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Junior doctors caring for up to 400 patients a night


Hospital doctors may be responsible for up to 400 patients a night and junior doctors may often be the most senior person on duty, according to a report from the Royal College of Physicians.

Each doctor cares for an average of 61 patients each night but it ranges from one to 400, research from 670 medical teams in England and Wales showed.

In comparison, a doctor cares for just 11 patients on average during the day.

The data also revealed that junior doctors with less than two years’ experience on NHS wards can often be the most senior person on duty at night.

Dr Andrew Goddard, director of the medical workforce unit at the Royal College of Physicians, which carried out the survey, described the results as “worrying”.

He said: “The very low number of doctors per patient at night in some hospitals raises serious concerns for patient safety and there are also worrying reports of very junior doctors being left unsupported, which urgently require further investigation.”

An anonymous survey was sent to all consultants in England and Wales asking them to record the make-up of their team and how many patients were being cared for.

The study, to be published in the journal Clinical Medicine, was carried out to assess the impact of the European Working Time Directive (EWTD), which limits the number of hours a trainee doctor can work to 48 per week.

It found day cover on wards ranged from two to 65 patients per junior doctor, with the highest ratio per doctor in Wales and the lowest in London, where there is a higher number of trainees.

John Black, president of the Royal College of Surgeons, said: “This new evidence from the RCP corroborates what surgical trainees have been telling us for months.

“Under EWTD, rotas are unworkable to the point of being dangerous and junior doctors without adequate supervision are being asked to make critical decisions beyond their competence.”


Readers' comments (11)

  • Is this the reason they breeze onto a ward, look at a few Nursing notes, sign a prescription chart and bugger off without ever even seeing the patient then?

    I'm sorry I am being a little sarky, but only a little bit!

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  • Tell me about it! If l had a pound for every FY1 on nights asking me what to do and how to do it, l would be a very rich person. I feel so sorry for them. We as nurses are struggling, but so are they. However, unlike them, l have no compunction about calling the Registrar on call or even the Consultant at 03:00 for further advice.

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  • We are all, Doctors and Nurses, looking after completely unsafe levels of patients. There just isn't enough staff.

    The difference is, since Doctors stick together, back each other up and have a great union with teeth, whats the odds that they will get something done about this now? For themselves of course.

    Us Nurses will still continue to struggle.

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  • I agree its not only doctors that are being left to look after large quantityt of patients but nurses are too!! And I agree the fy1 comes on the ward and asks the nurses what to do but when a newly qualified junior staff nurses bleeps the dr's they gey told 'I'm a bust dr I don't have time for this!!'. Its unsafe to expect doctors or nurses to look after be responsible and accountable for large numbers of patients. Were going through a nose dive in the number of RN's in the uk and this will only deter new ones even further! But more to the point don't you think dr's and nurses should be sticking together and not competing about our workload and actually think of the patient for a change as that's what we came into the job for, to look after the acutely ill patient ans help them recover from their illness!! And on a personal note I think some junior doctors need to get a grip and realise that's what they are JUNIOR doctors!! Some come swanning onto the ward and get annoyed that you bleeped a dr for some analgesia! Hello realty check that's what you do as a doctor you prescribe things!!!

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  • be good if the doctors and nurses could actually speak and READ english!!! just an opinion!!

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  • I'm in the North-West of the UK and in my experience, the majority of doctors , English or not! are over-worked and caring professionals. Unfortunately there are too many patients per doctor/nurse ratio. Consequently in an emergency when the doctor can't come which is common place in today's NHS, nurses do make clinical decision and intervene off their own initiative and common sense purely because we have no alternative. Experienced nurses have in effect become doctors on the cheap. Occasionally there is a rather aloof doctor but this is soon knocked on the head once the reality of working in the NHS hits home.
    I recently asked a doctor if they complain to management about danger levels as much as we nurses do. He said yes. I then asked if senior doctors and consultants ever backed them up and complained to management about the dangerous lack of doctors in the hospital. The reply was always 'yes'. So it appears consultants do not have as much weight in management of he hospitals as they did in the said 'good old days'.

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  • Doctors should not be expected to care for up to 400 patients a night. This is usually oncall after they have worked all day and they have to attend the morning ward round as well. Why dont the unions and GMC help them and demand more training posts in hospitals so work can be equally distributed? And for those nurses who state the doctor asked them what they should do, there is no harm in asking a ward nurse what their specific requirement is, its MDT working. After all if you are responsible for 400 patients you have to ask so you can move on to the other 399 patients with the speed of lightning.

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  • It's disgraceful that there are so few doctors on during the night, and not good for patient's either. While I agree that staffing generally is a big issue for both doctors and nurses, in all my 20 years of nursing I have never had 400 patients to look after all by myself, whereas this is commonplace for the F1/F2 doctors in the hospital where I work.

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  • the answer is obvious. we need more people in employment, whatever the service is, and in the NHS services it should not even be the subject of debate. Until this happens care for patients will remain at dangerous levels and there will be more wastage of existing staff (an invaluable and irreplaceable resource) through stress related illnesses, burnout and pure and simple absenteeism (with immeasurable but avoidable costs to the economy) because they are no longer able to cope with the heavy and increasing demands made on them, or become totally demotivated through the hopelessness and helplessness of not being able to deliver the care they wish to and have been trained to give.

    for the economy to work, to raise standards of living and to keep riots off the streets and reduce crime rates more jobs need to be created to fill all the roles across the whole of society that are missing. these cannot be replaced by IT and machines alone. Even these need highly qualified, highly reflective and motivated staff with excellent cognitive skills, as well as good interpersonal relationships (which mangers often seem to sadly lack) to operate them in order for services to run safely and smoothly.

    people need to learn to care for others as well as themselves so that there more workers are attracted into the social and caring professions - surely this is better than a life without perspective and a potential one of drugs, alcohol and poor dietary habits and loafing around?

    is this not commonsense. perhaps we could all better put up with a period of austerity if we could see some positive future goals which we could all work together to achieve and a government with the right drive to motivate us.

    all we see instead, at the moment, is rising costs, greed, precarious standards of living, existential anxiety and concerns for our future and increasing numbers of people out of work and very many with little hope for the future and unable to cope financially, and not enough professionals to provide them with adequate care if they are vulnerable, fall ill or grow old!

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  • No, no no you're all mistaken. Everyone in the NHS is 'on board' with the NHS reform. Abolishing the 50p tax rate will also create wealth and everything will be just fine. Call me Dave said so.

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