The impact of the Working Time Regulations on medical education and training

What were the key findings?

Since 2009, following the full introduction of the Working Time Regulations, doctors in training have been limited to working no more than 48 hours a week. These hours are averaged over a 26‑week period.

We commissioned the University of Durham to examine the impact of these restrictions on medical education and training in the UK. The Regulations are intended to protect health and safety by limiting the number of hours doctors work.

The research included a series of organisational case studies and a supporting literature review. The case studies gathered views from trainees, as well as staff from deaneries and Trusts or Health Boards across the UK.

The literature review, which included evidence from outside the UK where longer working hours are more common, showed a clear link between long hours and fatigue. It also found evidence that fatigue has a negative impact on patient safety.

The case studies were based on 82 doctors in training across the UK. They found that while the Regulations have reduced total working hours, some issues, such as stress and fatigue, remain. The report also notes that some doctors work very long hours during their busiest shifts, which increases the risk of mistakes.

Most doctors in training welcomed the benefits of the Working Time Regulations. However, increasing pressure between service delivery and education and training meant that some doctors reported completing learning activities in their own time.

Doctors in training generally felt unable to challenge poor rotas or working practices. There was also a perception that existing quality management processes were not sensitive enough to these issues, and concerns were raised about how accurately working hours are monitored.

The research concludes that the Working Time Regulations were not a simple intervention, but a change within an already complex system, which also includes the New Deal Regulations. Any solutions to ongoing concerns will therefore need to be equally systematic.

I want the full report

Final report on primary research

Working Time Regulations on Medical Education and Training: Literature Review