JUNIOR DOCTOR

In 1991 the government, the NHS and the British Medical Association agreed a package of measures on working hours, pay and conditions which was called the New Deal for Junior Doctors. This restricted these doctors' hours to a maximum average of 56 hours actual work and 72 hours on call of duty per week, although it was not enforced until December 1, 2000. The European Working Time Directive required the average working week to fall to 48 hours or less by 2009. The shortening of junior doctors' working hours means that the quantity of experience they can gain during training is less. This is countered by many who say that 48 hours per week is more than enough time to receive quality training and the hours worked in excess of this do not meaningfully contribute to quality training and actually result in poor patient treatment. Roles in other clinical professions are blurring demarcation between what a doctor and, for example, some nurses can do. Shorter duty shifts demand closer teamwork across professions and effective handovers. Medicine is becoming more specialised, but more cross-cover between specialties at night is needed to preserve doctors' working time during days and evenings, when most patient care and learning under supervision takes place. The number of years of postgraduate training is set to reduce under the 2005 plans for Modernising Medical Careers, which will require doctors to decide which specialty to follow sooner after graduation. The interaction with health care managers (who are not usually doctors in the UK) has changed during recent years to involve doctors in the running of hospital specialty groups and community-based practice. More developed leadership and financial training is required to equip doctors with the skills to manage budgets and responsibilities.