Junior Doctors’ 48 Hour Expert Working Group: September 2018

Attendees and apologies

Present

• Professor Philip Cachia, Chair
• Ms Jeane Freeman, Cabinet Secretary for Health and Sport (introduction only)
• Professor Derek Bell, Scottish Academy of Medical Royal Colleges
• Dr Luke Yates, Scottish Academy of Medical Royal Colleges
• Mr Sean Gallimore, BMA
• Dr Lewis Hughes, BMA
• Dr Simon Edgar, Director of Medical Education
• Mr Daniel McQueen, Healthcare Improvement Scotland, Public Partner
• Ms Anne Dickson, NHS Education for Scotland
• Dr Jane Burns, Management Steering Group
• Dr Annie Ingram, Management Steering Group

Professional advisors

• Dr John Colvin, Professional Adviser and Senior Medical Officer

EWG secretariat and support

• Mr Chris Raftery, Head of NHS Pay and Conditions
• Dr Carolyn McKerracher, Policy Manager (secretariat)

Apologies

• Professor Clare McKenzie, NHS Education for Scotland
• Mr Daniel MacDonald, Workforce Adviser
• Ms Sandra Neill, Senior Policy Manager (secretariat)

Items and actions

The Cabinet Secretary for Health and Sport opened the meeting by thanking attendees for agreeing to participate in the EWG and Professor Cachia for agreeing to chair the group and for the preparatory work he has done to date. Ms Freeman emphasised the Government’s commitment to delivering a maximum 48 hour working week for junior doctors both timeously and safely. Ms Freeman also stated that she would consider all advice from the group with regards to the optimum way of minimising fatigue amongst junior doctors whilst ensuring both staff and patient safety and continuity of clinical services.

Professor Cachia confirmed the purpose of the group and his role in ensuring that all relevant stakeholders are consulted and their opinions explored, reflected and summarised as appropriate. He stated that membership of the group was a balance between adequate representation and functionality, but that other stakeholders may be consulted or invited to participate as decided by the group.

Professor Cachia stated that the purpose of this preliminary workshop was have an initial discussion about the opportunities and barriers to implementing a 48 hour maximum working week. There would an opportunity for the participants to be involved in finalising the membership of the group and the programme of work. He then invited participants to introduce themselves and then make presentations on behalf of the contributing organisations.

Presentations

• Dr Luke Yates, Scottish Academy of Medical Royal Colleges
• Dr Lewis Hughes, BMA
• Dr Simon Edgar, Director of Medical Education
• Ms Anne Dickson, NHS Education for Scotland
• Dr Jane Burns & Dr Annie Ingram, Management Steering Group

Discussion

There was a wide ranging discussion at the end of the presentations on how the EWG should develop a programme of work to make recommendations to the Cabinet Secretary.

All stakeholders commented that achieving a maximum 48 hour working week without consideration of the impact of the rota changes on the whole system (including the impact on other staff groups and continuity of clinical service) and on the quality of junior doctors’ work and education experiences and wellbeing, would not add value.

There was support for a risk based approach and flexibility in developing and testing potential solutions.

There was a broad consensus of agreement on a number of priorities that should underpin the work of the EWG:

• recommendations for achieving a 48 hour working week for junior doctors should take into account the impact of changes on the whole system and other staff groups
• the EWG should collaborate and work with other groups in Scotland and the UK that have been set up to look at the health and wellbeing of junior doctors
• agreement that making changes to rotas in isolation without consideration of the impact on health and wellbeing will not work
• EWG should undertake analysis and modelling of current rotas looking for examples of best practice with a view to sharing these and reducing variation
• the EWG should work with the service to pilot and evaluate potential rota changes on a local and/or specialty basis before wholesale implementation
• there may be a need for innovation around rotas (e.g. intelligent rota design, e-rostering) and an improvement methodology approach
• may require service or education redesign
• no quick fix – potentially requires a whole systems approach
• need to collect and share evidence and best practice

Action points

• all data / evidence / papers / presentations to Carolyn by 5/10/18
• Carolyn: distribute the above by 5/10/18
• November meeting will include discussion and agreement on the EWG programme of work and terms of reference
• John Colvin: organise PCAT presentation for next meeting
• Annie Ingram: to arrange presentation on e-rostering initiative in Grampian
• Simon Edgar: consult with Daniel MacDonald regarding rota compliance and areas where there is maximum variation

Proposed meetings: November, February, April.

Date of next meeting to be confirmed ASAP.