JUNIOR DOCTORS DUTY/ ON CALL POLICY

JUNIOR DOCTORS DUTY/ ON CALL POLICY Policy Details NHFT document reference CLP005 Version 09.06.2015 Date Ratified 09.06.2015 Ratified by Trust Policy Board Implementation Date 10.06.2015 Responsible Director Medical Director Review Date 09.06.2017 Related Policies & other documents NICE (CG25) Safe Use of Ligature Cutters (CLPr008) Rapid Tranquilisation Policy (MMP011) Control of Medicines Policy (MMP001) Incident Reporting Policy (RH002) Resuscitation Policy (CLP002) Seclusion Policy (CLP007) European Working Time Directives (2009) Freedom of Information category Policy Junior Doctors Duty/On Call Policy 1 of 14 Implementation Date: 10.06.2015

TABLE OF CONTENTS 1. DOCUMENT CONTROL SUMMARY... 3 2. INTRODUCTION... 4 3. PURPOSE... 4 4. DEFINITION OF TERMS... 4 5. DUTIES... 4 6. PROCESS... 5 7. TRAINING... 10 8. MONITORING COMPLIANCE WITH THIS DOCUMENT... 10 9. REFERENCES AND BIBLIOGRAPHY... 11 10. RELATED TRUST POLICY... 11 APPENDIX 1 EQUALITY ANALYSIS REPORT... 12 Junior Doctors Duty/On Call Policy 2 of 14 Implementation Date: 10.06.2015

1. DOCUMENT CONTROL SUMMARY Document Title Document Purpose (executive brief) Junior Doctors Duty/On Call Policy To provide Junior Doctors with guidance to the on-call processes within NHFT Status: - New / Update/ Review Areas affected by the policy Policy originators/authors Consultation and Communication with Stakeholders including public and patient group involvement Review All NHFT in-patient areas Dr Hiral Hazari Dr Nadim Almoshmosh in consultation with: Dr Alex O Neill-Kerr Dr Bryan Timmins Medical Staffing Committee Archiving Arrangements and register of documents Equality Analysis (including Mental Capacity Act 2007) Training Needs Analysis See section 7 The Trust Policy Lead is responsible for the archiving of this policy and will hold archived copies on a central register See Appendix 1 Monitoring Compliance and See section 8 Effectiveness Meets national criteria with regard to NHSLA Not applicable NICE Rapid Tranquilisation NSF Not applicable Mental Health Act Not applicable CQC Not applicable Other New Deal for Junior Doctors; Hours and European Working Time Directive Further comments to be Changes to handover arrangements reflect considered at the time of feedback from the Deanery and junior ratification for this policy (i.e. doctors about the effectiveness of national policy, commissioning handover arrangements requirements, legislation) If this policy requires Trust Board Trust Policy Board ratification please provide specific details of requirements

2. INTRODUCTION As part of the Government s New Deal for Junior Doctors hours and European Working Time Directive, Trusts are obliged to reduce the number of calls made to Junior Doctors while on call. The actual working times out of hours have to be strictly followed to comply with these regulations. Any calls to the on-call doctors counts towards their working times including their travel to and back from Hospital. This is monitored for breeches by the Medical Staffing Department on a regular basis. The doctors on call at night have already done a full day s work and they are available out of hours to work. Good planning during normal working hours should reduce the need to call the duty doctor to finish routine ward work. All calls to the doctor on-call are now filtered through the Clinical Team Leaders (CTL) when available and when unavailable the nurse in charge of the team/ward will make the decision. The current on-call system in the Trust is a non-resident on-call ie. the on-call doctor is not resident in the hospital during the out of hours period. The doctor is required by terms and conditions to reside within a distance of 30 minutes or ten miles by road from their principal place of work unless an employing organisation agrees that they may reside at a greater distance. The trust provides accommodation to those junior doctors living outside this parameter during their on call period. In the event of medical emergencies where immediate medical attention is required, emergency services (999) will be contacted by the ward staff and the patient will be transferred to the nearest general hospital for immediate attention as appropriate. 3. PURPOSE To provide Junior Doctor s with guidance to the on-call processes within NHFT. The following are intended as guidelines. Patient care clearly takes precedence over any issues that can be dealt with at a later stage. It is expected that the On-call Doctor will display good judgement and reasonableness in determining which call to deal with first. 4. DEFINITION OF TERMS NHFT - Northamptonshire Healthcare NHS Foundation Trust CTL Clinical Team Leaders 5. DUTIES Chief Executive The Chief Executive has overall responsibility for the implementation of this policy. Junior Doctors Duty/On Call Policy 4 of 14 Implementation Date: 10.06.2015

