Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009.

The European Working Time Directive (EWTD) has resulted in large changes in the working patterns of junior doctors in the U.K. All consultant physicians in England and Wales were invited to anonymously submit data on their teams for 11 am and 11 pm on 5 November 2009. Data on doctor number, grade, location and patient number were collected. Data were available on 887 hospital teams at 11 am and on 670 teams at 11 pm. At 11 am, the average number of patients per ward doctor was 11 (2-65). At 11 pm the average number of patients per doctor was 61 (1-400). Consultants were present overnight in 6.1% of teams. Doctors in the first two years of training were the most senior medical cover in 63 teams. Sickness rates varied between 1.5% and 3.5% for junior doctors, and were significantly higher in the second foundation year. Vacancy rates at the specialist registrar level were 8.6%. Trainees were available for training 66-80% of the time. These findings have significant implications for patient safety and quality of medical training in the U.K.