The European working time directive: implications for subspecialty acute care.

The requirements of the new deal for junior doctors' hours has meant that many smaller trusts are unable to provide adequate cover on-call for medical and surgical subspecialties. The care of the acute subspecialty patients has, therefore, shifted to general teams in many trusts. We assessed what impact this had upon the outcome of acute urological cases in our district general hospital by prospectively monitoring acute renal colic admissions over a 12-month period and surveyed the provision of services in other regional hospitals. The shift in care of the acute urological patient was associated with considerable morbidity for patients admitted in our hospital. The additional financial burden due to this morbidity was estimated to be 33000 pounds/annum. The implementation of the new deal must be achieved with every care to minimise the clinical and financial costs of withdrawing acute subspecialty services.