Medical Director The Medical Director has delegated responsibility for the implementation, dissemination and monitoring of the policy. Clinical Tutors The clinical tutors have the responsibility to ensure this policy is covered in the Junior Doctor induction programme, and to monitor compliance. Breeches will be investigated in conjunction with local process. Team Managers Team Managers need to ensure all relevant staff have read and understood the policy and that the policy is kept in an easily accessible place. Team Managers need to ensure all breeches (eg. Where the Doctor does not follow policy) are reported as per Trust policy. Medical Staffing Medical staff have the responsibility to ensure they have read and adhere to this policy. Clinicians The clinical staff need to be fully aware of this policy and the processes within it. Clinicians should be trained in Trust approved tools eg. NEW s, to support their decision making when requesting the on-call Doctor. 6. PROCESS The on-call system is for emergency and urgent calls. Examples are as follows (however the list is not exhaustive): a) If junior doctors need to access the Trust Policy Out of Hours this can be done using their Trust laptop and logging onto www.nhft.northants.nhs.uk b) Psychiatric/Medical Inpatient Emergencies Medical staff should only be called when someone is injured or medication and/or advice is needed. For serious self-harm attempts please refer to existing policies (CLPr008 Safe Use of Ligature Cutters and CRM002 Incident Reporting Policy). The Trusts Resuscitation Policy CLP002 should be followed and the appropriate number used to call the emergency services. c) Deterioration in Medical (NEWS) and/or Psychiatric Condition ie. a change in a patient s mental or physical health which would cause the patient unreasonable suffering if not dealt with until the next routine Junior Doctors Duty/On Call Policy 5 of 14 Implementation Date: 10.06.2015

visit by the Ward Doctor during working hours. Refer to Physical Healthcare Policy CLP070. d) The Prescribing and/or administering of Rapid Tranquilisation. The Rapid Tranquilisation policy MMP011 as per national guidance (CG25) requires that where a patient needs to be given rapid tranquilisation that the doctor should attend the ward within 30 minutes of being called. Where a patient needs rapid tranquilisation out of hours the junior doctor on call will be called and will be expected to attend the ward irrespective of the time of night. The doctor will assess the need for Rapid Tranquilisation, prescribe medication and be available following administration in case of complications. The junior doctor should conduct a medication reconciliation as per the Medicines Reconciliation Policy MMP013 to ensure the right medication is prescribed.if a patient has relapsed due to non compliance the junior doctor must consider whether to reintroduce the drug slowly with stepwise increases and refer to the BNF or take advise from the consultant on call. e) The arrival of out of hour s admissions. The doctor should not be called routinely about a new admission before the arrival of the patient to the ward.f) Seclusion All staff must adhere to the Trust s CLP007 Seclusion Policy. Patients admitted out of hours. The junior doctor should ensure the following should be carried out in addition to the Mental Health examination: physical examination (using Minimum Standards for Physical Examination Policy CLP049) Assessment of VTE (Policy for Primary Thromboprophylaxis (VTE) MMP016) Medicine Reconciliation and Prescription (Medicines Reconciliation Policy MMP013) Where the decision is taken to seclude a patient, the duty doctor should be notified at once and should attend immediately (within 30 minutes of being called) unless the seclusion is only for a very brief period (no more than 5 minutes). An initial multi-disciplinary review of the need for seclusion should be carried out as soon as practicable after the seclusion begins. If it is concluded that seclusion needs to continue, the review should establish the individual care needs of the patient while they are in seclusion and the steps necessary to bring the seclusion to an end as quickly as possible. Junior Doctors Duty/On Call Policy 6 of 14 Implementation Date: 10.06.2015

