Junior Doctors’ 48 Hour Expert Working Group: November 2018

Attendees and apologies

Present

• Professor Philip Cachia, Chair
• Dr Luke Yates, Scottish Academy of Medical Royal Colleges
• Mr Sean Gallimore, BMA
• Dr Lewis Hughes, BMA
• Dr Simon Edgar, Director of Medical Education (dial in)
• Professor Derek Bell, Scottish Academy of Medical Royal Colleges (dial in)
• Mr Daniel McQueen, Healthcare Improvement Scotland, Public Partner
• Dr Jane Burns, Management Steering Group

Professional advisors

• Dr John Colvin, Professional Adviser and Senior Medical Officer
• Mr Daniel MacDonald, Medical Workforce Adviser

EWG secretariat and support

• Dr Alex Rice, Clinical Leadership Fellow
• Mr Chris Raftery, Head of NHS Pay and Conditions
• Ms Sandra Neill, Senior Policy Manager (secretariat)
• Dr Carolyn McKerracher, Policy Manager (secretariat)

Presenters

• Dr Emily Broadis, Scottish Clinical Leadership Fellow 2016-17
• Mr Iain Elrick, Programme Manager e-rostering, NHS Grampian
• Donna Knowles, Doctors in Training Monitoring Team Leader, NHS Grampian

Apologies

• Dr Annie Ingram, Management Steering Group

Items and actions

The Chair welcomed everyone and introductions and apologies were made.

The note of 18 September meeting was discussed. It was generally felt that the note should be amended to reflect the shared concerns around the impact of rota changes on the whole system and the support for a risk based approach to considering possible solutions before it could be formerly agreed. Professor Cachia agreed to draft and incorporate a form of words into the note of meeting to be circulated to members for consideration and agreement.

Action: Chair.

It was agreed that future notes should be expanded to capture more of the exchanges and discussions but in the interest of openness and becoming available within the public domain they would need to be shared and signed off by Group members before they could be formally agreed.

Programme of work for EWG

Simon Edgar introduced his summary of the 48 hour challenge which led into a wider discussion including variation in rota design and hours worked, the impact on training experience, and actions to reduce intensity, increase value and reduce zero hours. Zero hours were described as rostered rest (zero) days used to balance excess hours worked on other days to achieve the 48 hour average. The group discussed the potential for creating additional measures (beyond PCAT) for identifying rota quality including hours range (variation) and zero days (waste). The Scottish Training Survey and PCAT will also support this work.

More detailed work than first anticipated was required to understand the problem we are attempting to address before suggesting and testing solutions and more radical options. Key risks to be considered are the pressures on staff particularly around OoH. There was agreement to consider wider reform but this would not be the primary focus of the work of the group in its first phase.

Terms of reference (ToR) for Phase 1

The terms of reference (ToR) document was discussed. The immediate focus is to produce a paper which the Cabinet Secretary can sign off which mandates the group to take forward the work required to consider and develop solutions to reduce fatigue and implement 48 hours.

The group agreed to submit their revised considerations for the ToR electronically by 30 November. The Chair would then agree a final combined version which would be circulated for final approval within the group.

Action: Group members and Chair.

Presentations

PCAT: Dr Emily Broadis, and e-rostering: Iain Elrick & Donna Knowles, NHS Grampian. Both presentations were informative and were recognised as powerful tools to assist with improving rota design and enhancing junior doctors' well-being.

Rota design: Daniel MacDonald. Nine different sample rotas had been modelled and shared with the group. These were based on existing compliant rotas from a range of settings and based on a single week. Assumptions had been applied including the protection of OoH (skills replacement) and that they work within existing rules.

Key themes include the loss of daytime cover and the major impact on training. These pose significant problems and the Deaneries are unlikely to approve such rotas. Clarification is also required around the definition of a working week and recognition that actual 48 hour working will effectively restrict bank work.

A discussion followed about how to progress the modelling work without major re-design. There was concern about lengthening training periods and the Deaneries and GMC reaction to this. There were suggestions around piloting in specific areas and at specific points during training and also a phased approach around whether if 48 hours was unachievable and at what point could it be achieved. It was agreed that an evaluation tool was required. NHS Lanarkshire volunteered to fully model in Medicine, Surgery and Emergency Medicine.

AOCB and dates of next meetings

Dates are: Tuesday 5th March and Wednesday 22nd May 2019. The meeting times to be extended to three hours and exact time and location, in Edinburgh, TBC.

Action: Secretariat.

December 2019