Winter is a busy time in hospitals, but the festive season adds to the burden of hard pressed junior doctors.
New ways of working are being piloted
It is over Christmas and New Year that those long hours of working get longer and the pressures increase.
For the doctors at Winchester's Royal Hampshire County Hospital there has been a welcome Christmas present this year in the form of cardiac nurse practitioners in A&E and pharmacists working on the emergency medical assessment unit.
This isn't just a rush of yuletide generosity on behalf of the trust's management, it's all part of the European Working Time Directive, which will apply to junior doctors from August 2004.
Winchester and Eastleigh Healthcare NHS Trust, which manages the hospital, is one of 19 pilot sites chosen from a total of 435 nationally to test different ways of working for junior medical staff.
Medical assistants will be taking on a lot of work that was historically done by junior doctors, such as performing ECGs and taking blood.
There are seven medical assistants about to start work in the medical and elderly division at the hospital.
Feedback from their recent training and trial period has been very positive.
Mandy Williams, the F grade nurse who leads the team, said: "When people see what they can do they say 'can we have one?'"
Consultant physician Dr Kevin Stewart points out why patients might benefit from the new roles more than they realise.
"Patient safety shouldn't be overlooked. Having tired doctors is of no use to anyone, especially those being treated.
"When I was a junior doctor 15 years ago I would come in to work on Christmas Eve and go home on Boxing Day.
"Now things are much more civilised as, under the work time directive, the longest any member of staff can work at a stretch is thirteen hours.
"The way we organise the rotas means that staff will get either Christmas day or Boxing Day at home with their family."
Seriously ill patients stand to get faster and possibly even higher quality care when the next phase of the trust's Work Time Directive pilot work swings into action.
Pharmacists will bring their skills to the emergency medical assessment unit (EMAU), where between 5% and 20% of cases are drug related.
Covering the ward from 0800 to 1900 weekdays, they investigate medical histories of patients and suggest appropriate medication.
Time pressures mean this is often done quickly by junior doctors.
Discrepancies which often appear on patients' medical histories will not slip past a pharmacist.
This is an area where a high degree of specialist training can really make a difference to the patient as well as taking the time burden off the specialist registrar.
The D-grade pharmacists' contribution will enable patients to be transferred to a ward or discharged within 24 hours of admission onto the EMAU.
Having cardiac nurse practitioners supporting junior doctors means that there will be faster intervention for heart attack sufferers.
These nurses will quickly assess patients and then treat those who need thrombolysis - a clot-busting drug injection which unblocks the vessels that have caused the arrest.
Junior doctors and consultants will still be on hand to administer care, but it is one job that can be removed from their workload as the specialist cardiac nurses will be covering for 90 hours each week.
Dr Stewart concluded: "This Trust is committed to giving our junior doctors a rounded training and making sure their time here is about quality.
"The traditional view is that doctors' apprenticeship is that long hours result in the right experience and training.
"But we don't want the focus on repetitive tasks to be at the expense of missing out on educational opportunities.
"The support of the medical assistants, pharmacists and cardiac nurse practitioners will go a long way to help this trust produce better doctors as well as improve patient care."