There are serious safety risks for both doctors and patients associated with fatigue. All too frequent news stories report tragic incidents involving doctors crashing their cars when driving home from work tired.
In recent years, the anecdotal evidence of this danger has been backed up by various studies, with one showing that of the top ten occupations associated with being involved in car accidents, nine were within the health service - with surgeons coming top of the list .
Due to rotations, junior doctors are especially likely to face long commutes to and from work placements.
Due to the rotational nature of their work, junior doctors are especially likely to face long commutes to and from their places of work, and they may be required to work in locations with poor public transport services.
What the BMA is doing
The BMA has long campaigned for safer worker conditions and the provision of adequate rest facilities for doctors, to ensure that they don't have to drive when they are too tired and that accidents can be avoided.
This is why the BMA junior doctors committee ensured this issue was directly addressed within the negotiations on the 2016 terms and conditions of service for junior doctors.
It is now a requirement for employers to provide junior doctors employed under the 2016 contract, with either a place to rest or alternative arrangements when you declare you are too tired to drive home.
This clause is only contractually binding on trainees employed under the new contract, however we believe that this principle should be considered basic good practice and offered to all doctors to avoid tragic fatigue-related accidents at all costs.
Contractual requirements for junior doctors
The new requirements are in paragraphs 9 and 10 of schedule 12 of the 2016 terms and conditions. These paragraphs are copied below:
9. Where a doctor advises the employer that the doctor feels unable to travel home following a night shift or a long, late shift due to tiredness, the employer shall where possible provide an appropriate rest facility where the doctor can sleep. The hours when the doctor is resting in the hospital under these circumstances will not count as work or working time. Where the provision of an appropriate rest facility is not possible, the employer must make sure that alternative arrangements are in place for the doctor's safe travel home.
10. Where a doctor is rostered to work on a non-resident on-call working pattern and is required to return to work during the night period, and the doctor considers it unsafe to undertake the return journey home due to concerns over tiredness, the employer shall where possible provide an appropriate rest facility if requested where the doctor can rest. The hours when the doctor is resting in the hospital under these circumstances will not count as work or working time. Where the provision of an appropriate rest facility is not possible, the employer must make sure that alternative arrangements are in place for the doctor's safe travel home.
An 'appropriate rest facility' can take two forms:
- a bedroom, of sufficient quality , provided directly by the employer
- an employer purchased hotel or B&B room in close proximity to the doctor's working site.
It may be that the provision of either of the above is not feasible, due to practical reasons such as lack of space at the worksite or a lack of suitable rooms in the local area. If that is the case, the requirement for 'alternative arrangements' to be made requires the employer to pay for a taxi home, or for public transport if more appropriate. This would also need to incorporate a contribution towards the doctor's next journey to their worksite, if they normally drive to work and their car is still at the hospital.
It is important to note that this provision is also available to those who don't drive to work, but feel too tired to travel home safely. There are further risks associated with travel when extremely fatigued at night relating to personal security on public transport, for example.
Fatigue and sleep deprivation – BMA briefing and guidance, Jan 2017
Half of junior doctors having accidents or near misses after night shifts - The Guardian
"I fell asleep at the wheel": the dangers of doctors driving home - The Guardian
"I was woken up at the wheel by oncoming traffic..." What happens to doctors after a night shift? - BBC
Over half of anaesthetic trainees have had car crash or near miss after night shift, survey finds - The BMJ
A report on the welfare, morale and experiences of anaesthetists in training: the need to listen - The Royal College of Anaesthetists
 Surgeons and GPs more likely to cause car accidents than other workers - The Guardian
 HSC 2000/36 guidance which is directly referenced in the 2002 Terms and Conditions of Service, still applies to the 2016 Terms and Conditions of Service as no successor agreement has been agreed. This guidance sets out the minimum requirements of any rest facilities provided for doctors.