Why is the EWTD relevant to me?
The European Working Time Directive (EWTD) is now enshrined in UK law under the Working Time Regulations (see note 1). The main pillar of this legislation is that every worker is entitled to an 11-hour break in every 24 hours, and that doctors in training must work no more than an average of 48 hours per week.
There are widespread concerns that in the push to achieve formal compliance, many of the trusts that reported readiness for the August 2009 deadline have not yet developed the kinds of sustainable staffing solutions that would mitigate the negative impact that reduced hours are expected to have on patient safety and the quality of training (see note 2).
In recognition of this, the Department of Health is continuing to explore options for further derogation.
What is the College position?
Complying fully with the 48h limit will be challenging for most rota planners and clinical teams.(see note 3). Diverse factors such as the acuity of care services, department size and even the relative isolation of units will all affect how severe the consequences are for patient care and training. The Royal College of Physicians represents 28 different specialities and is very conscious of the broad range of potential outcomes.
However, the College cannot support the introduction of a 48-hour working week for doctors in medical training unless the following conditions are met:
- Patient care and quality of training are not compromised when changes are made to trainee doctors’ rotas to achieve EWTD compliance;
- An appropriate balance between acute medicine and specialty training is achieved for all trainees, and specialty training is not lost to maintain acute medical cover for in-patients;
- There is an expansion of the consultant workforce as well as other healthcare professionals to allow the above;
- Individual trusts are assessed to ensure that patient care and the quality of training are not compromised.
Consequently the College believes that a flexible approach will be required to meet the needs of specific local circumstances. A “one size fits all” approach is not appropriate, particularly if these aspirations are beyond current or foreseeable legal authority. Each organisation and individual physicians will need to consider carefully which mechanisms such as derogation, consultant expansion, service configuration, innovative practice best ensures patient safety and protects medical training in their specific setting (see note 4).
What is the College doing now?
The College is working closely with the DH, Strategic Health Authorities and its regional advisor network to support trusts and clinicians in the development of robust local EWTD compliance plans.
This College was also heavily involved in efforts to secure DH support for the principle of derogation (see note 5). It is our view that derogation provides an opportunity in the most challenging circumstances for safe implementation over a transitional period.
Furthermore, the Medical Workforce Unit has developed guidance to enable NHS clinicians to work with their Clinical Director, Trust Medical Director and RCP regional advisor to secure a share of the substantial funding the Department of Health has set aside to help clinical teams achieve EWTD compliance. The funding is recurrent, meaning that it can be used to create the kinds of long term positions that would alleviate pressure brought about the Directive.
The College is also examining ways to develop a framework to assess what impact EWTD compliance has on the quality of medical training.
EWTD Derogation Update, 2 July 2009
A Scrutiny Panel of the National (England) EWTD reference Panel met in early June to review those rotas submitted for derogation by Strategic Health Authorities and to make recommendations. The Secretary of State for Health has accepted the recommendations of the Panel and on 25 June a Statutory Instrument was laid before Parliament to enable derogation from the EWTD to be applied to the rotas listed in the document below.
Panel report and the list of rotas (PDF 78Kb 
)
Reference notes
The European Working Time Directive - Full text (PDF 117k ) Taken from the Official Journal of the European Union.
Implementation of the European Working Time Directive in 2009 – implications for UK clinical service provision and training for the medical specialties. (Doc 130Kb )- Junior doctors' working hours: can 56 go into 48? (PDF ) Professor Roy Pounder
- It should be noted that while we support individual trainees’ right to 'opt out' of the EWTD to preserve their opportunities for training, or so they can gain work as an internal locum, we would caution rota planners against using the ‘opt out’ as a blanket solution to compliance difficulties.
- www.rcplondon.ac.uk/news/news.asp?PR_id=434
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