TRUST BOARD PART A REPORT 6 FEBRUARY 2018 GUARDAN OF SAFE WORKNG HOURS REPORT Purpose of the Report: (Strategic / Mandatory X) To provide assurance to the Board that junior doctors are safely rostered and working rotas are in compliance with terms and conditions of service. Sponsor: Author: Link to Aims / Objectives / BAF Additional nformation Stuart Walker, Chief Medical Officer Paul Thorpe, Guardian of Safe Working Hours P5: mplement the organisational development plan, creating an environment where colleagues feel confident, supported and empowered to deliver quality services. N/A Contained within report. Date of Previous Report: 7 November 2017 Date of Next Planned Report: Recommendation / Action Required: May 2018 The Board is asked to discuss and note the report. TSTA/02.18 Page 1 of 5
ANNUAL REPORT ON SAFE WORKNG HOURS: DOCTORS AND DENTSTS N TRANNG Executive Summary The 2016 contract for doctors in training has completed the implementation period, and all eligible doctors in training working at Taunton and Somerset NHS Foundation Trust have been successfully transferred to the contract. The Guardian of Safe Working Hours (GoSW), Director of Medical Education (DME), medical workforce and academy teams have worked closely together to build a structural and efficient approach to work scheduling, rota design, Exception Reporting and identification of rota gaps/vacancies. Educational supervisors have engaged well with the contractual requirements of exception reporting - at present within the same SPA allocation as prior to the 2016 contract. There has been more difficulty in achieving the goal of personalised work schedules, and the team continues to encourage this. The junior doctors forum has had variable response from junior doctors, but recent changes to the structure of the forum have improved engagement. The Trust has received one fine, and the forum has instructed the GoSW how to spend this sum to satisfy the contractual requirement. Exception reporting remains a useful tool to identify areas of challenge in the Trust. t is clear that junior doctor rotas are often quite stretched within the limit of allowable rostering. Rota gaps/vacancies, when they arise, are the main contributor to this. A significant area of challenge may arise in the near future related to compulsory rotation into psychiatry posts. The Board previously supported a process to evaluate the role of doctors in training, and how this might affect the impact on and need for investment in other staff groups. This strategic review is currently in the conception phase with the quality improvement team, and we will report back on developments to the Board over the 2018-9 period ntroduction The data presented below is to allow the Board to assess the current risks posed by rota gaps and vacancies. Filling the gaps is a challenging area, given the geographical position of the Trust away from the major surrounding teaching centres, the limited control we have over Deanery allocations and the general lack of suitable doctors to fill posts when they arise. However, the Trust has a good reputation, reflected in GMC training surveys, feedback from the regional BMA etc., for the care we extend to doctors in training, and the training/education we deliver. TSTA/02.18 Page 2 of 5
High level data Number of doctors / dentists in training (total): 221 Number of doctors / dentists in training on 2016 TCS (total): 181 Annual vacancy rate among this staff group: 6.94% Annual data summary relating to Rota Gaps Specialty Grade Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total gaps (average WTE) Acute Medicine ST1/2 2 2.5 2.5 2.5 2.35 ST3+ 0 0 1.5 1.5 0.75 Anaesthetics ST1/2 1 1 0 0 0.5 ST3+ 2 2 1 1 1.5 Emergency Medicine ST1/2 3.5 3.5 2.5 2.5 3 ST3+ 0 0 1 1 0.5 Haematology ST3+ 1 1 0 0 0.5 Obs & Gynae ST1/2 1 2 1 1 1.25 ST3+ 2 2 1 0 1.25 Paediatrics F2 0 0 0 1 0.25 ST1/3 1 0 0 0 0.25 ST4+ 0.5 0.5 0 0 0.5 Surgery ST3+ 1 2 2 2 1.75 Trauma & Ortho F2 0 1 0 1 0.5 ST3+ 1 1 0 0 0.5 Total 16 18.5 12.5 13.5 15.35 ssues arising The overall annual vacancy rate may appear low as a headline figure, especially when compared to other staff groups. However, given the continued reliance of the service on doctors in training (especially for out-of-hours frontline care) any vacancy is a challenge, and has an effect. Overall, the cost of exception reporting and fines have been very low to the Trust, and certainly less than the cost of the salary pay rise associated with the 2016 contract. However, there are areas of