Letter from Dr J R Ponsford, University
Hospitals Coventry and Warwickshire NHS Trust
I wonder if you would be kind enough to consider
the following observations and impressions with regard to the
effects of the Working Time Directive on NHS capacity, medical
training and standards of care?
Please find enclosed a copy of an internal hospital
letter enumerating a number of potential logistical consequences
of imposition of the Working Time Directive on capacity and standards
of training (Annex A).
At present NHS consultants work on average beyond
48 hours for the NHS. What will happen if they are forced to curtail
their hours even before considering the possibility that they
will need to take on additional work as junior doctors hours fall?
Is it proposed that the Working Time Directive
will only apply to NHS employment and not to any additional private
practice carried out after 48 hours? If so this would hardly be
equitable to those unable to afford private care. Further more
it would pose a serious risk of NHS doctors emulating former NHS
dentists, abandoning NHS work in favour of more lucrative private
health care activity.
Perhaps you would consider a personal example?
Having qualified as a doctor in 1969 I spent some 3½ years
working on a one in two on-call rota in a variety of posts. In
all of these cases work was busy but efficient running of the
hospital and adequate staffing ratios allowed most of the work
to be done during the day and evening with relatively little interruption
of sleep at night. As an assistant lecturer I worked a one in
one rota for six months in charge of a novel intensive care unit
in 1971. As a senior registrar in neurology at St Mary's I worked
a one in one rota for some 2½ years. Again work was structured
to be busy throughout the day and evening with little interruption
of sleep. I began as a consultant neurologist in 1981 continuing
to work on a one in two rota shared with one other neurologist,
each of us having the help of one senior house officer but no
registrar. In the last few years the number of consultants has
increased with additional junior staffing.
Despite this, my workload has increased steadily
to the extent that I currently average 80 hours per week, working
or travelling between hospitals, not counting any time resting
or sleeping while at work. My 1981 contract stipulated 3½
clinics per week to allow me time to carry out numerous ward referrals
and to supervise my own inpatients. I now see somewhat fewer ward
referrals personally but have increased my outpatient clinics
to eight per week, the Association of British Neurologists recommending
three outpatient clinics per week. My personal catchment remains
higher than average at 280,000, the average UK neurologist now
covering 170,000 population. At present I am just able to keep
my personal outpatient clinics waiting time at the recommended
three months without carrying out expensive waiting list initiative
clinics. Although more neurologists are now being trained in many
cases replacement posts require two or three new neurologists
to take over the work of their predecessors and it is likely that
for some years that a number of such posts will remain unfilled.
I have chosen to work long hours carrying out
only clinical work, teaching, and a modicum of research because
I enjoy it and until recently there has been no one else to do
the work. I work full time for the NHS out of choice. The vast
majority of this additional work is unpaid. Attempts for some
years to provoke local and central NHS management to devise at
least a pro-rata basis for payment that would encourage other
consultants to take on regular additional work at a rate that
the NHS could afford without the inconvenience to patients and
financial cost to the NHS of waiting list initiatives has so far
been unsuccessful. It remains my belief that if a transparently
fair and affordable salary scale could be achieved many more doctors
would be content to work a little longer on average than at present
in order that many hands might make light work. This, together
with a gradually increasing number of staff over time, should
allow the NHS to regain the much shorter waiting times of 30 years
ago, and match current European standards at much less cost, with
more experienced and knowledgeable staff.
Given that many of their patients, let alone
Prime Ministers, may be working 80 hours per week it hardly seems
liberal, egalitarian or fraternal to deny doctors the right to
work similar hours if they wish and have the time to do so.
If the opt-out were abolished I very much doubt
that I would be able to sustain more than 3½ clinics per
week with an inevitable and potentially serious increase in waiting
time for local patients.
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