Doctor hour cuts 'will harm care'

Doctors may see patients less frequently, Professor Pounder warns

Patient care will suffer when junior doctors' hours are cut to conform with the European Working Time Directive, a leading medic has warned.

From August 2009, a junior will not be able to work more than 48 hours a week, compared with the current limit of 56.

But Professor Roy Pounder, of the Royal College of Physicians, warns it will not be possible to safely implement the change without more doctors.

The Department of Health says the 48-hour-week will be implemented.

It is unlikely [patients] want to trade continuity of care for slightly fresher doctors Professor Roy Pounder, Royal College of Physicians

Writing in the RCP journal, Clinical Medicine, Professor Pounder says the EWTD will mean all junior doctors working, in effect, eight hours fewer per week - the equivalent of one less shift.

Staffing at night and the weekend is already too lean to make further reductions, so he forecasts the cuts will have to be made in daytime staffing.

Professor Pounder warns this will have a major impact on the training provided to junior doctors, which is delivered during daytime shifts.

But he says the biggest effect will be on patient care.

"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch and learn about the progress of an illness.

"Seeing a patient once or twice before handing over to the next doctor, who then does the same after a short period, means it is difficult to detect a subtle deterioration in a patient's condition."

Fewer investigations

Reducing doctors' working hours is partially aimed at preventing potentially harmful fatigue.

But Professor Pounder adds: "There is no robust evidence concerning patients' attitudes to the effects of the EWTD on their inpatient care but it is unlikely they want to trade continuity of care for slightly fresher doctors."

He cited a pilot at one hospital where hours were cut from 56 to 48 per week, which found there were too few doctors to do the necessary tasks.

"Fewer investigations were ordered, fewer patients examined, poorer continuity notes written, fewer relatives seen and slower discharge drugs or letters."

The NHS is planning for all doctors in training to be working a 48-hour week from 2009 and half already do so Department of Health spokeswoman

Professor Pounder called for the number of training posts to be increased from the current 34,000 to 46,000 to provide enough doctors to implement the directive.

"It is possible to create legal rotas that are not best for patient care, training or cost effective overall.

"It may be that the solution is to recruit more junior doctors and consultants."

More doctors training

Mr Ram Moorthy, chairman of the BMA Junior Doctors committee, said: "The Department of Health and NHS have had plenty of time to prepare for the 48-hour week.

"It must not be allowed to compromise the quality of doctors' training, which is a massive concern, or the service the NHS provides."

A spokeswoman for the Department of Health said: "The NHS is planning for all doctors in training to be working a 48-hour week from 2009 and half already do so."

She said hospitals in north-west England were working to an implementation date of August 2008 - one year early.

"NHS staff have achieved this progress through reforming outdated working practices and recruitment.

"The number of doctors in training has risen by over 50% since 1997 and the number of medical school graduates has increased by 70%."