Doctors are under intense pressure

Under the European Working Time Directive doctors in training will be limited to a 58-hour week from August 2004.

A survey of emergency cover at 211 English hospitals by the Royal College of Physicians (RCP) concluded that if these restrictions were already in place, more than 40 of them would find it very difficult to cope.

Professor Carol Black, RCP president, will use a routine meeting with the Health Minister John Hutton on Tuesday to press home her concerns about an issue she believes is one of the most difficult faced by the NHS.

We want to be sure that patients are safe and we also want to be sure that the doctors have a way of life that is a reasonable way of life Professor Carol Black Royal College of Physicians

The hours junior doctors work in hospital, including the time they spend asleep while on call, will be cut back severely.

At present the maximum is 72 hours.

When that figure is cut back to 58 by European rules, many hospitals will struggle to continue providing a 24-hour service, according to the RCP.

Its research suggests about 22% of hospitals would cope with current staffing levels and some hospitals would need just two or three additional doctors to manage.

But others would require concentrated effort in the next few months if they were to cope with what will happen next year.

And the smallest NHS trusts may have no alternative but to close some facilities - including casualty units - at night.

Safety

Professsor Black told BBC Radio 4's Today programme: "We want to be sure that patients are safe and we also want to be sure that the doctors have a way of life that is a reasonable way of life."

We do not accept that acheiving WTD compliance by itself will lead to the closure of any A&E departments Department of Health

Having more doctors or "alternative backup" would help to ensure safety when the working time directive comes in.

But while having healthcare workers would help, "what it doesn't provide is the decision-making capacity in the middle of the night and that is where you do need the doctors to make decisions about diagnosis, management and then you need a better backup team," she added.

Dr Simon Eccles, deputy chairman of the junior doctors' committee of the British Medical Association, said "a huge change of attitude and way of working" was needed to cope with the changes.

"Traditionally hospitals have been covered by an 'on-call' - a doctor sleeping in the hospital at night available if required."

While that had been around since the 1950s, is was no longer appropriate, particularly in acute medicine and emergency medicine, Dr Eccles said.

But according to a RCP survey, 65% of hospitals still use the "on-call" system.

The core of the problem was a lack of doctors, Dr Eccles said.

"We have one-third the number of doctors per head of population of most of mainland Europe."

Government response

A spokesman for the Department of Health said it was trying to find solutions that would ensure services for patients would not be affected.

He added: "We do not accept that acheiving WTD compliance by itself will lead to the closure of any A&E departments.

"The RCP survey was based on the assumption that it takes 10 middle-grade doctors to staff a full-shift rota, which we do not accept.

"Different working patterns by other professional groups and/or consultants doing sessions into the evening provides scope to plan services differently.

"Work done at a number of sites has shown this can work.

"The survey takes no account of other staff groups and their working patterns, which might mean there is no need for a full shift rota of 10 middle-grade doctors, so throwing serious doubt over fears that these acute hospitals will be at risk."