concern, especially in acute medicine where the pressures appear most frequent, where gaps have direct operational consequences, and for doctors in training to receive their appropriate breaks and educational input. The 2016 contract has many stringent aspects, related to safe working, that are challenging to comply with. t is clear that when rota gaps and vacancies arise, they have a direct effect on the frequency of exception reporting in those clinical areas. This appears to have a much greater effect than the volume of work coming into the hospital generally. With the likely mandatory requirement to significantly increase the rotation of the most junior doctors in training into posts in psychiatry, this will potentially reduce the pool of these doctors available for other frontline posts. There is therefore the potential for more gaps to develop over the 2018-19 year. TSTA/02.18 Page 3 of 5
At each contract change over the past 30 years, there have been calls to change many of the tasks performed and roles filled by doctors in training in the UK, especially when compared to their expected tasks and roles in other developed nations. A key block to this is identifying other staff groups who may more appropriately adopt these tasks as part of their core role, especially out-of-hours. Ensuring that frontline rosters comply with the designed rota, and the 2016 contract is challenging and promised T solutions to help trusts achieve this uniformly have not materialised. The effects of the alliance between Taunton and Somerset NHS Foundation Trust and Somerset Partnership NHS Foundation Trust (SomPar) are considered but difficult to gauge at present. Actions taken to resolve issues The workforce team at Taunton and Somerset NHS Foundation Trust and SomPar FT are responsive for these areas of need, when directorates identify them. They are working directly with colleagues across the proposed merger to identify any challenges, risks or opportunities. We are working with directorates to ensure ownership of rostering at the frontline level. t has not been necessary to redesign many rotas at this stage, but some work schedule reviews have taken place mainly confirming the need to ensure that rostering maps with the template rota. We have commenced preparation of a quality improvement project to take a root and branch strategic view at where the role of the doctors in training fit in the Trust. This has to aim at introducing a modicum of spare capacity and flexibility in rotas and tasks allocated to junior doctors to, as a minimum, cope with our current 7% level of vacancy, and also to anticipate a likely rise in that percentage. This may well require challenges to the traditional views of how junior doctors are allocated and employed in the Trust. We have identified an area to spend our only fine (replacing the Mess Microwave) as instructed by the junior doctors forum. Summary n his first year the Guardian has built a strategic view of the challenges to safe working and educational opportunity of doctors in training in Taunton and Somerset NHS Foundation Trust. On a regional, and indeed national, comparison, we are confident that the Trust demonstrates appropriate concern and interest in these issues, notwithstanding the financial challenges present. However, there is clearly a common theme that can be summarised as junior doctors are stretched as thinly as possible over the current workload, which underpins almost every concern raised. TSTA/02.18 Page 4 of 5
t is clear that there may be fewer, certainly not unchanged or more, junior doctors available to the Trust in the future. The picture of gaps and pressure seen above therefore has the potential to deteriorate in time if not properly mitigated. f we wish to maintain our reputation for delivery of high class education in the context of a safe clinical service, we have to consider how to introduce more flexibility, in trainee rostering, to cope with rota gaps and vacancies in the future. Questions for consideration The GoSW would ask the Board to continue to support the current strategic review of doctors in training role within the acute service, using the vehicle of a major quality improvement project, examining levels of rostering, flexibility of role, and those staff groups where increased investment may be required to reallocate tasks currently undertaken by junior doctors. The GoSW and workforce team would be grateful for any feedback from the Board into the issues raised in this report. TSTA/02.18 Page 5 of 5