Up to half of all junior doctors are being pressured to work scores of unpaid extra hours with many warning that the practice puts NHS patients at risk, the British Medical Association claims.
Large numbers of the doctors believe that their careers would be on the line if they tried to resist the extra "free" hours, and so are scared to speak out.
Medical leaders warn that the problem is on the increase as hospitals prepare for the European Working Hours Directive which will reduce the official working week to 48 hours by August 2009. The BMA yesterday called for an urgent review of the training system to ensure the quality of patient care is not further jeopardized.
Doctors are regularly working 20-30 extra hours a week – frequently for no pay – on top of their contracted 56 hours, according to research to be published by the BMA this week. Nearly a third reported treating urgent patients during their time off, while two fifths had attended training in their own time because rotas were so stretched.
The findings come after The Independent on Sunday first reported the national shortage of junior doctors resulting from a new recruitment system.
"We are hearing from lots of juniors being bullied by their trusts," said Mr Andrew O'Brien, deputy chairman of the BMA Junior Doctors Committee. Doctors say implicit – and in some cases explicit – threats to block their careers are made.
The problem is two-fold. Hospitals are already struggling to fill posts because fewer junior doctors will take short-term jobs as a result of an unpopular new recruitment system.
Gaps are increasingly filled by overstretched staff rather than temporary locums. At the same time, hospitals need to employ more doctors to reduce work loads by eight hours a week. The result is hundreds of juniors being pressured into working "hidden" hours because hospitals face financial punishments if doctors report working more hours than they should.
Dr Andy Thornley, 32, who recently finished a six-month post at the University Hospital of North Durham, was one of six doctors left covering a 10-person rota when the trust was unable to fill the posts. "You feel morally obliged to make sure the service is covered and patients are safe. But working extra hours, especially more nights, affects how much training and supervision you get," he said.
One trainee surgeon at a large teaching hospital, who asked to remain anonymous, was also warned after he protested. "I was told the trust was 'troubled' by staff trying to highlight and get paid for these extra hours. It was strongly suggested my progression slip wouldn't be signed off if I hadn't worked 'sufficient' hours."
Alastair Henderson, acting director of NHS Employers said: "It is not acceptable for any doctors to be forced to work extra hours and not declare these. If the BMA has genuine evidence they should raise it with the medical directors and chief executives of individual hospitals."
A spokesperson for the Department of Health said it had asked Strategic Health Authorities for evidence of the extent of the problem.
"We do take it seriously. The BMA's survey is potentially misleading. The number of doctors who took part in it represents less than half of one per cent of those working in the NHS."
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