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The implementation of the European Working Time Regulations (EWTR), coupled with the ongoing impact of Modernising Medical Careers (MMC), has necessitated a significant redevelopment of out-of-hours cover for surgical specialties in the UK. A review of the literature related to the provision of out-of-hours ENT cover gives an insight into the impact of these changes on a comparatively small surgical specialty. A 2008 survey revealed that three-quarters of junior doctors providing ENT out-of-hours care were crosscovering specialties other than ENT – a figure up from just over half of junior doctors in 2005, prior to stricter EWTR rules. Of all 'first-on-call' doctors for ENT, only 19–32% have prior ENT experience. Consequently, ENT services are provided frequently by inexperienced, non-enT doctors covering multiple other specialties, often as part of a 'hospital-at-night' team.

The Impact of the European Working Time Regulations and Modernising Medical Careers on Out-of-hours ENT Cover