The involvement of junior doctors in implementing changes to working hours in the UK is not a new concept. Going back to the 1990s, the regional task forces on junior doctors’ working hours, charged with the responsibility of implementing the new deal, often included junior doctor medical advisers.
In the North West, the strategic health authority has seen the benefits of such junior clinical leadership and continued with similar models to the current day. So the challenge of implementing the European working time directive and the 48-hour working week for 6,500 junior doctors provided a real opportunity to push this clinical leadership model further. From August 2007, a team of six junior doctor medical advisers was directed by a junior doctor leader to achieve EWTD compliance within 12 months, one year ahead of national requirements.
Realistic solutions
Clinical leadership and junior doctor involvement in this agenda allows realistic and sustainable solutions to come directly from the front line. Junior doctors understand the nature of the challenges you will face both in service delivery and medical training when reducing working hours.
Second, they understand the demands and requirements of each specialty at varying grades are different, one size does not fit all. Not only this, but the cultures also differ vastly and this has a significant bearing on successful implementation.
Third, our experience since the 1990s has demonstrated clearly that junior doctors are effective at leading their peers and senior colleagues through significant change. And such clinical engagement is again vital for successful implementation and sustainability. Such an environment also encourages innovation and often better solutions. Finally, this opportunity itself provides excellent medical managerial and leadership experience for the team, creating the clinical leaders of the future.
In terms of evaluation, was this approach successful? In August 2008, NHS North West achieved 97 per cent EWTD compliance for all junior doctors in training. Subsequent monitoring has confirmed 94 per cent sustained actual compliance in September 2008, with the results of the latest monitoring due in May 2009. The achievements of the team have been acknowledged as they received the HSJ 2008 Workforce Development Award and were shortlisted for the Secretary of State’s Award in Healthcare Management. Turning to look at clinical leadership and the development of future leaders, again the results speak for themselves. Since August 2008, former team members have undertaken the following roles:
- fellow to the national leadership council
- fellow to the NHS Institute for Innovation and Improvement
- Health Foundation leadership fellow
- North Western Deanery medical leadership programme participant
- NHS Breaking Through scheme participant
- Foundation hospital directorate manager
- Full-time MBA student
- Leader of EWTD team, NHS North West
- BAMMbino board member
Top tips for organisations facing full EWTD implementation for August 2009
- Start planning now! Do not deliberate; there is not long left. The more time you have, the more space there is to consider innovation, service improvement and preservation of training.
- Involve all clinicians in the department, junior and senior doctors and ward staff – particularly nurses. They will all have a hand in ensuring your success, or failure!
- Where possible, try to involve the junior doctors who will be rotating in to the new rota next. Junior doctors rotate frequently, with little notice of where they are going next, so this can be a challenge. However, despite your best efforts with the current doctors to create the best possible solutions, the new incoming doctors may feel aggrieved they were not consulted, impeding sustainability of your solution.
- Do follow national guidance and document your changes via the Department of Health’s “approval to change band” process. This will show you have consulted all key stakeholders and also protect you from any future pay-banding claims.
- Communicate – often sustainable solutions require whole systems changes affecting more than just junior doctors. Ensure your organisation is aware of the changes and their role in ensuring solutions work.
Our solutions have included large-scale service reconfiguration as seen in Making it Better, advice on rota design including collaboration with the Royal colleges, and use of IT and hospital at night.
No comments yet