The British Medical Association (BMA) expressed its opposition to a suggestion from the UK government that junior doctors should work up to 65 hours a week. This is nine hours more than the current limit.

At a meeting of Europe's employment ministers, the British delegation proposed that doctors should work up to 65 hours a week for the next eight years. And up to 60 hours a week for seven years after that, according to papers circulated ahead of time.

The move marks a reversal of a 20-year declared policy to cut doctors' hours and was said to be unacceptable by the European Commission. Junior doctors are presently exempt from the European Working Time Directive, which outlaws employees being made to work more than 48 hours a week. The European Commission wants to include doctors in the scheme but have already accepted that this should be phased in over seven years, with a 54-hour limit in the meantime.

Since 1991, junior doctors have been set a target limit of 56 hours a week, under the so-called new deal agreed between the former Conservative government and the BMA. The limit only covers time spent working in the hospital or clinic. It does not cover on-call time. In reality, one in six juniors works more than the 56 hours; working more than 72 hours a week is not uncommon.

Dr. Andrew Hobart, head of the BMA Junior Doctors' Committee, said: "Those 56 hours are spent working in surgery or clinic, filling in notes, chasing after results, dealing with emergencies or attending lectures. None of it is spare time."

The original exemption of doctors from the Working Time Directive, and the new proposals for a 15-year gap before they are included in its provisions, are said to be motivated by a shortage of doctors. Health department spokespersons point out that it takes 15 years to train a specialist doctor.

The shortage of doctors, however, is itself a product of increasing cuts to the National Health Service implemented by this and previous governments. This is set to worsen with the new proposals. Hobart said, "I think that if they forced doctors back to a 65-hour week, many of them would simply leave the job".

The proposals come amid increased concern about mistakes being made through fatigue, and the dangers posed to patients by the increasingly long working hours imposed upon medical staff. In an article "Junior doctors fight exhaustion", the BBC report Dr. Ian Wilson, deputy chairman of the BMA's Junior Doctors' Committee annual conference, confirming that patients are undoubtedly at risk when doctors have to work excessively long hours.

"I have made mistakes that have turned out not to be serious. But I think I have been lucky. It is only a small step from making a minor error to making a major mistake. Part of you goes on to auto pilot, part of you just deals with it, and another part starts to blame patients for being sick. Somebody estimated that the end of a long shift can have the same impact on mental performance as drinking three or four pints of beer.

"I have been so tired that I have sat down to write some notes, fallen asleep and woken up to find my pen dragging across the page. There were also times when I have not been able to be nice to people."

Reports of remarks like these are few and far between, not because Wilson's experiences are unique, but because of the systematic gagging of hospital doctors.

According to a survey conducted by Hospital Doctor magazine, more than one in ten hospital doctors have faced pressure from management not to speak to the press. The BMA's Junior Doctors' Committee cite cases of the "harassment and intimidation" of juniors who speak to the press, and have condemned NHS hospital management for attempting to insert gagging clauses into trainees' contracts.