What's Required and by When
The key aspects of the EWTD as it will apply to doctors in training are:
Working hours per week
By August 2004, a reduction to overall average weekly working hours of 58 hours
An interim 56-hour week by August 2007
A further reduction to 48 hours August 2009 (this could be extended to 2012)
Rest provisions from August 2004
11 hours' continuous rest in every 24 hour period
Minimum 20 minute break when shift exceeds 6 hours
Minimum 24 hour rest in every 7 days or
Minimum 48 hour rest in every 14 days
Minimum 4 weeks' annual leave
Maximum 8 hours work in 24 for night workers (if applicable)
Other factors impacting on the working hours of doctors in training
The EWTD must be seen as part of a package of initiatives that will affect the hours worked by doctors in training. These initiatives are intended to support safe working practices, improving the quality of care given to patients whilst at the same time ensuring doctors obtain effective training and support from employers. These initiatives include the New Deal, Improving Working Lives (IWL), and planned flexibilities in applying the Directive's rest provisions.
The New Deal sets out a contractual limit of weekly hours worked by doctors in training of 56 hours per week from August 2003 and Trusts will need to ensure posts are compliant. NHS Trusts will also be required to provide, by April 2003, a portfolio of evidence over a wide range of policies and procedures that improve the working lives of staff as part of the IWL standard.
A recent ruling in the European Court of Justice also has significant implications for the design of posts for doctors in training. The SiMAP ruling that "time spent on call by doctors… must be regarded in its entirety as working time… if they are required to be present at the health centre" means that current resident on call working patterns will generally not be compatible with the EWTD from 2004.
Taken together with the other requirements of the EWTD, the implication is that current resident on call working patterns will generally not be compatible with the EWTD from 2004. Trusts will therefore need to look critically at working patterns and whether it is necessary for doctors to be resident. Where the intensity of calls requires resident cover, it is likely to be necessary to move to new patterns of working such as shifts or partial shifts.
Finally, the UK will be making changes to the rest provisions of the EWTD by derogating to allow the provision of compensatory rest where it is not possible to provide the full period of continuous rest. The effect of this will be to give individual Trusts the maximum amount of flexibility in applying this part of the Directive.
Annex A gives further details on New Deal, the SiMAP ruling and derogations and Annex B gives relevant website information.
Practical guidance on achieving EWTD compliance