One NHS manager with a close knowledge of implementing the directive advised the Guardian to be sceptical about trusts - like her own - which claimed to be safely within the law.
In fear for her job, she requested anonymity before telling us: "Devising a new rota is not a problem. Most trusts did this a long time ago. So on paper, we are compliant. But there are many extra factors stopping this working in practice.
"The main issue is the rule requiring doctors in training to take an uninterrupted 30-minute break every five hours.
"Imagine you're the only doctor on your ward. The nurses and ward manager are moaning at you to get your work done. Your consultant (who writes your all-important reference) is due to arrive shortly for a ward round, and to review the work you have or haven't done.
"You are about to take your break at the 4 hour 30 minute mark of your shift when a patient with an internal bleed comes on the ward needing urgent attention. Do you take your break?
"Another factor may sway you here. If you don't take your break, your pay may increase. If a rota is monitored, the doctors carry around a card for two weeks, self-regulating their work. If they take less than 75% of breaks, they are deemed to be 'band 3'.
"Most doctors are on a rota that is band 1B (40% salary supplement), 2B (50%) or 2A (80%). Going up to band 3 raises the supplement to 100%. This could potentially be a massive cost pressure.
"The question that springs to mind is: why not manage these juniors and just make them have a break? Speaking generally, consultants do not particularly care about a European directive. You can write all the compliant rotas you like, but consultants have to manage them. Mostly, they won't.
"I assume that your questionnaires will highlight areas with recruitment difficulties and I would bet that paediatrics comes out top.
"But I would say the real difficulties will arise in areas with poor management. If you have a consultant who does not take an interest, thinks the directive is rubbish and tells his juniors (in a subtle way of course) that they should really work longer to get a good reference, then all good work around EWTD [European working time directive] goes out of the window.
"You could have as many doctors as you like, but they'll take heed of their consultant, not the guidelines.
"Under the old rules, we ran a system at night in which all of our juniors were asleep over the road in the residences, but all were available. We bleeped them when we needed them.
"This is obviously illegal under the directive. So rather than have, for example, 10 doctors all asleep, but all on-call all of the time, we constructed a rota with nine doctors on all day, and one on at night.
"But this way of working is not particularly productive in some departments. Ear, nose and throat (ENT) is a quiet area at night. They may have one incident at night every two weeks that can't be dealt with by a medical SHO (senior house officer) or A&E doctor.
"An area like ENT used to have doctors asleep in the trust during the night, available for work. However, they would have far more nights uninterrupted sleep than not. To be legal, we have moved many areas like ENT on to full shift. This is not a good use of resources."
