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- ANP, advanced nurse practitioners
- MMC, Modernising Medical Careers
- NHS, National Health Service
- WTD, Working Time Directive
- WTR, Working Time Regulations
The changes necessitated by the Working Time Directive are likely to be painful but can be ameliorated by careful planning
In August 2004 the Working Time Directive (WTD) came into force for doctors in training, imposing a maximum of 58 working hours per week with minimum rest requirements. The next challenge will be WTD 2009, which takes the maximum working hours down to 48.1 For many of us trying to cope with service and training demands and achieve a reasonable work–life balance this may seem a step too far.
The WTD limit already applies to nurses and other National Health Service (NHS) staff including consultants and staff grade doctors. Doctors in training will no longer be exempted from the original WTD, now enacted in the UK as part of health and safety law as the Working Time Regulations (WTR).2 The WTR specify maximum hours of work and minimum rest periods based on the SIMAP3 and Jaeger4 judgements in the European Court of Justice. All time spent resident in the hospital, even if sleeping, is to count as working time for the purposes of the directive. Taken in conjunction with the New Deal,5 working time is limited to 13 h in any 24 with at least an 11 h rest between shifts. These constraints are of particular importance in rota design when providing 24 h emergency cover. An absolute minimum of eight practitioners is currently required to run a basic full shift system. A rota “cell” model6 using at least 10 doctors has been proposed to give extra cover for periods of peak activity and facilitate greatly improved handover. When the 48 h week is implemented, a rota cell of even 10 doctors will be under considerable pressure, further limiting time for experience in clinics …
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