Junior doctors - 48-hour maximum working week (without averaging): expert working group report

Appendix 10: Professional Compliance Analysis Tool

Scottish Government Health Workforce, Leadership and Service Transformation Directorate have developed a quality improvement (QI) framework that examines the working patterns of doctors-in-training: the Professional Compliance Analysis Tool (PCAT). PCAT evaluates the rota templates and the supporting professional environment across three interdependent domains: Patient Safety, Quality of Training and Trainee Health and Wellbeing.

Contractual compliance does not guarantee quality in terms of working patterns or training experiences. A number of recent surveys have shown that poor morale is driving some doctors to leave medicine, influenced by working environments and generational factors as well as wider issues facing the medical profession. Recent UK-wide research found that while Working Time Regulations had improved prolonged excessive hours, fatigue arises not only from hours worked, but also from an unpredictable mixture of shifts, work intensity and inadequate rest. Organisational, professional and cultural drivers also play a part, including the relationship between trainees and seniors. It is important to avoid focusing exclusively on number of hours worked when addressing issues of fatigue and risk among doctors-in-training.

PCAT generates a report based on a qualitative internal survey and examination of rota data. This report is presented at a feedback meeting of the whole team (trainees, training leads and service management leads) to discuss the findings and to establish areas for improvement, ensuring that the improvement plan, accountabilities and timelines are all agreed. The process engages and empowers trainees, allowing them to see real changes being implemented as a direct result of their feedback. This in-depth and specific analysis of an individual department’s strengths and opportunities informs QI conversations around working patterns and training experiences that can effect genuine improvement and greatly enhance the experiences of doctors-in-training.. As well as enhancing the health and wellbeing of doctors-in-training we are collecting evidence on additional benefits for departments and Health Boards from participation in the PCAT process.

PCAT is being successfully implemented via a number of different routes. The Royal College of Anaesthetists and Royal College of Surgeons of Edinburgh have endorsed PCAT as a means of improving the health and wellbeing of doctors-in-training. Both these Royal Colleges have committed funding and personnel to support the delivery of PCAT. A number of Health Boards are delivering PCAT through their Directors of Medical Education.

The PCAT tool has been endorsed by NHS Health Board Chairs’ Group, the NHS Management Steering Group and by the BMA Junior Doctors Committee. Board Medical and HR Directors and Directors of Medical Education are also supporting this work.

By using the PCAT Framework, Boards will be able to demonstrate that they are actively working to support and improve trainee working patterns using a holistic approach. PCAT also provide assurance around supporting departments and specialties to manage difficulties with the quality of their training environment or with recruitment and retention issues.

Recommendation

Systematic adoption of PCAT by all Boards can be an immediate action to improve the working patterns as part of the ongoing suite of measures while the 48 hour Expert Group work is underway. The Cabinet Secretary is invited to note progress and approve accelerating roll out of PCAT across all of NHS Scotland.

John Colvin