Health Policy and Economic Research Unit
Report author: Duncan Bland
October 2014
OF CONSULTANT
WORKING PATTERNS
AND ON CALL
2 BMA survey of consultant working patterns and on call services
Index
Executive summary ... 3
Survey overview ... 4
Previous BMA research into consultant working patterns ... 4
Caveats to these findings ... 5
On call rotas ... 6
On call – Monday to Friday ... 7
On call – Weekends ... 10
Compensatory rest ... 13
NHS Employer core hours of work ... 14
Planned consultant presence in hospitals ... 16
Appendix ... 19
Tables
Table 1– Intensity category and frequency of non resident on call (including comparison with the 2013 survey) ... 6Table 2 – Category A rota frequency by specialty ... 6
Table 3 – Category A rota frequency by NHS employer type ... 7
Table 4 – Frequency of calls, attendance and total time spent at hospital when on call by specialty (Monday to Friday) ... 8
Table 5 – Frequency of calls, attendance and total time spent at hospital when on call by NHS employer type (Monday to Friday) ... 9
Table 6 – Frequency of calls, attendance and total time spent at hospital when on call at the weekend ... 11
Table 7 – Frequency of calls, attendance and total time spent at hospital when on call by NHS employer type8 (Saturday and/or Sunday) ... 12
Figures
Figure 1 – Distribution for the number of calls requiring attendance at hospital (Monday to Friday) ... 8Figure 2 – Likelihood of being called and required to attend hospital at least once by specialty (Monday to Friday) ... 9
Figure 3 – Frequency of sleep disturbance when on call during Monday to Friday ... 10
Figure 4 – Distribution for the number of calls requiring attendance at hospital (Saturday and/or Sunday) ... 11
Figure 5 – Likelihood of being called and required to attend hospital at least once by specialty (Saturday and/or Sunday) ... 12
Figure 6 – Frequency of sleep disturbance when on call at the weekend (Saturday and/or Sunday) ... 13
Figure 7 – Access to compensatory rest following a night spent on call when sleep has been disturbed ... 14
Figure 8 – To the nearest half hour, at what time do ‘core’ hours begin at your main NHS employer? (by ‘normal’ or ‘high priority’ NHS employer status) ... 15
Figure 9 – To the nearest half hour, at what time do ‘core’ hours end at your main NHS employer? (by ‘normal’ or ‘high priority’ NHS employer status) ... 15
Figure 10 – The 24-hour distribution of start and finish times for planned consultant shifts on a weekday (n=764)... 16
Figure 11 – The 24-hour distribution of start and finish times for planned consultant shifts on Saturday (n=101) ... 17
Figure 12 – The 24-hour distribution of start and finish times for planned consultant shifts on Sunday (n=90) ... 18
Executive summary
On call – Monday to Friday
• 88 per cent of consultants reported being on a non-resident on call rota.
• Respondents reported receiving an average three telephone calls when on call during Monday to Friday. Surgeons recorded the highest average number of calls (five).
• Almost half of respondents reported being called to attend hospital; varying between one and six occasions. Anaesthetists (74 per cent) and surgeons (71 per cent) were most likely to be required to attend hospital if called.
• Consultants worked an average three hours when attending hospital on call; anaesthetists worked an average four hours.
• More than four in 10 consultants reported their sleep had been disturbed in order to attend hospital on one night when on call during a Monday to Friday.
On call – Weekends
• Consultants on call at weekends reported receiving five calls on average (higher than Monday to Friday).
• Almost two-thirds of consultants on call at the weekend reported attending hospital between one and six times (higher than equivalent for Monday to Friday). As with Monday to Friday, surgical specialists (88 per cent) and anaesthetists (82 per cent) were most likely to be required to attend hospital if called.
• Consultants reported working an average six hours when called to attend hospital at weekends (twice the number of hours for a weekday).
• One-third of respondents were required to break their normal sleep pattern to attend hospital on a night at the weekend. One-fifth said their sleep was disturbed on both nights when on call at the weekend.
Compensatory rest
• Seven in 10 respondents reported never having access to compensatory rest following a night when their sleep had been disturbed.
‘High’ versus ‘normal’ priority for seven day services
• There were no differences in patterns of on call work or availability of compensatory rest according to the priority given to seven day service provision by NHS employers.
