Doctors' leaders yesterday began monitoring the hours junior doctors work in hospitals as new limits enforced by European law were introduced.
As many as one in six NHS trusts may be breaking the rules and others facing severe difficulties, a Guardian survey testing preparedness suggested last week, and the British Medical Association is targeting six unnamed trusts where it may intervene over lack of compliance.
Trusts risk £5,000 fines for failing to meet the conditions of a European directive which limits junior doctors' hours to 58 a week, the first stage in a phased fall to 48 by 2009.
The Health and Safety Executive has indicated that it will wait for evidence of malpractice over a period before intervening, meaning the BMA could be the first to launch legal action through employment tribunals.
The junior health minister Stephen Ladyman said yesterday that the "overwhelming majority" of trusts now fully complied with the demands of the directive, and others had reached agreement with junior doctors on interim arrangements - a "fantastic achievement" thanks to the hard work of staff.
"Only in a little handful of trusts, agreement remains to be reached and all efforts continue to be made to resolve this."
The BMA has promised to support doctors with legal advice "where appropriate". Simon Eccles, chairman of the BMA junior doctors' committee, said: "This is health and safety legislation. It is being introduced to protect patients as well as doctors and hospitals need to take it seriously."
The BMA is also worried that arrangements introduced in hospitals to comply with the law have affected doctors' training.
It says doctors are required to work long shifts of up to 13 hours, and where these are being used to staff hospitals at night, trainees are often denied the opportunity to do work which increases their knowledge.
"We shouldn't forget that junior doctors are in hospitals to learn as well as look after patients," Dr Eccles said. "Safe hours must not mean unsafe training."
Chris Atkinson, of the NHS Confederation, representing hospital trusts, told BBC Online yesterday: "Most hospitals have managed to meet the requirements. Those that haven't may within the next few months. However, there may be issues that cannot be overcome, such as shortages of staff in a certain speciality.
"The Health and Safety Executive, which will oversee this, has said it will wait to see what the trust has tried to do. If it is making every effort, the HSE will take a more lenient view.
"Patients will benefit because doctors will be working fewer hours and will be less tired, so standards of care should be increased."
