago when it was introduced.

In a survey it found four in five consultants and two in three trainees felt patient care had deteriorated.

Two thirds of trainees said their training time had decreased and more than half of consultants said they were operating without trainees.

They warn it will lead to a shortage of skilled surgeons and is already damaging patient care by leaving inexperienced staff on wards to assess patients.

Another analysis by the Royal College of Physicians suggests some junior doctors are responsible for as many as 400 patients at night.

Evidence from 670 medical teams in England and Wales revealed junior doctors with less than two years' experience were often the most senior on duty at night on some wards and there was a lack of on-site consultant back-up.

A Yorkshire Post survey of 17 NHS trusts in the region found that on one weekday night in May junior staff were responsible for around 30 beds on average although officials in York claimed there was one doctor for every 13 beds. This rose to one for every 69 beds in Sheffield, seven juniors covering 650 medical beds in the city

Some hospitals failed to provide figures, notably the giant Leeds trust which could not even say how many beds or junior doctors it had.

Reliance on locum staff varied, more than a quarter of junior doctor rotas at Airedale, Chesterfield, Doncaster, Mid Yorkshire, North Lincolnshire and Goole, Scarborough, Sheffield and South Tees trusts being reliant on temporary staff.

One in five junior doctor posts was unfilled at the Doncaster and Bassetlaw trust and one in 10 at York and the Wakefield-based Mid Yorkshire trust.

Problems caused by the directive and other changes to training, prompted more than 40 consultants at Mid Yorkshire to sign a letter in February complaining "the health and lives of patients are being put at risk and the health and wellbeing of junior doctors is suffering".

It added: "We can no longer stand by and allow these changes to go unchallenged and we therefore call for the current system to be urgently reviewed and replaced for the good of patients, staff and the NHS as a whole."

The concerns prompted regional medical director Chris Welsh to meet specialists and the issues raised were passed to the Department of Health.

The director of medical education at Mid Yorkshire, Andrew Jackson, said doctors' rotas were being reviewed ready for when two new hospitals were fully open shortly but the trust was always examining better ways to deliver care.

"One example is that we are putting in place a 'hospital at night' programme which is about ensuring that the team we have on duty at night has the right mix of skills to deal with the majority of urgent patient needs at any one time. This means that the team will work more effectively to provide clinical leadership, technical support and following good practice for safe and effective handover of patients with an escalation policy for senior input," he added.

The British Medical Association has suggested revamping rotas to maximise training, some routine tasks being taken by staff other than doctors.

Its investigation found four in 10 junior doctors were working on understaffed rotas.

Half of juniors questioned said they worked more than 56 hours over a week despite the European directive and one in three more than 65 hours, particularly if posts on their rotas were empty.

Half thought the directive had negatively affected training and had missed it to cover rota gaps.