Monitoring row on doctors' hours

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By Matthew Hill BBC News health correspondent Doctors are due to be reducing their hours

The dispute over junior doctors working hours has intensified - with trainee medics being threatened with disciplinary action if they fail to declare how many hours they are working.

All junior doctors at Bristol's main teaching hospital, the University Hospitals Bristol, were sent a letter in January asking them to sign up to guidelines on controlling their working hours.

The memo, which has been obtained by the BBC, was sent because of European legislation coming into force in August compels doctors to work no more than 48 hours a week.

But there is concern from junior surgeons, in particular, that working these hours will not give them enough hands-on experience, especially when this time includes when they are on-call and sleeping.

Surgeons used to do 32,000 hours training over eight years before becoming consultants.

But, according to figures from the Association of Surgeons in Training Surgeons, trainee surgeons will only be doing 18,000 hours from this August.

Threat of sanctions

The Bristol memo tells all trainee doctors they must fill out diary forms so the hours they work can be monitored.

If you are on a plane you expect your pilot will have had a minimum number of hours flying before they are fully qualified - and this should be the same for surgeons Bristol doctor

It says "persistent failure" to do this could "automatically lead to disciplinary procedures".

It also says: "In the event that you do not return your completed diary monitoring exercise (unless there are extreme exceptional circumstances) this will be regarded as a breach of your employment and therefore appropriate sanctions will be implemented".

Under the new rules, junior doctors can only work extra hours if their consultant is prepared to sanction it for exceptional reasons.

But there is a lot of pressure on consultants to meet the directive.

For each failure to meet the rules the Heath and Safety Executive could fine a hospital £5,000.

One of the junior surgeons who received this letter - but wants to remain anonymous - said he and colleagues may not fill in all the hours they work because they want to make sure they have enough hands-on training to be safe.

In effect, they would be working extra hours in secret.

He said: "If you are on a plane you expect your pilot will have had a minimum number of hours flying before they are fully qualified - and this should be the same for surgeons.

"No provisions have been put in place to make up the hours we are going to lose when the European working times directive comes in.

"Then we are supposed to go through the same number of years training, with half the number of hours operating and we will be expected to be fully qualified at the end."

The Royal College of surgeons also takes a dim view of the memo as well as the new directive.

'Heavy handed'

Ben Creswell, the President of the Association of Surgeons in Training, said: "I think the Bristol memo is slightly heavy handed, but certainly it's a national problem.

"We know for a fact that its impossible to provide a safe surgical service and obtain a safe surgical training in a 48 hour week and we know from national survey data that trainees are already routinely working in excess of their hours."

Dr Jonathan Sheffield, the medical director who sent out the memo, said he had to make sure the new law is obeyed, and if doctors work too many hours, then patients may suffer.

He said: "It is my responsibility, as the senior doctor in the organisation, to make sure that we don't put undue pressure on doctors, that we don't overwork them and make sure they are working in a safe environment for their health as well as their education."