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• EWTD: Different solutions for different hospitals
  John Gilbert
  Published on: 22 August 2007
• The Working Time Direct – the next step?
  Roger M Buchdahl
  Published on: 10 July 2007

• Published on: 22 August 2007

  EWTD: Different solutions for different hospitals

  • John Gilbert, Consultant Paediatrician

  Dear Editor,

  Campbell and Spencer have enumerated the challenges that the European Working Time Directive (EWTD) presents(1). The basis of the problem appears to be that doctors in training will have to be grouped together in larger cells with a minimum of 10 on each rota. The rationale behind this assertion is that exposure to useful training time in clinics and non- acute work will be eroded with smaller numbers...

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  Dear Editor,

  Campbell and Spencer have enumerated the challenges that the European Working Time Directive (EWTD) presents(1). The basis of the problem appears to be that doctors in training will have to be grouped together in larger cells with a minimum of 10 on each rota. The rationale behind this assertion is that exposure to useful training time in clinics and non- acute work will be eroded with smaller numbers on a rota(2). This may well be the case in the context of a large hospital with many sub-specialist clinics and day time training opportunities, but it does not recognise the importance of learning to asses and manage the acutely ill child.

  Our experience is that 62% of admissions from the Emergency Department occur outside of the normal working day. These unwell children are a precious training resource which is only of value at the time when they are assessed and managed in the acute situation. If these admissions are to provide useful training opportunities trainees must have access to appropriate supervision out of hours.

  The corollary of increasing numbers on a rota is that more doctors are present during the normal working day. With 10 in a cell there will be an average of 6 doctors present during the normal working day. This is more than is needed in a smaller District General Hospital.

  We have maintained a 2009 EWTD compliant middle grade rota over the last year with 7 doctors. The educational value of the training posts has been affirmed by both the College and the Deanery and this has been achieved by ensuring an appropriate level of out of hours Consultant supervision. We believe that this model should be considered when facing the challenges of the EWTD, particularly in the context of more remote District General Hospitals.

  References:

  1.Campbell C, Spencer SA. The Implications of the Working Time Directive: how can paediatrics survive? Arch Dis Child 2007; 92: 573-5.

  2. Royal College of Physicians. Designing safer rotas for junior doctors in the 48-hour week. Report of a multidisciplinary working group. http://www.rcplondon.ac.uk/pubs

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  Conflict of Interest:
  None declared.

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• Published on: 10 July 2007

  The Working Time Direct – the next step?

  • Roger M Buchdahl, Consultant Paediatrician

  Dear Editor,

  Colin Campbell and Stephen Spencer (1) have presented elegantly the dilemmas facing most UK paediatric units in their attempt to reduce the average hours to 48 by 2009. Their solutions include employing senior doctors as resident on call, the “hospital at night” solution , the expansion of the advanced nurse practioner grade and rationalisation of the number of units. They left out however the one so...

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  Dear Editor,

  Colin Campbell and Stephen Spencer (1) have presented elegantly the dilemmas facing most UK paediatric units in their attempt to reduce the average hours to 48 by 2009. Their solutions include employing senior doctors as resident on call, the “hospital at night” solution , the expansion of the advanced nurse practioner grade and rationalisation of the number of units. They left out however the one solution which would avoid all the associated problems and that is to enlist the support of representive bodies such as the Royal Colleges and BMA to back a call to keep the current working time limit at 56-58 hours. Such a move would preserve the status quo in terms of the provision of more comprehensive training programmes, allow better patient care continuity and stop the relentless demand for ever increasing numbers of junior doctors many of whom have to be imported from countries who can ill afford to lose them. We are told the new Health Secretary is a listener. We need to shout loud.

  Reference:

  1.Campbell C, Spencer SA. The Implications of the Working Time Directive: how can paediatrics survive? Arch Dis Child 2007; 92: 573-5.

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  Conflict of Interest:
  None declared.

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