Junior NHS doctors are beginning their first full working week under the European Working Time Directive (EWTD) - and many are not happy about it.
By Alex Stevenson
The directive limits workers to an average 48-hour working week and is currently being followed by all NHS staff except junior doctors. Their reliance on longer hours for training presents an unresolved headache in hospitals up and down Britain, setting their representatives at odds with the government.
As of August 1st, after ten years of preparation and £310 million to help hospitals implement the changes needed, the EWTD finally came into full force.
But its implementation has been overshadowed by angry concerns from organisations representing NHS staff.
The Department of Health points to gradual reductions in their working hours over recent years, from 58 in August 2004 to 56 in August 2007.
It now claims the NHS is 97 per cent compliant with the new regulation but the British Medical Association (BMA) is unconvinced by this figure.
Andy Thornley, chairman of the BMA's junior doctors committee, points to a survey published in the Health Service Journal in May suggesting that one in ten had been told to lie about their working hours.
The proportion claiming they had been asked to lie among those whose hours exceeded the maximum limit rose to one in six, it noted.
"Our members are worried about their training; many feel it has reduced in quality as working hours have been reduced," Dr Thornley said.
"The future of the NHS depends on the production of the high quality consultants of tomorrow. This cannot be done if standards of training are allowed to slide."
To opt out or not to opt out
The government rejects this argument, saying there is no evidence that training has become less effective.
A DoH spokesman said: "The quality of training and supervision is more important than the quantity of hours completed."
But the BMA is not alone in its concerns. RemedyUK, a movement of doctors worried by training reforms for NHS staff, is worried that trainee doctors who are happy to work longer hours will be prevented from doing so.
It says the opt-out form only appeared on the NHS Employers website days before the directive came into force and wants a "coordinated" approach to giving doctors the problem.
"The issue is over two-thirds of doctors want the right to opt-out and over 90 per cent of would exercise their opt-out," a spokesman told politics.co.uk.
"It seems a real waste not to use that goodwill within the profession. A lot of what we call craft specialities - based on experience like surgery - rely on that experiential exposure and so there's a lot of will. that they would quite happily opt-out of the directive."
In addition to the 48-hour limit the EWTD imposes a number of rest requirements.
There should be a minimum 11 hours of continuous rest in every 24-hour period, a minimum rest break of 20 minutes after every six hours worked and a minimum period of 24 hours continuous rest in every seven-day period.
Frustration with the DoH ultimately rests on whether NHS managers can successfully reduce the number of junior doctors' hours without compromising their training.
"It is possible to meet training demands and maintain patient services," Dr Thornley of the BMA insisted.
"Solutions rely on hospital managers working with doctors to ensure that doctors' time is best used and all training opportunities are maximised. It will also need a movement to an NHS that is more reliant on an expanded consultant workforce, which will benefit patients and the profession as a whole."
There are wider concerns within the NHS, however. The Royal College of Surgeons (RCS) has made clear its view that the 48-hour week is a "major threat to safe patient care which will result in very thin medical cover". It believes it will "devastate" training levels.
John Black, president of the RCS, remained upbeat in a letter to members published two weeks ago, however.
He wrote: "These are very difficult times, but I remain confident that a long-term solution meeting the aims of surgeons will be achieved."
The EWTD was enacted into UK law as the working time regulations in October 1998, with the government negotiating an extension of up to 12 years to prepare for the full implementation for doctors in training.
With the final deadline passing this week, ministers have failed to win many within the NHS round.