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RCSEd Denounces Suggestion Working Time Directive Be Ignored

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22 Jul 2014

The Royal College of Surgeons of Edinburgh (RCSEd) challenges the Department of Health suggestion that trainee doctors in the UK should 'opt out' of the European Working Time Directive (EWTD) of a 48 hour week to enable them to get the training they need and deliver healthcare in the UK's Trust hospitals.

RCSEd, which recently opened its first-ever base of operations in Birmingham to cater for the 80% of its UK membership based in England and Wales, warns there is a danger that Trusts will put pressure on surgical trainees to opt out of the directive only for this extra time to be swallowed up covering rota gaps and not gaining any additional useful educational experience.

RCSEd President and Consultant Trauma and Orthopaedic Surgeon, Mr Ian Ritchie says:

"We believe that the problem does not lie with the working time directive but with its implementation which has left National Health Service Trusts throughout the UK, dependent on trainees for the delivery of service. It is an absolute truth that service is an integral part of training and certainly should not be separated as is being suggested, however, it should not rely on trainees to the extent it does. In addition, as the record of hours worked is based on a weekly average over six months, implementation of the directive has also been marked by noticeably long shifts and fewer opportunities for consultants and trainees to work together.

Director of the College’s Faculty of Surgical Trainers Craig McIlhenny; the only dedicated training faculty in the UK; is concerned about the opt-out plans. He says:

"High quality surgical training is vital to the provision of excellent surgical care and high levels of patient safety, and simply increasing hours that trainees are at work will not improve either surgical training quality or the safety of care for patients.

“We need to continue to move towards a system of training that means supervision by appropriate and motivated trainers working towards clearly defined competencies for surgical trainees. Giving the trainees extra hours to work ‘in the hope’ that they somehow independently gain more experience in between shift pressures is not using time effectively and carries no guarantee that that this extra time will be effective in making them better or safer consultants.”

A recent poll of surgeons in training at the newly opened Birmingham centre; which during its week-long launch played host to over 250 consultants, trainees and prominent figures in healthcare from across the UK; showed that whilst more than half of trainees (54%) agree that the EWTD is good for patients, the vast majority - close to nine out of ten (88%) - felt that there was an imbalance between service provision and training in their Trust.

Surgeon-in-training Richard McGregor, Trainee Member of Council and Chair of the Trainees Committee adds:

"This is a very emotive subject, and one that affects the very fabric of how many surgeons in training live their lives up and down the United Kingdom.  The statement released today by the DoH is a visceral reaction to a service under pressure, and in surgical training, quantity is no substitute for quality. The danger of such a vague statement issued by the Health Secretary is that it could lead to a series of unintended consequences. Training and service provision are inextricably linked, and by fracturing the two, or worse, giving Trusts the power to press surgeons in training to “opt out” of the EWTD, it will create a two tiered system of training. Moreover, it will be a disaster for retaining and recruiting junior doctors to the specialty. This announcement is not good for doctors, and it is not good for patients. ”

Craig McIlhenny, who is also a Consultant Urological surgeon, continues:

"As surgeons we should strive for an improved system of training that maximizes all opportunities to ensure we produce consultants fit for providing excellent, safe surgical care in our current NHS. The artificial separation of service and training is misguided and excellent service and training should go hand in hand.”

RCSEd President Ian Ritchie concludes:

"Encouraging trainees to opt out of the Working Time Directive will not improve training, but allowing the Health Services to become less reliant on trainees for the delivery of service will; changing rotas and shift patterns to include time for trainees to receive training and for consultants to deliver it will. I would challenge the service to do these things and once they have been done the quality of training will be much better, without resorting to a working pattern which ultimately leads to higher risk to the patient and to the trainees.”

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