What has been the effect of the EWTD so far? The intention was to improve the working lives of doctors in training, and to increase patient safety, by removing tired doctors from front line care. It remains the view of our royal college, if not the politicians. Specialist registrars are still embryonic consultants, although for how much longer this notion will continue is debatable. Little thought was given to the consequences of this action, specifically that it would destabilise workforce planning, already tottering under short term political initiatives, in which there was no strategic thought whatsoever. Moves were made to increase the number of specialist registrars to provide added numbers within the tiers of the on‐call rota, and to meet the first wave of EWTD hours. It was necessary to work a shift system of resident on‐call medical staff, utilising medical staff who were used to being in the second tier, since the numbers required were of the order of 8–10, in the rota, perhaps necessitating the abolition an intermediate tier. These would, of necessity, be ophthalmologists, and were in the same position as front line acute specialty services in DGHs. Here, there was a requirement for resident doctors on site after normal working hours. The same could not be said of large “stand alone” units. We are sitting on a bomb that is ticking. A few small units found themselves amalgamating with their neighbours to maintain an emergency service round the clock, a few abandoned any thoughts of providing 24 hour cover, and a very few provided consultant first on‐call cover after 10 pm or midnight. Even then, it is necessary for these doctors to reduce the number of hours worked (and trained) during the normal working day.įewer doctors meant a greater reduction in hours worked during the normal working week. This had some financial repercussions for those individuals on call, but in general had little effect on the running of departments providing six doctors could be found to be in the first tier of the on‐call system. Providing there is general medical cover on site, it is not necessary for ophthalmologists to be resident on‐call, even though accommodation was on site. Most district general hospitals (DGHs) had provided a 24 hour emergency service. Ophthalmology, in general, was in a fairly favourable position. It was rapidly apparent that the responses to this would be varied, depending on type and size of hospital, and discipline. Specifically, that a rest period must be taken immediately after the work period to which it related. The specific rest requirements after a period of work, were also challenged, and clarified by the “Jaeger” judgment, which applied to rest periods after a period at work. This ruled that “resident on‐call” was work, whether engaged in clinical activity, sound asleep, or any other activity. Luckily for us all, help was at hand in the shape of a specific challenge to the directive, known as the “Simapp” case. Crucial to determining how trusts would respond to this was the definition of work, when the resident was on call-that is, was asleep, doing on‐call work, or resting.
#RHYTHM DOCTOR TIER 8 HOW TO#
Not surprisingly, there was a flurry of activity, and a plethora of documents, guiding and advising trusts on how to deal with this issue, both from the Department of Health, and the royal colleges. Compliance is checked by continual monitoring. This was not optional, but was a legal requirement and breaches of this legislation are subject to significant financial penalties, to be imposed on the employing trusts.
Thereafter, in August 2007, this should be reduced to 56 hours per week, and in 2009 to 48 hours. It is not widely appreciated that all other grades of medical staff are bound by this legislation unless they specifically, and individually “opt out.”Īn amending directive was issued in 2000, 2 removing the exemption of doctors in training from the EWTD, to take initial effect in August 2004, when the average weekly working time had to be reduced to 58 hours.
The EWTD applied to all medical staff, except doctors in training-that is, the house officer and specialist registrar grades. 1 The main features of the legislation relate to the average maximum numbers of hours that could in law be worked in a week, the duration and timing of rest periods, days off, and paid leave. The directive was enacted in UK law, from 1 October 1998. The European working time directive (EWTD) is a directive of the European Union within the umbrella of health and safety legislation.
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