Response from The Royal College of Radiologists. 1. TRANSPOSITION Comments

Transcription

1 Consultation - practical implementation of Directive 2003/88/EC (Working Time Directive) concerning certain aspects of the organisation of working time Response from The Royal College of Radiologists 1. TRANSPOSITION Comments Do you consider that the Working Time Directive has been transposed in a satisfactory way in the EU Member States? The Royal College of Radiologists (RCR) is only able to comment on healthcare in the UK. The Working Time Directive has been implemented and is monitored to ensure compliance within the NHS for doctors in training and other professional groups. Consultants may opt out in order to facilitate provision of an appropriate level of service and training for junior doctors and other staff groups. If you consider that there is room for concern about transposition in specific sectors or concerning specific provisions, please give details. The RCR responded to this question when providing evidence to the Working Time Directive Taskforce in 2013 and our concerns remain the same. We will respond to this question both in general terms and then with specific comments relating to our two specialties of clinical oncology and clinical radiology. 1

2 General The European Working Time Directive (EWTD) has resulted in: The need for time off in lieu which reduces training time within normal working hours. The potential to miss programmed training activities eg organised courses, because of time of in lieu/shift working. Reduced continuity of training and continuity of patient care Time off for trainers after on call reducing their availability for training Reduced daytime capacity to deliver service/care due to compensatory rest. Doctors entering specialty training being felt to have less previous clinical experience and requiring greater supervision. Clinical Radiology The biggest impact the EWTD has had on trainee radiologists is around on call provision. Given the stringent rules on protected sleep and the maximum number of continuous hours of work and compensatory leave, many training schemes have significant issues providing an out of hours Registrar service for on call without severely impacting upon non service commitment training. Lists are frequently cancelled or transferred to colleagues due to the legal restrictions of the EWTD and compensatory 2

3 leave pre and post on call. Time for training is being seriously hampered. Training schemes are not able to provide the continuous rest required on paper and are forced to go to a shift system. This means fewer trainees available for a larger number of shifts. Consultant radiologists frequently work the next day, and even the next morning, after working during the previous night on call. It is also difficult to prevent or monitor radiologists who may work additionally out of hours for a teleradiology company. Clinical Oncology The biggest effect the EWTD has had on clinical oncology training is the reduced daytime staffing levels of juniors, in particular at SHO level. The change in shift patterns has been quite dramatic leading to reduced clinical experience, vastly reduced continuity of in patient care, and thereby increased dependence on Registrar ward presence. This takes SpRs away from radiotherapy planning in particular. The recent survey by the RCR s Oncology Registrars Forum provides evidence to back this up and in particular issues with the capacity of the wider team caused by the EWTD. Where CO trainees are incorporated into hospital acute medical rotas, the need to take time off in lieu leads to significantly reduced training opportunities. 3

4 Previously, the effect of the EWTD on CO trainees has been mitigated by the fact that trainees could be based at home during out of hours on call shifts with the trainees being relatively undisturbed, so the EWTD allowed working as normal the next day. This is changing with on call becoming busier and registrars are required to take time off the next day to comply with EWTD. This impacts on the routine clinical service and training. If you consider that transposition of the Directive has been particularly satisfactory in any respect, please give details. Broadly the EWTD has offered good guidance on rests and breaks during on call periods, without which there may have been unsafe practice/rotas in place and increased likelihood of errors, especially as out of hours medical care increases. 2. SOCIAL PARTNERSHIP Comments Do you consider that the social partners have been sufficiently consulted and involved by the national authorities before the adoption of national measures transposing the Directive, as well as concerning the practical implementation of these measures? Implementation was staged in the UK to enable transition to different ways of working with shifts and partial shifts. Increase in the numbers of trainees and consultants required to cover shifts and provide training has lagged behind and there is now a chronic lack of medical workforce in our specialties of clinical oncology and clinical radiology. Consultations were and are being held but funding for sufficient 4

5 staffing levels and training posts is still not available. The Directive provides at Articles 17 and 18 for derogations by means of collective agreements or agreements concluded between the two sides of industry. Please indicate how you evaluate the experience in this regard. Individual agreements between employers and consultants are the only ones that we are aware of. We do not know how they are monitored presumably through job plan monitoring. We do not feel they are an appropriate solution as are unsafe for patients and doctors. Are there any examples which you consider as providing possible models of good practice? The UK overall. Overnight networked reporting by large groups of radiologists eg in a region or at a specialist centre. 3. MONITORING OF IMPLEMENTATION Comments Please indicate whether you consider that the enforcement National monitoring is undertaken for junior staff employed within the NHS. 5

