The Challenges of 7-day working The Colchester Experience Paul Mills Principal Pharmacist, Clinical Services Colchester Hospital University NHS Foundation Trust
About Colchester Hospital Healthcare to around 370000 people in Colchester and surrounding areas Services to Clacton and Harwich hospitals (Anglian Community Enterprise ACE) Service to Halstead hospital (Central Essex Community Services CECS) 2012/13 data 418,911 Outpatient attendances 76,338 Accident & Emergency patients 90,729 Inpatient and day case admissions Just over 600 beds Pharmacy department just over 100 staff (22 pharmacists; not all WTE) ~45% clinical / dispensary ~55% technical services/admin
About Colchester Hospital Work begun on a 25m radiotherapy centre at Colchester General Hospital the establishment of a specialist centre for major vascular surgery enabled the roll-out of the NHS AAA Screening Programme a 5m Sterile Services Unit at Colchester General Hospital, the most advanced unit of its kind in the East of England NHS region, became operational 814,000 was invested in three new digital mobile screening units operating theatre staff at Colchester General Hospital became among the first in the country to use 3D technology to help with laparoscopic (keyhole) surgery Colchester General Hospital became what was believed to be the first hospital in the UK to carry out a new type of minimally-invasive surgery a 170,000 refurbishment of Elmstead Services Day Unit, Colchester General Hospital...
Historical Pharmacy Practice (for years and years ) Mon-Fri: 0830 to 1700 Sat: 0930 to 1230 (mainly dispensary based with ward sweeps) Sun: semi-official service??..10am to 1-2pm..?? ish (on-call pharmacist + 2 volunteer dispensers) Bank Holidays: 0930 to 1230 (mainly dispensary based with ward sweeps)
Local Drivers for change New Trust Director of Operations..!! Trust drive to improve the Emergency Care Pathway - Emergency Care Re-organisation Implementation Team (ECRIT) ***previous CQC visits*** Recognised clinical unmet need on Sundays Accepted patient safety issues (lack of Medicines Reconciliation, clinical pharmacy input, etc)
The Process Initial Staff Consultation May 2011 Proposed formal Sunday opening 0930-1230 2 pharmacists and 2 dispensers (all technicians and dispensary qualified SATOs) 1 pharmacist in dispensary + 1 ward/eau based No change to Saturday working This was turned down by the Trust as it didn t go far enough!!!
The Process Second Staff Consultation Aug 2011 Proposed formal Sunday opening 1100-1400 3 pharmacists and 3 dispensers (all technicians and dispensary qualified SATOs) 1 pharmacist dispensary based + 2 ward/eau based Proposed formal Saturday opening 1000-1400 3 pharmacists, 1 clinical technician and minimum of 4 dispensers Cost Neutral..!! Proposal staff will reduce their weekly working hours slightly to accommodate increase in Sunday working
The Process Formal Response to Feedback No adjustment in usual hours TOIL for Sunday working All staff expected to work equally not pro rata for part time staff Lots of discussion about the 1000-1400 choice Breaks..?? Annual leave..?? yes, but custom and practice is to simply swap weekend commitment Sickness absence..??
The Current Service Mon - Fri: 0830 to 1700 Sat: 1000 to 1400 Sun: 1000 to 1400 Bank Holidays: 1000 to 1400 Pharmacists and Dispensary staff each work 3 hours of the 4 hour formal opening hours. Each pharmacist works ~9-10 Saturdays per year Each pharmacist works ~7-8 Sundays per year
SATURDAY PLAN 10am 11am 11am 12pm 12pm 1pm Pharmacist 1 Clinical Activity Clinical Activity Clinical Activity 1pm 2pm Pharmacist 2 Dispensary Clinical Activity Clinical Activity Pharmacist 3 Dispensary Dispensary Dispensary Clinical Technician Clinical Activity Clinical Activity Clinical Activity Dispensary Technician (X 1) Dispensary Team Including Band 2.
SUNDAY PLAN 10am 11am 11am 12pm 12pm 1pm Pharmacist 1 Clinical Activity Clinical Activity Clinical Activity 1pm 2pm Pharmacist 2 Dispensary Clinical Activity Clinical Activity Pharmacist 3 Dispensary Dispensary Dispensary Dispensary Technician (X 1) Dispensary Team
The Impact..?? Lots of initial negative feedback from staff but Now ingrained in practice and accepted as part of usual working life Extra clinical activity on the EAU and other areas welcomed by senior Trust colleagues. Clinical activity being monitored by ongoing MR and EDS data.
HR issues Not aware of any..!! HR colleagues involved during Consultation process.
The Future Trans-Pharm Creating a pharmacy service fit for the future and more besides