• Responses to the survey offer tentative evidence that ‘core hours’ of NHS employers giving ‘high priority’ to seven day services start marginally earlier and finish marginally later in a typical working day.
24-hour patterns of planned consultant presence
• Only approximately 1 per cent of consultants reported starting a planned shift at work outside of 07.00 to 20.00 hrs.
• No more than 5 per cent of consultants were present at work on a planned shift outside of 07.00 to 20.00 hrs.
• There were no systematic differencesin planned consultant presence across a whole 24-hour period on weekends or weekdays regardless whether respondents’ NHS employer gave seven day services a ‘normal’ or ‘high’ priority. This is a subtle contrast to potential small differences in ‘core’ hours only.
Demography
• The sample demographics for the survey are broadly in line with the wider workforce, notwithstanding oversampling of consultants in Northern Ireland (appendix).
4 BMA survey of consultant working patterns and on call service
Survey overview
The BMA last surveyed a sample of the consultant membership in 2013 on a relatively wide range of issues relating to workload and the current consultant contract.1 The purpose of this 2014
survey was to collect more detailed information about the rate and composition of consultant on call work. The 2014 survey also included questions on night time disturbance and subsequent access to compensatory rest.
The survey was conducted online between 5 August 2014 and 2 September 2014 and received responses from 847 of 5,822 members registered as consultants on the BMA membership database. The sample was comprised of 5,000 members in England and all consultants in Northern Ireland, consenting to receive email communications. The England sample was broken down further. Seventeen NHS employers that self reported to NHS England’s 2013 survey of acute hospitals2 as currently giving seven day service provision a ‘high priority’ comprised
50 per cent of the sample in England. NHS employers that self reported giving seven day services a ‘normal priority’ were also sampled at 50 per cent within England. Respondents’ employer is referred to as either ‘normal’ or ‘high priority’ throughout the report and any systematic differences in responses identified where relevant.
By sampling in this way, the survey attempted to identify any differences in current patterns of on call provision and planned consultant presence according to hypothetical differences in the readiness of employers to extend hospital services seven days a week.
Sixteen respondents to the survey were not currently working and were excluded from analysis; the maximum number of respondents was therefore adjusted to 831. Only the largest specialty groupings are described in the present report due to their sample size.
Previous BMA research into consultant working patterns
In the 2013 survey of consultants, respondents were asked about the planned shifts they had worked in both plain (7am to 7pm) and premium (7pm to 7am) timea in their most recent fullworking week. In that survey, high proportions of respondents reported working at these times. This was most likely a consequence of reporting a combination of on call work together with routine, planned workb in hospitals, rather than planned work only, as was intended by the
survey. This survey also highlighted a limitation of the simple distinction between plain time (7am to 7pm) and premium time working (7pm to 7am) as distinguishing work undertaken in late evening from full night shifts was problematic.
An additional purpose of the 2014 survey was therefore to clearly delineate unplanned consultant presence at hospital such as on call work, from planned, routine attendance when a consultant will expect to be working. To do this effectively, the survey asked respondents to record the start and finish times of their planned shifts between Monday and Sunday of their most recent full working week. This was entirely separate from questions about work undertaken when on call. This would enable the pattern of 24-hour planned consultant presence at hospital to be described for the first time by our research. This is shown on page 16.
a Under the current consultant contract, consultants receive enhanced rates of pay for work that takes place between 7pm and 7am Monday to Friday and at any time at the weekend. Work in plain time (7am to 7pm) is at normal contracted rates of pay.
b Consultants were asked to report the planned hours they had worked across Monday to Friday and the weekend. Planned time was defined as hours of work explicitly agreed in a consultant job plan.
Caveats to these findings
Given the survey response rate, sample size and the size of the consultant workforce, the margin of error for responses in the present survey is plus or minus 3 per cent for most questions. The responses to this survey are reasonably representative of the broader picture in England and Northern Ireland.
Where appropriate, the survey compares responses from respondents according to the status of their NHS employer in relation to progression towards seven day services. This binary distinction is derived from employers’ self reported responses to NHS England’s 2013 survey of acute hospitals. As such, any presumed differences in progression towards seven day services and associated relation to patterns of on call or other work were hypothetical.
