NHS hospitals have been ordered to introduce sweeping changes in an effort to reduce the working hours of trainee doctors.

Ministers have called for junior doctors to work fewer shifts and for hospitals to make better use of other healthcare workers.

The changes will enable trusts to comply with the European Working Time Directive, which will affect junior doctors from August 2004.

We need to expand capacity, increase quality and redesign some services Health Minister John Hutton

Under the directive, which already affects most UK employees, junior doctors will be expected to work no more than 58 hours a week on average.

Ministers have given the go-ahead to 19 pilot schemes in hospitals across England to identify ways trusts can comply with the new rules.

The Department of Health has also published guidelines to help the NHS to adhere to the directive.

These recommend fewer shifts for junior doctors. This will mean trainees will spend less time on call at hospital but will provide emergency cover for more patients than at present.

Guidelines

The guidelines also suggest that other healthcare workers could be used more efficiently and information technology could improve working practices.

Health Minister John Hutton said the directive was part of the government's wider policy of modernising the NHS.

"The guidance issued today and the pilot projects will contribute to finding solutions that work in different specialities, in different hospitals," he said.

"There isn't a one size fits all solution as each hospital will face different problems.

"We need to expand capacity, increase quality and redesign some services.

"We also need to make best use of investment in staff, training, equipment and information technology to ensure the best possible standards of patient care."

Peter Hutton, president of the Academy of Medical Royal Colleges, said: "The European Working Time Directive was introduced to improve the working lives and safety of the workforce.

"Its successful implementation in the NHS requires close co-operation between doctors, managers and other healthcare workers."

Challenge

Dr Gill Morgan, chief executive of the NHS Confederation, which represents health service managers, said introducing the new working hours would be a challenge for the NHS.

She added: "This guidance will be welcome to the service in mapping a whole range of possible solutions which trusts can use to meet their particular needs."

The Royal College of Physicians welcomed the guidelines. In a statement it said: "The guidance recognises the very real problems faced particularly by smaller hospitals, that need to provide a high quality in-patient service for acutely ill medical patients, yet have few doctors - juniors or consultants.

"There are many emergencies, where only immediate help from a skilled doctor is appropriate."

Karen Jennings of trade union Unison said: "It is important to have plans in place to cut junior doctors' hours in preparation for 2004 and vital that the knock-on effect on nurses, therapists, scientists and the rest of the workforce is acknowledged."