Working Time – an NHS perspective Bill McMillan Head of Medical Pay and Workforce NHS Employers 21 October 2011

EWTD in the NHS Doctors in Training Reducing hours 1991 until 2010 Rotas compliant but training damaged Modernising services/reconfiguration/new ways of working Simap/Jaeger – compensatory rest/ what’s work when on call

European Working Time Directive in the NHS - Doctors in Training 1991 –83 hours per week max; training in 72 hours

European Working Time Directive in the NHS - Doctors in Training 2000 –40 hours basic –40-48 hours – pay supplements of 20%, 40% and 50% – hours – pay supplements of 50% and 80% –>56 hours – pay supplements of 100% –Strong financial incentive for employers to reduce hours

European Working Time Directive in the NHS - Doctors in Training 2009 – rotas compliant except for 273 derogations (86 left as at January 2010 – roughly 1.3% of all 6646 rotas across 247 employers) until 31 July 2011

European Working Time Directive in the NHS - Doctors in Training 2010 GMC report on postgraduate training – EWTD becoming routine and accepted Temple – training can be delivered in a 48 hour week... But.. Consultant delivered services Collins – working beyond their competence / comfort zone; mortality poorer at nights and weekends

2011 GMC State of medical education and practice

Positive impact Reduced hours Compliance with Working Time Regulations (EWTD) Has driven solutions – eg Hospital at Night Healthy recruitment and retention

Negative impact Burdensome – monitoring and appeals Single breaches disproportionately expensive – banding applies to all doctors on a rota Constrains rota design and flexibility (exacerbated by differing EWTD limits and requirements and ECJ SIMAP/Jaeger rulings) Rigid shift patterns make training less of a priority

What next Change contract to reduce variability of pay and structure contract in same way as other doctors Get more flexibility in EWTD particularly in relation to Simap /Jaeger