The survey asked respondents about their time spent on call (excluding planned work) in their most recent full working week. For some respondents the number of days in which they were on call may vary. Due to the necessary brevity of the survey it was not feasible to capture all daily activities. The survey therefore cannot be assumed to be as granular as a detailed individual work diary. The survey recorded very high proportions of respondents were working on call during a Monday to Friday (85.2 per cent) or Saturday and/or Sunday (68.1 per cent) in the last week. These figures, which do not align with self reported rota frequencies, suggest that respondents interpreted questioning about their most recent working week variably: some may have reported being on call in the most recent week; and some may have reported their most recent on call activity. Further, response bias, caused by differences in the accuracy of individual recollections is not a unique artefact of this survey, although we cannot exclude the possibility that some respondents’ accounts of their on call work may have altered over time.
Although the survey focussed on non-resident on call, it is possible that some respondents reported information relating to their resident on call work. Such instances should be few however. Responses which might have indicated misunderstanding, such as extremely high rates of attendance at hospital indicative of being resident on site, were removed.
The vast majority of respondents to the survey were based at hospitals for their main place of work. However, a small number of consultant specialists, such as those working in academia or public health may only work at hospital sites for part of their time.
6 BMA survey of consultant working patterns and on call service
On call rotas
In the previous BMA survey of consultants conducted at the end of 2013, approximately only 5 per cent of respondents reported working as part of a resident on call rota. The present survey therefore restricted questions to non-resident working. In the current survey, 87.6 per cent of respondents took part in a non-resident on call rota.
Although the sample size for the current survey was smaller than in 2013 (increasing the potential for greater spread within the data), there is strong agreement between both surveys. This agreement is strongest for Category A rotasc (table 1). Of the specialties shown in table 2,
respondents in paediatrics and child health reported the most frequent rota, on average (one in 7.1) (table 2).
Average rota frequency was one in 8.9. There were no differences in rota frequency according to the respondent’s NHS employer and therefore no evidence of a difference in rotas based on current priority given to seven day services. There was slightly greater spread in the data from respondents at high priority trusts but this was in proportion with the respective sample sizes (table 3).
Table 1 – Intensity category and frequency of non resident on call (including comparison with the 2013 survey)
Intensity and average frequency on-call
Category A Category B
2013 2014 2013 2014
Sample size (n) 1,042 597 447 147
Mean rota frequency (e.g.1 in …) 9.1 8.9 10.1 9.9
Median rota frequency (e.g.1 in …) 8.0 8.0 9.0 8.0
Inter-quartile range 6.0 to 11.0 6.0 to 10.0 6.0 to 12.0 6.0 to 14.0
Table 2 – Category A rota frequency by specialty
Specialty (n) Mean Median Inter-quartile
range Medical specialties (n=138) 8.8 8.0 6.0 to 10.0 Surgical specialties (n=114) 7.3 7.0 5.0 to 8.0 Anaesthetics (n=106) 11.3 10.0 8.0 to 14.0
Paediatrics and child health (n=63)
7.1 7.0 5.8 to 8.0
Clinical oncology and radiology (n=58)
9.4 8.0 6.4 to 12.0
All (n=597)
8.9 8.0 6.0 to 10.0
Note: Only specialties with a sample size of at least 50 shown. Equivalent data for obstetrics and gynaecology (n=41) and emergency medicine (n=33) available on request.
c In Category A rotas, it is typical for a consultant to be required to return immediately to site or undertake interventions of similar complexity to those carried out at hospital. For Category B rotas, it is more typical for a consultant to be able to respond by giving telephone advice and/or returning to work later.
Table 3 – Category A rota frequency by NHS employer type2 NHS employer
(n)
Mean Median Inter-quartile
range Normal priority Trust
(n=355)
8.8 8.0 6.0 to 10.0
High priority Trust (n=241)
9.2 8.0 6.0 to 12.0
All (n=597)
8.9 8.0 6.0 to 10.0
Note: Respondents separated into two groups according to the priority given by their employing trust to progression towards seven day services in the NHS England survey.
