Junior Doctors’ 48 Hour Expert Working Group: May 2019

Attendees and apologies

Present

• Professor Philip Cachia, Chair
• Professor Derek Bell, Scottish Academy of Medical Royal Colleges
• Dr Luke Yates, Scottish Academy of Medical Royal Colleges, Trainee Representative
• Dr Lewis Hughes, BMA
• Ms Anne Dickson, NES
• Ms Geraldine Donnelly, BMA (deputising for Sean Gallimore)

Professional advisors 

• Mr Daniel MacDonald, Medical Workforce Adviser

EWG Secretariat and support

• Dr Alex Rice, Clinical Leadership Fellow
• Dr Chris Sheridan, Clinical Leadership Fellow
• Dr Pavel Stroev, Policy Manager (secretariat)

Apologies

• Dr John Colvin, Professional Adviser and Senior Medical Officer
• Dr Simon Edgar, Director of Medical Education
• Mr Sean Gallimore, BMA
• Mr Daniel McQueen, HIS Public Partner
• Dr Jane Burns, MSG Management Steering Group
• Professor Clare McKenzie, NES
• Dr Annie Ingram, MSG Management Steering Group

Items and actions

The Chair welcomed everyone and introductions and apologies were made.

The Note of 5 March meeting was agreed. It was agreed that the notes of the meetings would be published on the Group’s website.  

Action: Secretariat to publish the notes and send a link to the members of the group.

Fatigue measurement

The current work of the GMC Wellbeing group was discussed. It was reported that the GMC/Wellbeing Group’s work is taking shape and is expected to be published soon. Alex Rice has met with the chair who confirmed that their group will share data and conclusions with us. Alex will provide the group with feedback from this report when available.

Criteria for educational approval of rotas

It was reported by NES that the check list for PCAT is being utilised in some settings as well as a sign-off of the rotas by trainee representative to make sure it was workable. Deans use local knowledge when approving rotas. It was agreed that there would be benefits from a more standardised and consistent national approach to the educational approval process. 

It was pointed out that some trainees find it difficult to attend protected teaching sessions with current rotas, leading to some teaching having to be repeated on non-working days. A maximum 48 hour working week is likely exacerbate this issue.

The Chair requested conclusions from NES on the draft 48 hour rotas put forward for the Lanarkshire pilot by the end of June for use at the table-top exercise on July 9th . NES are continuing to work towards a standardised, consistent national process for educational approval. The Chair pointed out that this would be a good by-product from this group and he was keen to have all the benefits recorded.      

Action: NES to evaluate the rotas and share the outcome by the end of June.

Modelling work

It was reported that the setup in Lanarkshire was unusual in that FY1s did not do nights there. The most up-to-date rotas were used to consider the impact of the maximum 48 hour week in Emergency Medicine, General Medicine and General Surgery. It was found that about 3 months of training time would be lost over FY1 and FY2 and ability to take leave would be affected. Surgical trainees would lose about 70 weeks over 6 year training period. It was also pointed out that the structure of rotas in Emergency Medicine did not lend to ease of analysis. 

It was discussed how teaching and service delivery would be impacted and it was agreed that there would be greater need for use of innovative approaches to to ensure workplace based training and formal educational sessions can be delivered.   

The modelling work so far, looking at current service delivery and educational models, suggests that a 48 hour maximum week will have a negative impact on service and educational delivery and will result in more split shifts, fewer long ones, more work on weekends and inability to take a week off for doctors in training.  

Running order for the Lanarkshire table-top exercise on 9 July for evaluating the rotas was discussed. It was agreed that all groups of staff had to be engaged to obtain qualitative information and narrative. A discussion followed about continuity of care and continuity of training. It was agreed that apart from having an educational approval, every rota has to be safe for patients and doctors (and continuity was important for both) and it was decided to include information on staff satisfaction and measurement of fatigue in evaluation.

Further discussion took place about who would be seen as an independent member of the group and involvement of quality managers from Deanery as well as structure of questions in questionnaires (open-ended rather than closed). 

The key themes for questionnaires were agreed as Safety, Service Impact, Education and Employee Experience (continuity being a cross-cutting theme). It was noted that if an employee comes up with a safety/governance issue, we need to have a structure in place allowing them to relay the message without compromising themselves. Some meetings will have to run concurrently – a number of facilitators will be needed.  

Actions: Chair to write to NHS Lanarkshire with the proposal for the day to be circulated among the participants. 

NES to engage experienced quality visitors (possibly – group leaders, facilitators of the process on the day).

Members of the group to come up with semi-structured questions and share them with NHS Lanarkshire.

External engagement 

It was agreed that, since outcomes of the GMC wellbeing working group will be available in a few weeks’ time, we should wait for this data and the outcome of the Lanarkshire table-top exercise before deciding on whether to engage external experts to support the work of the EWG.  

Dates of the future meetings

 The following dates were agreed:

•  Monday 24 June, 2.00 pm – 5.00 pm, St Andrew’s House

•  Monday 2 September, 2.00 pm – 5.00 pm, St Andrew’s House

•  Wednesday 20 November, 2.00 pm – 5.00 pm, St Andrew’s House