f) Overdose/Unfamiliar Medication If a situation arises when a patient has taken an overdose (either intentional or unintentional; i.e the wrong dose or wrong patient administered medication). The junior doctor may be called for advice. For unfamiliar medication the doctor should check the BNF or online resources to obtain further information about the medication. The doctor on call can phone the consultant on call for further advice or clarification. The doctor on call can contact the National Patients Information Service (Toxbase) on 0844 892 0111 or www.toxbase.org. They will provide a patient specific action plan and advice on monitoring. 6.1 INCIDENTS WHEN ON-CALL DOCTOR SHOULD NOT BE CONTACTED Out of hours calls to doctors are channelled through the CTL when available and when unavailable the nurse in charge of the team/ward will make the decision. In general the on-call doctor should not be called unless there is compelling reason to call immediately. Common examples are given below: 6.1.1 Prescription Charts staff administering medicine should be aware when space is running out and bring this to the Team Doctor s attention. Staff should also ensure that medication charts are signed and dated before the end of the shift. The duty doctor should not be called to rewrite a prescription chart unless the existing chart exposes the patient to significant risk. 6.1.2 Verbal messages for medication Doctors are reminded that instructions by telephone to a practitioner to administer a previously unprescribed substance are not acceptable. In exceptional circumstances, where medication (NOT including Controlled Drugs) has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are considered necessary, the use of information technology such as by fax, email or electronic record may be used. When using fax or email information governance issues must be taken into consideration. A verbal order is not acceptable on its own. The fax prescription/direction (copy of email or entry in electronic record) to administer must be stapled to the patient s existing medication chart. This should be followed up by a new prescription signed by the prescriber who sent the fax/email or EPEX entry confirming the changes within normally a maximum of 24 hours (72 hours maximum Bank Holidays and weekends). In any event, the changes must have been authorised (via fax/email/epex entry) by a registered prescriber before the new dosage is administered. Junior Doctors Duty/On Call Policy 7 of 14 Implementation Date: 10.06.2015

It is, however, recognised that in certain situations patients may deteriorate rapidly and faxed or emailed prescriptions for new medications may be necessary to avoid compromising patient care. These should be followed up within 24 hours (72 hours max) with a hard copy. Important: It is the prescribers responsibility to ensure clinical assessment is undertaken and allergy status checked prior to prescribing. Verbal orders or faxed prescriptions for Controlled Drugs are NOT allowed, as legal requirements will not be met. 6.1.3 Missing Patients Routinely the On Call Doctor does not need to know when a patient absconds or returns to the ward unless on return to the ward, medical attention is required or the patient is believed to pose a significant risk to themselves or others. 6.1.4 Minor falls and accident Nursing staff should use their professional judgement as to whether medical attention is needed. If in doubt the CTL should be asked. 6.1.5 Transfer of patients between wards Routinely the On-call Doctor need not be called unless there is a change in the patient s psychiatric or medical condition or if transfer is associated with increased risk of absconding, harm to self or others. 6.1 TELEPHONE CALLS Berrywood switchboard holds all mobile and landline contact telephone numbers for all medical staff. 6.1.2 Working Hours Internal Calls Nurse in charge on the ward may contact Junior Doctors directly Berrywood reception 9 am 5 pm South, Berrywood Hospital St Mary s Reception 9 am 5 pm North, Welland and SMH External Calls All calls for all doctors should go to the Secretary of the appropriate Consultant 6.1.3 Out of Hours Out of hours CTL in charge when available (or nurse in charge of ward/team in TL absence) can contact the Junior Doctor direct or via Berrywood switchboard Junior Doctors Duty/On Call Policy 8 of 14 Implementation Date: 10.06.2015