6 and monitoring of the Directive at national level is satisfactory. If you see any problems, please indicate their overall impact and make recommendations for improvement. Diary monitoring of doctors in training undertaken on a regular basis. Monitoring of consultants, however, has not been undertaken satisfactorily, particularly given the risks and possible consequences for patient outcomes from fatigue and negative impact on accuracy. See section 1 above Allowing greater flexibility in how the rules are enforced. National high level and practical support to increase funded training numbers to support the changes. Radiology, especially non-interventional, is well suited to observational learning/training. This is a safe way of training that needs to be encouraged for those who wish to take advantage of having had a quiet shift. Interventional radiology training has already been extended to six years from five. Consideration of doing this for other radiology sub-specialties should be considered Planning for radiotherapy is largely undertaken during normal working hours. To deliver training in radiotherapy planning for clinical oncologists, it is therefore essential that implementation of EWTD does not impact on radiotherapy planning time. Increase in medical workforce and overnight/weekend networked radiologist reporting in the UK would allow proper implementation of the EWTD for consultants. 6

7 Can you identify any examples of good practice as concerns monitoring and enforcement? Careful use of on call rotas to minimise impact on training where possible. Maximise out of hours work as a training opportunity. Combined rotas with other specialties to provide cover and minimise impact (CO). Centralisation of on call to major centres with DGH cover provided at consultant level and with use of outsourcing companies to provide some/all out of hours cover (CR). Informal arrangements in some Trusts where trainees are welcome to stay and learn even if the EWTD deems them not able to work. There needs to be clarification on this issue as this is not standard nationwide. The RCR has made the case and it has been accepted nationally that radiology needs more consultants and consequently more trainees. The RCR has also made the case that clinical oncology needs more consultants and consequently more trainees 7

8 4.EVALUATION Please describe any evaluation work carried out under your authority. The RCR Statement on the Radiology Workforce June The RCR submission to the Academy of Medical Royal Colleges report on Seven Day Care (p82-88) EWTD, the temples report and other drivers towards a consultantdelivered service. TC Booth, J Collum, TR Taylor. Clin Rad Oct 2011 (Vol 6, issue 10, p ) The RCR s Junior Radiologists Forum carried out a survey in 2012 some of which related to EWTD. The relevant findings were that 94% of trainees said that their rota was EWTD compliant but 35% believed that it was impacting their training. This is the same percentage for both non-interventional and interventional radiologists. The RCR has reviewed the current clinical oncology workforce and the expected workload and demonstrated a significant shortfall. The clinical oncology workforce will increase by 11% compared with an expected 45% increase in workload. The RCR s Oncology Registrar Forum s Trainee Survey in 2013 reported that the majority of trainees (80%) considered their work life balance satisfactory and that the standard of training received was 8

9 good or excellent (80%) but time pressures for trainees and trainers were recognised as issues. Please indicate what were the main conclusions as regards the socio-economic impact of the transposing measures, in particular on: workers' health and safety work/life balance business flexibility/competitiveness consumer s/service users SMEs administrative/regulatory burden. Does the practical application of the Directive in the Member States, in your view, meet the objectives of the Directive (i.e. to protect and improve the health and safety of workers, while providing flexibility in the application of certain provisions and avoiding imposing unnecessary constraints on SMEs)? 9

10 5. OUTLOOK Please indicate: any priorities for your organisation in this subject area; any proposal for additions or changes to the Directive, stating the reasons; Flexibility in enforcement to enable trainees to attend essential training opportunities Change the Directive to enable doctors in training to make a judgement as to whether they can attend training opportunities eg tutorials after on call/shift by not classifying this as work any flanking measures at EU level which you consider could be useful. The previous national reporting exercise launched in 2007 resulted in the adoption in 2010 of the Report from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on implementation by Member States of Directive 2003/88/EC ('The Working Time Directive, COM(2010) 802 final. The final report was accompanied by a Commission staff working paper: Detailed report on the implementation by Member States of Directive 2003/88/EC concerning certain aspects of the organisation of working time ("The Working Time Directive '), SEC(2010) 1611 final. 10