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May 25, 2010

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Misgivings voiced over medics’ shift-work patterns

Junior doctors are working irregular shift patterns, which, although they may be compliant with the European Working Time Directive, could be putting both the doctors’ and their patients’ health at risk.

This is the warning from the British Medical Association Scotland, following a report produced by its Scottish Junior Doctors Committee (SJDC).

The report explains that the Working Time Directive is one of a number of drivers encouraging a move away from the traditional 24-hour resident-on-call pattern for junior doctors to a more regimented shift pattern, with the aim of protecting medics from working excessive hours without adequate rest.

Many junior doctors work a combination of shifts – for example, a week of night shifts followed by another week of late shifts, with a day or two off in between. According to the report, such a shift pattern is compliant with rules on working time, but could still have serious implications for the health and well-being of doctors.

Cautions the report: “[I]t has become evident that poor rota design of Working Time Regulations-compliant shift patterns may also result in a shift structure predisposed to high-intensity work, which may lead to fatigue and may carry unacceptable burdens of risk to doctors and patients.”

It adds: “Many rotas, which are compliant with New Deal and Working Time Regulations (WTR) on paper, may, in fact, lead to considerable predictable fatigue in the doctors who work those rotas. For example, there are juniors who are working rotas that include seven consecutive 12.5-hour night shifts.”

Various studies have recognised a link between shift work and a range of health conditions, including heart disease, breast cancer and peptic ulcers, while shift patterns among women have also been highlighted as a potential cause of problems during pregnancy.

To minimise these risks, the report calls on NHS boards to develop safe rotas for staff and to encourage doctors to take rest breaks during night shifts. It calls on employers to involve junior doctors in drawing up work rotas, and urges management and trainees to pilot rota changes to find a “mutually acceptable solution”.

Chair of the SJDC, Dr Gordon Lehany, commented: “It is important that as NHS boards try to become compliant with European Working Time Regulations they also consider safe shift-working patterns. To do this effectively, junior doctors should be involved in drawing up rotas. It is essential that the problems associated with working irregular shift patterns are recognised and reduced.”

Although the Working Time Regulations allow for up to 13 consecutive shifts, this should be avoided, says the report, owing to the high risk of fatigue among doctors working to this pattern. Of similar high risk is the practice of working seven consecutive 13-hour shifts, followed by a week of low, or even zero hours. The report also advocates a reduction in the number of shifts worked in any seven-day period to, say, five.

Search for the report, Shift work, rest and sleep: Minimising the risks, on the BMA Scotland website at www.bma.org.uk/sc/

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