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When I graduated in 1995, hospital medicine in the UK was organised around a "firm"-a team of consultants, registrars, senior house officers, and house officers who knew their patients, and each other.The firm model had flaws: standards varied, hours were long, and the culture could be paternalistic.Yet it delivered something we have since lost: continuity, tacit knowledge, and shared accountability.The European Working Time Directive (EWTD), introduced in the UK in 1998, and rota redesign dismantled this structure.Studies of the EWTD highlight mixed effects: there were some improvements in work-life balance, but also reductions in continuity, team cohesion, and training quality.The number of handovers multiplied, and responsibility for the patient journey often became unclear.
Asif Qasim (Mon,) studied this question.