Calls from Other Medical Staff The switchboard will screen all calls out of hours and will only pass calls directly from other medical staff. 6.2 ESCALATION PROCESS If a Junior Doctor is not available/or decides it is not necessary to come to the ward and the CTL or nurse in charge feels that the doctor should attend then the escalation process should take affect. This is as follows: Psychiatry Contact switchboard and ask for the Speciality Doctor/Staff Grade on call to seek advice and support as appropriate The Speciality Doctor/Staff Grade if available will come to the site and address the problem if required Should they be unavailable to come due to already managing another emergency, the Consultant on call will be contacted to give advice and support as appropriate. 6.3 PALLIATIVE CARE The palliative care rotas have a two tier on call system. If the Junior Doctor on call cannot attend and the ward and the nurse in charge feels it necessary that a doctor should attend the escalation process is as follows: Contact switchboard and ask for the Consultant on call The Consultant will provide the necessary support including attendance at the ward as appropriate. 6.4 RESPONSIBILITIES AND ACCOUNTABILITY a. Timetables Ward Doctors must ensure a copy of their timetable is on the ward so that nursing staff can use these times to discuss any problems. Doctors should arrange cross-over when attending peripheral clinics, teaching etc. Junior Doctors need to ensure they communicate with staff during the day and complete the communications book. b. Communicating with colleagues you must follow the GMC Guide to Good Medical Practice when you are off duty, suitable arrangements have been made for your patients medical care. These arrangements should include effective hand-over procedures, involving clear communication with healthcare colleagues. c. All on call junior doctors have a laptop and VPN access to the Trust Electronic Record (EPER). Junior doctors should document any advise or discussions with clinical staff in EPEX including any decisions made. d. Communications Book each ward should have a book where the clinical team can record queries, blood results etc. This will ensure Junior Doctors Duty/On Call Policy 9 of 14 Implementation Date: 10.06.2015

problems are not missed eg. If the primary nurse is busy when the doctor visits. e. Sites covered during on-call the sites that are covered by Junior Doctors for the on call people are all NHFT in patient resources ie. Berrywood Hospital, Kent House and The Brambles Rehabilitation Units, The Sett (CAMHS), St Marys Hospital, Cynthia Spencer Hospice and Cransley Hospice. 7. TRAINING Training required to fulfil this policy will be provided on accordance with the Trust s training needs analysis. Management of training will be in accordance with the Trust s Statutory and Mandatory Training Policy. All Junior Doctors commencing in the Trust will receive training on this policy as part of their Induction programme. 8. MONITORING COMPLIANCE WITH THIS DOCUMENT Aspect of compliance or effectiveness being monitored Duties Day to day compliance and policy breeches European Working Time Directive The table below outlines the Trusts monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs. Method of monitoring Individual responsible for the monitoring Monitoring frequency To be addressed by the monitoring activities below. Via logged information Via logged information Medical Staffing/North and South Clinical Tutors Medical Staffing Compliance /breeches logged daily. Reviewed in line with Junior Doctor supervision Twice per year Group or committee who receive the findings or report Consultants Consultants Group or committee or individual responsible for completing any actions Medical Director supported by Clinical Tutors Medical Director supported by Clinical Tutors Policy Review Consultation Medical Director Annually Trust Policy Board Medical Director Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed. 9. REFERENCES AND BIBLIOGRAPHY Junior Doctors Duty/On Call Policy 10 of 14 Implementation Date: 10.06.2015

The New Deal for Junior Doctors 1991, Junior Doctors Contract December 2000 The European Working Times Directives (EWTD) compliance Aug 2009 Good Medical Practice, General Medical Council NICE Guidelines Rapid Tranquilisation (CG25) 10. RELATED TRUST POLICY This policy should be read in conjunction with the following Northamptonshire Healthcare Foundation NHS Trust policies and procedures: CLPr008 Procedure for the safe use of ligature cutters CRM002 Incident Reporting Policy CLP002 Resuscitation Policy CLP007 Seclusion Policy NMP011 Rapid Tranquilisation Policy NMP001 Control of Medicines Policy Junior Doctors Duty/On Call Policy 11 of 14 Implementation Date: 10.06.2015

