Trusts urged to reduce elective activity during junior doctor transition

The majority of junior doctors move into year long placements on the first Wednesday in August, although some also rotate position in February.

There has been concern patient safety risks rise at these times, with studies suggesting an increase in mortality for patients both in the UK and internationally. This has led to August being widely dubbed “the killing season”.

In a paper seen by HSJ, NHS Employers and the Academy of Medical Royal Colleges have jointly called on providers to consider reducing their elective activity so that more senior staff can be available on hospital wards to support and supervise junior doctors. They also suggest reducing paperwork and annual leave to ensure rotas are appropriately staffed.

In 2012 NHS medical director Sir Bruce Keogh instructed trusts to ensure new doctors underwent a paid four day shadowing period before starting their jobs.

A study of emergency admissions between 2000 and 2008 by Imperial College researchers suggested there was a 6 per cent increase in the likelihood of death in patients admitted on the first Wednesday in August compared to those admitted the previous week.

However, data seen by HSJ show in each of the last three years the number of admissions in England fell to its lowest point in the summer months, partially as a result of staff taking annual leave at the height of summer.

In a joint report, Recommendations for Safe Trainee Changeover, NHS Employers and the academy suggest trusts postpone strategic meetings, audit activity and non-essential paperwork, as well as cut back on routine outpatient clinics and elective procedures, to “release key consultant grade doctors from those duties”.

It suggests rotas should be populated with specialty doctors and consultants to fill “what would otherwise be gaps in service provision”, adding: “This may mean annual leave is less available at the relevant time.”

Howard Ryland, a clinical fellow at the academy, said more evidence was needed to prove mortality did increase during changeover. But he added: “We are highlighting the fact that potentially the amount of elective activity that is being undertaken at that time of changeover may need to be looked at.”

Gill Bellord, director of employment relations at NHS Employers, said the suggestions were designed to promote patient safety and good care.

“Many trusts are already doing this [reducing activity] and we are talking just for that short period of time,” she said. “We think the recommendations will provide a commonsense approach to the transition in August.”