An Editorial in this week's Lancet looks at the recently released review of the effect of the European Working Time Directive (EWTD) on the quality of medical training in England, by John Temple.
The Editorial says: "The report concludes that good training and health care can be delivered within the 48 h if consultants are there in person to train and supervise junior doctors—consultants will need to work 'flexible hours'. Flexible hours seems to be a euphemism to avoid the S word (shift working)."
It highlights the response of the Royal College of Surgeons, which, although pleased with the acknowledgment of the negative effect of the EWTD on training, responded that "the remedies proposed are unworkable". The College argues against a consultant delivered model and calls for acute specialties to be exempted from the Directive. The Editorial says: "This return to the past, however, with doctors working excessive hours, is unlikely. After all, the EWTD was implemented to improve health and safety of both doctors and patients by decreasing risks posed by overworked medical staff. Moreover, Temple states that a consultant-delivered service leads to a decrease in average length of hospital stay and a decrease in admissions, both of which could lead to efficiency savings."
The European Commission will assess the impact of the EWTD, and report this summer. The Editorial highlights that Temple decried the lack of hard data on the impact of the EWTD: "Lacking conclusive data", he wrote, "the Review has taken consistent and repeated opinion and information as a proxy for evidence".
The Editorial concludes: "A Europe-wide focus will be more welcome than piecemeal reviews by individual countries. The EWTD is here to stay, so doctors in training and their trainers— and hospital managers—will have to find ways to work within the Directive to provide the essential training needed for safe practice, practice provided by well-rested doctors."
The Lancet Press Office. T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full Editorial see: http://press.thelancet.com/editorials1906.pdf
Journal
The Lancet