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After correctly predicting the chaos that would ensue from the introduction of the government’s ill-fated junior doctors training scheme, Dr David Nicholl has a new warning – and this time it’s EU which is to blame. And patients will be at the sharp end.

With the chaos of MMC (the problematic junior doctors training system)last year, I don’t mean to be the bearer of bad news, but things are likely to get a lot more chaotic from 1st August 2009.

Why this specific date? This is when the European Working Time Directive (EWTD) demands that all junior doctors work no more than 48 hours. Currently all junior doctors work no more than 56 hours a week.

Why 2009 will matter so much is that in little over a year every junior doctor must work eight hours less every single week. Where will the hospital planners save the eight hours?

The answer is not pleasant and is buried in a report from Prof Roy Pounder- he is the lead for European Working Time Directive, Workforce Unit at the Royal College of Physicians.

Apart from having an awfully long title, his report is worth reading, not least because this is the same author who has predicted so devastatingly some of the workforce problems in relation to MMC last year.

Prof Pounder is a man who knows what he is talking about even if others at the Department of Health are "inept" according to the Health Select Committee.

His report mentions one anonymous English hospital which introduced a 48 hour week and concludes that continuity of care was a major problem - there were “not enough doctors left to get the clinical jobs done during the daytime.

"Fewer investigations were ordered, less patients examined, poorer continuity notes written, fewer relative seen and slower discharge drugs or letters."

Perhaps it is not suprising that the hospital is anonymous in the report given the clear problems of patient safety but also that this will “cripple the efficiency of a Trust” according to Prof Pounder.

I have to say I cannot think of a single colleague, consultant or junior, who is eagerly awaiting 1st August 2009.

Prof Pounder’s enquiries of his colleagues in Europe suggested that only Sweden, Denmark and the UK will actually comply with the EWTD. It recalls the comedian Al Murray’s joke “What do you call a place with no rules? France. What do you call a place with too many rules? Germany”

I would add: “What do you call a place that follows the rules? England” It would be funny if the consequences were not so potentially dire.



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