Patient safety put at risk by long hours for Junior Doctors

Many junior doctors are still working excessive hours, due to increasing pressures and staff shortages, and are worried this is putting patient safety at risk, a IPSOS Mori report for the BMA has shown.

Ahead of potential negotiations with NHS Employers on a new contract for doctors and dentists in training, the BMA analysed feedback from over 1,600 junior doctors and final years medical students on the employment and training issues most important to them.

Despite the European Working Time Directive bringing in an average 48-hour working week, the reality is that some junior doctors are working up to 100 hours a week to meet demand, with many worrying for their own and their patients’ safety as tiredness impacts on their ability to work and make decisions safely. 

This comes amidst increasing concerns about patient safety in the NHS. Comments by the doctors in training reveal the problem:

“My average working week may have complied [with the ETWD] but on occasion, especially on nights, I would have worked over 100 hours in one week which was not safe by the end.” (Junior Doctor, Scotland)

“Current hours are bad enough, especially since we have to stay late unpaid most days to finish ward work due to poor staffing. We need the same hours but more staff, not less staff more hours. (Junior Doctor, Wales)

Serious levels of understaffing are also resulting in junior doctors working unrecorded and unpaid extra hours in order to meet patient demand and to ensure extra work is not dumped onto colleagues.

“The fact is we feel obligated to stay to finish our jobs so that patient care doesn’t suffer and we also don’t want to ‘dump’ jobs onto our colleagues working the evening and night shifts.” (Junior Doctor, England)

A large number of junior doctors have also expressed concern at the impact of long hours or long stretches of consecutive shifts on their home lives, with the unpredictability of training rotations, lack of flexible leave and insufficient time to recuperate following unsociable hours all affecting morale.

“I should not have to work 12 day stretches, or 12 hour shifts; it’s not safe and means no quality of life outside work.” (Junior Doctor, England)

Commenting on the feedback, Dr Ben Molyneux, Chair of the BMA’s Junior Doctors Committee said:

“It is of great concern that junior doctors are being forced to work excessive hours and are often under intolerable pressure in order to ensure patient safety. There have been radical changes to the way we work since the current junior doctors contract was introduced 13 years ago. The feedback highlights that despite working time regulations, juniors are still working long shifts night after night as well as extra, unrecorded hours.

“We also need to address quality-of-life issues, such as getting decent notice of where and when we will be working and the use of fixed leave. Two weeks before the annual August changeover of jobs, thousands of junior doctors still don’t know basic details such as what they will be working or how much they will be paid. Some don’t even know where they will be working in a fortnight.

“The Keogh Review highlighted that despite the lack of support and value placed on junior doctors, they remain the best champions for their patients and this must not be lost to the growing sense of frustration they feel.

“We will now work towards negotiating with NHS Employers for terms and conditions that address junior doctors’ concerns and recognise the vital role they play in the NHS.”

It seems absurd that we can put tachographs into lorries to ensure drivers don't drive beyond legal specifications, and yet we can't regulate the hours worked by junior doctors. Staff shortages and lack of funding are taking their toll on patient safety.