Days numbered for sleeping on the job?
The European Working Time Directive
· No more than 48 hours work a week (averaged over
a reference period)*
· Eleven hours continuous rest in 24 hours
· Twenty-four hours continuous rest in seven days (or 48 hrs in
14 days)
· Twenty-minute breaks in work periods of over 6 hours
· Four weeks annual leave
· For night workers, an average of no more than eight hours work
in 24 over the reference period.
* An employee may sign a waiver agreement with his or her employer
if he or she wishes to work more than the maximum permitted hours. |
On-call pharmacy services may need to be reviewed following guidance from the Department of Health which states that time spent by residents asleep during their on-call shift must be classified as working time for the purposes of the European Working Time Directive (EWTD). The EWTD was enacted in
the UK in 1998, and restricts the working week to 48 hours and requires
a minimum rest period of 11 hours between shifts. This guidance follows
a ruling last September in the European Court of Justice (ECJ) known as
the “Jaeger judgement”.
Norbert Jaeger, a resident surgeon from Germany, took his hospital authority
to court claiming that his employer was breaking the EWTD. Dr Jaeger worked
a regular 38.5 hour week, but was also required to spend around 30 hours
a week on-call, and on the hospital premises. An on-call room with a bed
was made available to Dr Jaeger, and he saw patients when requested to
by hospital staff.
Dr Jaeger claimed that the time he was required to be on the hospital premises
should be counted as “working time”, even if he was asleep.
He also claimed that he was not being given the minimum 11 hour rest periods
to which he was entitled under the EWTD, as he was often required to go
back to work immediately after completing a night on-call.
The ECJ ruled in favour of Dr Jaeger, saying that staff who are required
to be available to provide a service must be regarded as working. The court
further stated that this was not altered by the fact that the employee
is provided with a bed, and allowed to be asleep.
The court also ruled that the time spent asleep during an on-call shift
could not be regarded as rest time by his employers. He was therefore entitled
to a minimum 11 hour period of rest, before being asked to work again.
The DoH guidance has been issued following the Jaeger case and the similar
SiMAP judgement, involving a group of Spanish doctors. The DoH states that “staff
who are required as part of their duties to be resident in hospital or
other place of work out of hours and who are provided with on-call facilities
are considered to be working during their period of duty. The whole of
the resident on-call period counts as working time whether or not the member
of staff is working.” The DoH has said that the rules are different
for staff who are not required to be at their place of work. “Staff
who are off-site, non-resident on-call or who are not required to be continuously
present at the hospital or other place of work are not considered to be
working unless called to do so.”
Just one night on-call each week could take residents’ hours over
the maximum of 48 a week. However, implications of this guidance will depend
on the current on-call arrangements for each hospital.
Shift working
The pharmacy department at the Southern Derbyshire Acute Hospitals Trust
(comprising the Derbyshire Royal Infirmary and Derby City general hospitals)
changed its on-call system a couple of years ago. The change was made in
response to increasing workloads and concerns about the safety of junior
pharmacists working excessive hours. Sixteen pharmacists now work on a
shift system, which includes the overnight shift from 8pm to 8am. The pharmacist
working overnight answers the bleep, provides information and makes supplies
as was the practice with the previous residency system. However, in addition,
they do other clinical pharmacy duties, eg, reviewing new patients, taking
drug histories on the admission unit, etc. This then forms part of their
normal working hours, and they observe the requirement for at least 11
hours rest at the end of the shift. The shift working pharmacists are supported
by shift working technicians and “second on-call” experienced
pharmacists.
Clive Newman, principal pharmacist for clinical services at the trust,
explained that not only is the new system compliant with the law, but it
also allows pharmacy to offer a true 24-hour clinical pharmacy service,
without excessive hours for staff. “We believe that this shift system
offers fairer hours to our pharmacists, a better service for our patients
and supports recruitment and retention within the trust,” he said.
Many on-call pharmacists may be happy working more than 48 hours a week
but will need to sign a “waiver agreement” to comply with the
law. However, the signing of a waiver agreement cannot be a requirement
of being offered a job, and an employee who has signed a waiver can revoke
this simply by giving appropriate notice.
The EWTD may provide opportunities for some pharmacists, such as those
at Winchester’s Royal Hampshire County Hospital which is one of 19
pilot sites for reduced junior doctor hours [from 1 August, junior doctors
can only be required to work for 58 hours a week, with the maximum hours
dropping to 48 a week in 2009]. Pharmacists in Winchester have taken on
additional roles on the emergency medical assessment unit, taking over
some of the work previously done by junior doctors. Between 8am and 7pm
on weekdays, pharmacists record drug histories, look for possible cases
of drug-induced admissions and attend the two daily consultant ward rounds.
Cathy Pogson, medicines management pharmacist at the hospital, said: “The
unit works more efficiently because we ensure that the drugs are correct
on admission, and prepare discharge prescriptions so that patients are
sent home more quickly. The medical and nursing staff appreciate our expertise,
and have provided strong support.”
According to Alison Ewing, Royal Pharmaceutical Society Vice-President
and clinical director of pharmacy at Royal Liverpool and Broadgreen Hospitals
NHS Trust, many hospital pharmacy departments will now have to change their
on-call arrangements to comply with the EWTD. She added: “This may
clearly be a challenge for some, but this could be an opportunity to introduce
shift working and provide an extended clinical pharmacy service for longer
hours. With junior doctors’ hours also being reduced, pharmacists
can look to extend their roles further provided appropriate funding can
be found.”
Further information on the DoH guidance is available here |
Hospital Pharmacist