In a survey published in the British Medical Journal, more than 86% of patients, nurses and medical students thought junior doctors were paid at least the same as their standard rate when they worked beyond their normal hours. Almost 30% thought they were paid double time.

In fact, they get only 50% of their normal pay for on-call work, and according to a recent survey, one-sixth of junior doctors are regularly working overtime.

Dr Mark Porter, Chairman of the British Medical Association's Junior Doctors' Committee, said: "This study shows that the nurses and patients asked about doctors' pay tend to value junior doctors more highly than does the Department of Health."

Lack of cover

Dr Paula Greed, of the Northern Regional Junior Doctors' Committee, said junior doctors were likely to work more intensely out of hours because there was often no cover from consultants.

She said she knew of junior doctors who were doing operations for the first time without supervision from consultants because "the system is so tight."

"They have to pick it up as they go along," she said. She added that the problem was worse in obstetrics and gynaecology because of an acute shortage of consultants.

Consultants

The BMA says junior doctors are being trained in the specialism, but are not being appointed as consultants, often because trusts do not have the money.

Some staff want the European directive to apply

The Health minister Alan Milburn is likely to face angry questions about pay and hours when he addresses the BMA's Junior Doctors' Committee on Friday.

A recent NHS survey conducted for the government shows a sixth of junior hospital doctors in England and Wales are still working more than the recommended 72 hours a week.

European directive

Some doctors are pressing for the European working time directive to be applied to the health service. This allows for a maximum 48-hour working week.

Others are worried that any reduction will affect their pay and endanger patients because they will not have enough time to train.

Dr Greed, who represents the BMA on the working time directive, says patients are at risk because of the long hours worked by doctors.

She believes accidents due to overworking are either covered up, accepted or go unnoticed.

Good will

"The NHS is basically working on good will," she stated. She is working with junior doctors in Europe to present a united front on the working time directive. She believes British doctors are paid less and work longer hours than many of their European counterparts.

She added that cutting down the number of non-medical jobs being done by junior doctors was one way of reducing hours. "We are doing tasks like finding beds when we should be treating patients," she said. "It is a waste of our time."