Junior Doctors’ 48 Hour Expert Working Group: September 2019

Attendees and apologies

Present

• Professor Philip Cachia, Chair
• Dr Luke Yates, Scottish Academy of Medical Royal Colleges, Trainee Representative (via the phone link)
• Dr Michael Jones, Scottish Academy of Medical Royal Colleges (via the phone link)
• Dr Lewis Hughes, BMA 
• Dr Jane Burns, MSG Management Steering Group
• Ms Anne Dickson, NES
• Mr Sean Gallimore, BMA 
• Mr Daniel McQueen, HIS Public Partner

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)

Observers

• Dr Katie Ritchie, Clinical Leadership Fellow
• Michelle Currie, Clinical Leadership Fellow

Apologies

• Dr Simon Edgar, Director of Medical Education 
• Professor Clare McKenzie, NES
• Dr John Colvin, Professional Adviser and Senior Medical Officer 
• Dr Annie Ingram, MSG Management Steering Group
• Professor Derek Bell, Scottish Academy of Medical Royal Colleges
   

Items and actions

The Chair welcomed everyone and introductions and apologies were made.

The Note of 24 June meeting was agreed. 

Lanarkshire table-top exercise

Alex Rice, Chris Sheridan and Daniel McQueen presented to the group their reflections on Lanarkshire table-top exercise on 9 July. 

Wide range of staff took part in the exercise and the level of engagement was high. The exercise was very well organised. Both positive and negative themes across all groups formed a consistent message. All concerns raised about 48 hour rotas were consistent and similar in all groups: 

• lack of staff – about 30% more Junior Doctors would be required to staff these rotas (not taking into account need for more consultants to supervise the juniors, senior nurses to be trained as AHPs etc.)
• continuity of care
• training – clinical exposure, continuity (i.e. being able to observe the patient before, during and after treatment) 
• loss of skills in the ward
• attractiveness of Scotland as a place to work and train – postgraduate training could take a few years longer
• work/life balance – arrangements for annual and study leave, split weekends
• fatigue – more day/night and night/day switches (3 instead of 2 in the rota) 

All participants were initially positive about the idea of 48 hour rota in principle. However, on discussing the proposals in more detail, concerns about resources and service delivery were cited across the board. Even current rotas already had problems around training for FY1 before bringing the hours down.

Daniel McQueen provided his reflections. He pointed out willingness of the staff taking part in the exercise to consider changes. The general consensus was that 48 hour limit would lead to changes in service provision and lengthening training if staff numbers were conserved. Otherwise, staff numbers would have to go up by about 30%. He proposed considering phased approach to deal with this issue.

He also spoke about fatigue pointing out that Junior Doctors were not taking statutory breaks and questioning whether the maximum length of shift should be taken down to 10 hours.

Jane Burns commended the spirit of the exercise – people were open to discussion. However, once implications became clear, a few trainees said “I won’t get my training!” Concerns were raised that it would not improve people’s wellbeing, would reduce available training opportunities and would require expansion of other grades i.e. Specialty Doctors, AHPs etc. All boards report not having enough JDs.

The chair asked to record thanks to all attendees, focus groups and participants.

Discussion took place over ensuring Junior Doctors have the time  to take the required breaks during working time to reduce fatigue risk. Reducing their involvement in mundane and repetitive tasks with little intrinsic educational value would help. It was pointed out that better use of IT systems and more effective management of tasks would also help. 

Rest facilities and use of the systems already in place for monitoring and accurate recording of working patterns was also discussed.  

Report structure

It was agreed that the first draft of the report should be ready for November. The wellbeing work from GMC might or might not be available by then. It was agreed that further rota modelling and/or table top exercises in different clinical settings would not add value to the data and narrative we have collected at this point.

 The structure of the report was proposed as:

• introduction and working of the EWG
• rota design – software and approach
• rota analysis from Lanarkshire
• NES Educational approval process
• Lanarkshire table top exercise – process, outcomes, conclusions
• wellbeing work across UK and Scotland. Relationships with 48hr EWG
• conclusions and recommendations

PC to contact group members to discuss input to the draft report.

Action:

• Chair

Dates of the next meeting:

The following date was agreed:

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

Action:

• Secretariat