Two different trusts have focused on ways of working within specialties as the route to compliance on junior doctors’ hours

As they work towards the European working time directive by 1 August, hospital trusts have looked at innovative ways to reduce the number of hours their junior doctors are expected to work, while still guaranteeing patient safety and training quality for junior medical staff.

Stockport foundation trust and Avon and Wiltshire Mental Health Partnership trust have both been involved in pilot projects in conjunction with Skills for Health - Workforce Projects Team.

Both trusts had become increasingly aware that, to ensure compliance by the 2009 deadline, ways of working for doctors in certain specialties needed to change.

Avon and Wiltshire Mental Health Partnership trust

Avon and Wiltshire Mental Health Partnership trust’s project set out to devise new solutions to the workload of its F2 junior doctors. The trust wanted to analyse and change their way of working to establish which tasks could be performed by others with more than one type of professional undertaking most of the tasks performed by F2s.

The trust also wanted to reduce the junior doctor callouts while improving the quality and timeliness of interventions to service users.

An analysis of current ways of working was carried out through an audit of all the calls that junior doctors were expected to answer. Protocols and triage systems were reviewed to ensure they would not be called out without reason and their activity during the day and night was audited.

During the pilot, the trust found that junior doctors were being called out unnecessarily.

The pilot helped the trust to realise new ways of working, including the development of Patient Group Directions which allowed nurses who had been appropriately trained to administer certain medications so that doctors were not called on to prescribe and sign off all drugs. This improved the quality and timeliness of interventions.

The pilot work helped the trust to “reprofile” the work of the senior house officer/F2s by establishing new rotas, policies and pathways.

Key Learning: Avon and Wiltshire

  • Do a detailed audit of working patterns of junior doctors to inform more efficient practices
  • Implement changes in the round. Any plans or decisions around changes in working practices should not be made in isolation as changes made in one area of the service are likely to have a direct impact on other roles and services that already exist
  • Junior doctors’ time can be used more efficiently. Make changes to optimise their efficiency for the benefits of service users

Stockport foundation trust

Stockport foundation trust looked at how to extend a urological hub and spoke model for the provision of services to patients in Macclesfield. Day case and outpatient services were to remain at Macclesfield district general hospital and all inpatient and emergency services were to be transferred to Stockport’s Stepping Hill Hospital.

The trust decided to introduce specialist nurses to extended roles at the Macclesfield site and in community settings in order to release existing medical staff for appropriate training as well as providing more effective out of hours cover. The only urology consultant based at Macclesfield was ready to take on a less demanding role and the staff grade doctors were keen to expand theirs. They were happy to change to a different on call rota and to travel more in order to gain better training and get specialist recognition.

Consultants at Stepping Hill changed their rota to include the Macclesfield site. Stockport recruited a clinical fellow and two staff grade doctors into their middle rota to fill identified gaps in capacity to become directive compliant and to incorporate the Macclesfield site. The hospital is also set to recruit an additional specialist registrar to take the rota to 1:7.

Key Learning: Stockport

  • Management team must visit all sites for regular communication
  • Clinical involvement is essential
  • Create champions to help promote scheme to fellow staff
  • Set measurable targets from the outset