Rethinking its emergency service enabled Homerton University Hospital foundation trust to maintain junior doctors’ training time while achieving compliance on hours

Homerton University Hospital foundation trust separated emergency from elective care by creating highly trained, multiprofessional teams to care for emergency medical, surgical and orthopaedic admissions on two redesignated acute care wards.

The project was led by medical director John Coakley, consultant in intensive care medicine, with chief operating officer Tracey Fletcher.

Strong leadership

Throughout the project the engagement and support of the chief executive and executive directors and their teams were vital to its success.

Homerton made changes to its original plans to have one 56-bed acute ward, created from two smaller existing wards, for emergency admissions. The impact of the changes on elective care had to be assessed and solutions had to be found for dealing with it.

“Because we understand that whenever you make changes, some aspects improve and some may get worse, we wanted to set up a system where any problems, dangers or lowering of quality would be identified very quickly, and - more importantly - put right,” says Dr Coakley.

“We had strong executive leadership and stakeholder involvement in the buildup. We sought stakeholder feedback quickly and acted on it.”

Compliance was achieved by separating the rotas of junior doctors to allow time dedicated exclusively to the care of emergency admissions and time devoted to the development of skills in base specialties. This split varies according to the training needs of doctors and their specialties.

The increase in dedicated beds was balanced by a corresponding reduction in general beds in other departments, as the improved immediate care on admission reduced the demand for them.

The consultants’ working day was expanded to 12 hours to maintain the percentage of time spent supervising junior staff, whose training hours did not fall as their hours were reduced.

Key learning

  • Project needs good management, someone who can say the organisation will make changes and keep to a deadline
  • Plans must always be made in the light of trust national priorities and targets
  • Acknowledge at the start that not every aspect of the plans will run smoothly
  • The project needs a range of sources for advice, support and change and a team of people from the project manager to the clinical director who can act swiftly on issues brought to their attention
  • Balancing the service and training needs is vital and it is important not to concentrate on one at the expense of another
  • Although the changes have been implemented the picture is by no means complete.

Meet Tim Lund, the EWTD programme lead

Tim Lund is national European working time directive programme lead, Skills for Health - Workforce Projects Team. He joined the team in January from the Department of Health, where he led the workforce availability and European working time directive team.

His experience spans several years and Mr Lund was also involved in many aspects of departmental work including finance and performance and Agenda for Change.

He says: “We want to re-emphasise pragmatism; people who are opposed to this would like to think there is a cliff edge on 1 August 2009, but this is not the case.

“There is flexibility, but colleagues need to understand the law and there needs to be leadership on this. There is help available: Workforce Projects Team has the remit, the resources and tools to support people.”

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