Introduced in August 2004, it aims to reduce working hours in order to improve workers' health and safety, but the current NHS shift system could threaten doctors' and, moreover, patients' safety, argue Professor Roy Pounder and colleagues.
Junior doctors' working hours are now limited to a shift of no more than 13 hours followed by a break of at least 11 hours. But a survey in December 2004 by the Royal College of Physicians found that most trainee doctors in NHS trusts were forced to work a 91 hour week as a series of night shifts.
Recent studies from the United States have proved the risks to patients and doctors of long working hours. Any shift system should have as few successive night shifts as possible, with a maximum of three consecutive nights. A single night shift, with a day off before and after, is reported to show the least distortion of circadian rhythms.
The aviation industry has taken note of research on short periods of sleep. The NHS must now reassess the practice of shift work to maximise doctors' safety and efficiency, and to safeguard the interests of patients, urge the authors.
They propose that doctors should be rostered for single nights, with one or two night shifts over a weekend. Health and safety measures should also be built into every shift and doctors should be taught how to cope with night work.
"Those who arrange junior doctors' working schedules should put patients' and doctors' safety first and foremost. It is ironic that the working time directive, introduced to protect workers' health and safety, should have led to the imposition of 91 hour nocturnal working weeks for most trainee doctors," they conclude.