The Ward Round: Is safe staffing about skill mix or numbers?

“The medical registrar used to be the sexiest job in the building; it’s now become the most onerous,” said Rhid Dowdle, chair of the Royal College of Physicians working party on safe medical staffing, when describing how medics are contending with workforce shortages never seen before.

Dr Dowdle told delegates at the HSJ Patient Safety Congress in Manchester this week that safe staffing had become a problem for doctors in recent years and it is now common for there to be gaps in rotas with no doctors available to fill them. “These are the same issues nurses were describing for a long time but [are] new to us,” he said. “Suddenly we had a staffing change and it was a very dramatic one.”

Dr Dowdle also highlighted the relationship between prompt care and adequate staffing – once you start getting delays in delivering care there should be an alarm bell ringing. “If care is being delayed, you may have a problem, it’s time to look at your staffing.”

RCP safe staffing guidance focuses on tiers of clinical decision making and Dr Dowdle urged the room to make sure their staffing is reflected in successful audit results. “Numbers alone don’t work, skill mix is important,” he said.

The question of skill mix was raised by an audience member, who asked about the impact of nursing associates on staffing ratios and whether they were taking the place of registered nurses.

Royal College of Nursing president Anne-Marie Rafferty said nursing associates must be enabled to operate at the top of their practice, but stressed it is about “the dynamics of deployment” and careful consideration of how they add value to teams.

The end to the doctors’ dispute?

The junior doctors’ contract dispute has officially ended. Last week, British Medical Association junior doctor members voted to accept the terms negotiated by their union in the long-running dispute with the NHS and the government.

This has, of course, been welcomed by the BMA. The union highlighted that “nearly 60 individual new concessions” were agreed, including enhanced shared parental leave and a claimed £90m investment to fund various contractual improvements.

But other doctors’ organisations have been less supportive of the deal. Lobbying group The Doctors’ Association UK said it was “appalled” by the below inflation 2 per cent yearly uplift and the fact it was being presented as a pay rise.

It also said senior registrars would be disproportionately disadvantaged by the new deal. It warned they could be £18,000 worse off because of it and said the NHS risks losing them altogether.

The Hospital Consultants and Specialists Association said it was “impossible” to support the contract, because of the long-term pay constraint the agreement requires.

Along with opposition to the contract, there was also resignation. One BMA member told me they didn’t vote in the referendum as the changes would be enforced by the government regardless and, almost three years on, it simply didn’t feel like they were still in dispute. “We just got on with it,” they said.

Although the BMA is undoubtedly celebrating the gains for members, another important question is how the contract debacle has affected the union’s relationship with its members, and what this will mean for future negotiations.

A pensions precedent set

Public sector pensions have hit the news again. Last week, the Supreme Court declined to hear an appeal from the government which argued against a ruling that pensions reforms discriminated against younger firefighters and judges.

Lawyers have suggested this could have far-reaching implications for all public sector workers, whose pensions had also been cut, saying it could add £4bn to the cost of public service pensions. This would of course include the NHS.

The bill for NHS pensions faced by the Treasury is creeping up. The consultation on whether to introduce a 50:50 contribution scheme for senior medics is still ongoing, the outcome unknown and not to be decided until at least the autumn. Could the future generosity of the Treasury be affected by the large public sector pay bill it is now facing?