APPENDIX 1 EQUALITY ANALYSIS REPORT Equality Analysis Report Name of function: Policy Date: 01.08.13 Assessing officers: Kate Howard Description of policy including the aims and objectives of proposed: (service review/resign, strategy, procedure, project, programme, budget, or work being undertaken): As part of the Government s New Deal for Junior Doctors hours and European Working Time Directive, Trusts are obliged to reduce the number of calls made to Junior Doctors while on call. The actual working times out of hours have to be strictly followed to comply with these regulations. Any calls to the on-call doctors counts towards their working times including their travel to and back from Hospital. This is monitored for breeches by the Medical Staffing Department on a regular basis. The doctors on call at night have already done a full day s work and they are available out of hours to work. Good planning during normal working hours should reduce the need to call the duty doctor to finish routine ward work. All calls to the doctor on-call are now filtered through the Clinical Team Leaders (CTL) when available and when unavailable the nurse in charge of the team/ward will make the decision. Aims and Objectives 1. To ensure safe and supported medical care over a 24 hour period 2. To ensure NHFT meets European Working Time Directives 3. To give guidance to nurses in relation to on-call processes Evidence and Impact provide details data community, service data, workforce information and data relating specific protected groups. Include details consultation and engagement with protected groups. Evidence base: NHFT Equality Information Report August 2012 Northampton County Council :Northamptonshire Results: 2011 Census Data Summary Corby Daventry East Northants Kettering Northampton South Northants Wellingborough Northants England 53,400 72,100 76,600 82,200 194,200 79,400 72,500 630,400 49,449,700 2001 2011 61,100 77,700 86,800 93,500 212,100 85,200 75,400 691,900 53,012,500 % rise 14.4% 7.8% 13.3% 13.7% 9.2% 7.3% 4.0% 9.8% 7.2% Ethnicity: 85.7% (White) and 14.3% (BME )- 1.75% (dual heritage); 4.01% (Asian); 2.5%(Black including British, African and Caribbean) ; 0.85 % (Chinese) ; 6.05 % (white other EEA, polish, Gypsy & Traveller) Gender: 49.6% males; 50.4% females (including 1% transgender) Disabled people: 19% (including 3.5 % < aged under 18) Faith communities: 71% Christian; 29% minority faith: (includes Hindu, Muslim, Sikh, atheists, nonbelief) Sexual orientation (gay, lesbian or bisexual): 5-7% (Stonewall estimate) Service Information: provide any relevant service data or information to inform the Equality Analysis including service user feedback, external consultation and engagements or research. Junior Doctors Duty/On Call Policy 12 of 14 Implementation Date: 10.06.2015

Equality Analysis Report Name of function: Policy Date: 01.08.13 Protected Groups STAGE 3: Consider the effect of our actions on people in terms (Equality Act 2010) of their protected status? The law requires us to take active steps to consider the need to: Eliminate unlawful discrimination, harassment and victimisation. Advance equality of opportunity Foster good relations with people with and with protected characteristic Age Disability Identify the specific adverse impacts that may occur due to this policy, project or strategy on different groups of people. Provide an explanation for your given response. Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Gender (male, female and transsexual, inclu. Pregnancy and maternity) Gender reassignment Sexual Orientation (incl. Marriage & civil partnerships Race Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Policy is inclusive to all client groups residing in in-patient settings for all junior medical staff Working hours/rotas should be developed with consideration of individuals religious needs Religion or Belief (including non belief) Equality Analysis outcome: Having considered the potential or actual effect of your project, policy etc, what changes will take place? None Junior Doctor rotation is agreed with the on-call personnel prior to the rota being published. Changes to the rota can be made in line with local protocol Action Plan Issue to be addressed Action Who Date to be completed Ratification a completed copy of the Equality Analysis form must be sent to Equality and Inclusion Officer to be approved. Junior Doctors Duty/On Call Policy 13 of 14 Implementation Date: 10.06.2015

Equality Analysis Report Name of function: Policy Date: 01.08.13 Approving Officers Date of completion: Junior Doctors Duty/On Call Policy 14 of 14 Implementation Date: 10.06.2015