Working time directive hinders junior doctors' progress

One significant barrier to the training of junior doctors is the EU time directive which enforces a maximum working week of 48 hours. Photograph: Martin Argles

August has earned an unfortunate nickname in the NHS; the "killing season", so called because of the effect of an influx of 6,000 newly qualified medical graduates into hospitals across the country. Research shows that this leads to a 6% rise in patient death rates during the same month each year. One reason this happens is because the juniors are not receiving the right level of support in their first few weeks of work, putting them under huge pressure and putting patients at risk.

Last year, the government decided to take action in the hope of addressing the issues of the graduate handover. It introduced a mentoring system to try to provide enough good quality support to new doctors, giving them access to senior staff who could help to guide them through those first few weeks. The effects of these measures should start to filter through this year. However, they only address part of the problem. The NHS has been trying to work around the EU's strict rules on working hours that have been stifling the training of new doctors since 2009.

One of the more significant barriers to the successful training of junior doctors is the EU time directive. These guidelines enforce a maximum working week of 48 hours. While that may seem like a good thing in principle, and in many other professions it would not cause a problem, this means that junior doctors are unable to steadily climb the steep learning curve of their new roles. Their shifts are not long enough to encounter the wide range of conditions and treatments that they need to experience to ensure their development, meaning effectively that juniors have to down tools halfway through an important training session. This is particularly relevant in specialist fields like surgery where procedures can take hours to complete.

By limiting the hours junior doctors can work and train, the EU rules are putting them under huge pressure to perform well and learn an enormous amount of information in a disjointed manner. The stress that goes with this stop-start situation certainly cannot be reducing their anxiety about the new position and if this situation continues we are likely to see a drop in doctors joining the NHS after they graduate.

Additionally, the poor image projected by the constant NHS bashing that results will eventually stick, diminishing the ability of the public sector to deliver and fuelling the progression towards privatisation of the NHS. This could push healthcare "free at the point of use" out of our grasp.

It is crucial that we give graduates an NHS environment where they are encouraged to thrive rather than a culture where they are scapegoats from the off. They must be allowed to learn in a "real-life" situation, without a curfew applying part way through the process. Otherwise we could end up with uninformed process being delivered in our hospitals, such as the sad state of palliative care found in the Liverpool Pathway project.

The part played by mentoring and support can go some way to improving the situation, but junior doctors need to be given the freedom to learn on the job, otherwise we could find we have a population of downbeat, demotivated senior staff in our hospitals, serving only to exacerbate the problem.

Gayna Hart is managing director of healthcare software provider, Quicksilva

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