Concern Over Junior Doctors' Shift Patterns

13-04-2007

Studies have shown that shift working increases the risk of peptic ulcers, diabetes and coronary heart disease. As a result of the European Working Time Directive, there has been a reduction in the overall number of hours junior doctors work. But this is leading to more shift work, leaving junior doctors suffering fatigue and some acknowledging that they perform poorly.

The directive has applied to NHS consultants and career-grade staff since October 1998. Initially junior doctors were exempt over fears the NHS would not be able to cope with the loss of so many junior doctor hours in such a short period of time. However, the directive has been phased in for junior doctors, and there will be a 48-hour maximum working week by 2009.

Most shift rotas require junior doctors to work seven consecutive 13-hour night shifts, but the Royal College of Physicians (RCP) recently recommended this pattern should be avoided.

The RCP suggests limiting consecutive night shifts to a maximum of four and reducing the duration of shifts in order to decrease the risk to patients and staff. Single night shifts are safest, but more doctors would be required to support such rotas, which is unlikely to be affordable. Shift working is likely to increase further as junior doctors' working hours are reduced to a maximum of 48 hours per week by 2009.

Without an evidence-based approach to the implementation of such large scale changes, there is a real danger of adding new, unknown risks and perhaps even worsening the status quo. There may also be concerns about future recruitment and staff retention, especially in 24-hour care specialities.

It seems women could be most at risk, with one Danish study finding a 50% increase in the risk of breast cancer in women who worked regular night shifts. Rates of miscarriages, low birth weight and premature births are also more prevalent amongst shift-workers.

These findings have repercussions given the rapidly increasing number of women in medicine, many of whom, at some point, will want to work part-time. This means they will do shift work for many more years than their male colleagues.

Evidence-based approaches to shift rostering showed that shifts are better tolerated when they rapidly rotate in a clockwise manner – that is, they change every few days in a morning, afternoon, then night pattern. It also showed that individual shifts should last no longer than 10 to 12 hours.

A spokesman for the Department of Health said: "The government has been committed to reducing junior doctors' working hours for a long time. We believe that junior doctors' working patterns should strike a sensible balance between services designed around patients, and services which support doctors' working lives and their training."

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