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"August is always a nightmare": 90% of doctors believe national training changeover decreases patient safety

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A new study has found that 90% of doctors who responded to a survey believe that patient safety throughout Scotland and the UK is compromised in August when the latest intake of medical trainee doctors start their training posts in the NHS on the same day nationally, and doctors already in training rotate into other positions.

Traditionally an estimated 50,000 doctors in the UK change over on the first Wednesday in August and there has been growing concern that this causes instability, poor safety and reduced patient care. In recent years, evidence has emerged to suggest that patients admitted at this time also have a higher early death rate than at other times.

In order to explore the impact of this changeover, the Royal College of Physicians of Edinburgh (RCPE) and the Society of Acute Medicine (SAM) conducted a survey of doctors’ experiences throughout Scotland and the UK, and this has just been published in the journal Clinical Medicine [1]. Key findings included –

  • 93% of respondents believed the August changeover has a negative impact on patient care
  • 90% of respondents believed the changeover has a negative impact on patient safety
  • 58% of respondents believed the changeover has a negative impact on doctors’ training

The negative effects on all aspects of care and training were found to last for up to one month.

A number of potential solutions were tested in the survey and over 80% of respondents believed that this situation could be greatly improved by moving away from the current national changeover on a single day to a staggered transition by grade, occurring over a period of over a month. Although not directly asked, the virtually unanimous view of comments submitted to the survey was that it would also be much more logical to move the changeover period to a different time of year in order to eliminate conflict with the holiday period.

Dr Louella Vaughan, Honorary Consultant Physician in Acute Medicine, and lead author of the study, said,

“The results of this survey add to the emerging evidence base which indicates that the current August changeover system increases a number of risks for patients, including an increased early death rate for patients admitted to hospital at this time.

“Over 90% of doctors who responded to the survey believe that patient safety is compromised every year in August by this outdated system. When considered along with other related evidence it is clear that the current system is in urgent need of reform. The doctors surveyed have indicated that not only is there an appetite for change, but the desire to enthusiastically lead and support it. All that is lacking now is the political will”.

Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh, said,

“Patient safety and the quality of patient care are of paramount importance and should not be knowingly compromised. For many years doctors have been aware of practical problems caused by this annual changeover. Formal evidence in support of our concerns has, however, been limited, but is now increasing and has reached the level where it should not be ignored.

“Other changes to established systems within healthcare have been shown to deliver real improvements for patients and similar consideration must be given to making the changeover in training safer. We would urge the Scottish and UK governments to review this matter as a matter of urgency”.

Notes to Editors:

[1] Details of the survey can be accessed in the current issue of Clinical Medicine, Volume 11, Issue 4, August 2011.
http://www.ingentaconnect.com/content/rcop/cm/2011/00000011/00000004/art00006

[2] The snapshot survey was sent to 4384 members of the RCPE and SAM, and received 763 responses.

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