On call – Monday to Friday
The survey asked respondents if they had been on call between Monday and Friday in their most recent full working week and 85.2 per cent reported that they had (620 of 728). Respondents were then asked to record the number of telephone calls they had received when on call, if any of those calls had required them to attend hospital and how much time they had spent in attendance at hospital in total. Due to the uneven distribution for number of calls received, number of times attended hospital and number of minutes spent attending, median values are more representative average figures.
Overall, respondents reported receiving an average of 3.0 telephone calls when on call during their most recent Monday to Friday. Respondents in surgery recorded the highest average number of calls; 5.0 overall (table 4).
Whilst it was most likely for respondents to report not being called to attend hospital at all, when taken as an average, a median single attendance at hospital was reported for all but medical specialties (table 4). Figure 1 shows the total distribution of attendances at hospital ranging from zero to 15 during Monday to Friday. Although almost half of respondents (48.7 per cent) reported not being called to attend hospital at all, almost half (47.4 per cent) reported being called out between one and six times across the week (figure 1).
Table 4 shows the average number of attendances at hospital within each specialty but it does not tell us how the chances of being called to attend hospital might vary. Figure 2 shows that the likelihood of being required to attend hospital at least once when called varied by specialty (figure 2). Anaesthetists had a 73.6 per cent chance of being required to attend and surgeons 70.7 per cent. By contrast, medical specialties had just a 24.8 per cent chance of being called to attend hospital.
Respondents spent a median 180.0 minutes attending hospital when on call with anaesthetists recording the highest average number of minutes: 240.0.
BMA survey of consultant working patterns and on call service 8
Table 4 – Frequency of calls, attendance and total time spent at hospital when on call by specialty (Monday to Friday)
Specialty (n) Frequency of calls received (Mon-Fri) Frequency of attendance at hospital (Mon-Fri)
Total time (mins) in attendance
(Mon-Fri)
Mean Median IQR Mean Median IQR Mean Median IQR
Medical specialties (n=153) 4.6 3.0 1.0 to 6.0 0.6 0.0 0.0 to 0.5 232.3 210.0 80.0 to 270.0 Surgical specialties (n=116) 8.7 5.0 3.0 to 10.0 2.3 1.0 0.0 to 3.0 260.0 180.0 120.0 to 300.0 Anaesthetics (n=91) 2.7 2.0 1.0 to 3.0 1.2 1.0 0.0 to 1.0 269.2 240.0 150.0 to 307.5 Paediatrics and child health (n=67) 4.9 3.0 2.0 to 5.0 0.9 1.0 0.0 to 1.0 216.9 210.0 120.0 to 300.0 Clinical oncology and radiology (n=58) 4.8 4.0 1.8 to 6.5 2.5 1.0 0.0 to 3.5 211.7 180.0 90.0 to 240.0 All (n=620) 5.0 3.0 1.25 to 6.0 1.3 1.0 0.0 to 1.0 234.2 180.0 120.0 to 300.0
Note: Only specialties with a sample size of at least 50 shown. Equivalent data for obstetrics and gynaecology (n=41) and emergency medicine (n=31) available on request.
IQR: Inter-quartile range.
Figure 1 – Distribution for the number of calls requiring attendance at hospital (Monday to Friday) 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Per cent
Number of calls requiring attendance at hospital 0 48.7 1 28.5 2 8.1 3 4.5 4 2.4 5 2.1 6 1.8 7 0.2 8 1.1 9 0.2 10 1.6 11 0.2 12 0.2 13 0.0 14 0.2 15 0.3
Figure 2 – Likelihood of being called and required to attend hospital at least once by specialty (Monday to Friday)
Table 5 shows that there were no differences in on call demands between consultants employed at trusts regarded as giving seven day services a high priority versus others.
Table 5 – Frequency of calls, attendance and total time spent at hospital when on call by NHS employer type2 (Monday to Friday)
Specialty (n) Frequency of calls received (Mon-Fri) Frequency of attendance at hospital (Mon-Fri)
Total time (mins) in attendance
(Mon-Fri)
Mean Median IQR Mean Median IQR Mean Median IQR
Normal priority NHS Trust (n=377) 4.9 3.0 2.0 to 5.0 1.2 0.0 0.0 to 1.0 232.6 180.0 120.0 to 300.0 High priority NHS Trust (n=242) 5.1 3.0 1.0 to 6.0 1.4 1.0 0.0 to 1.0 236.6 180.0 120.0 to 300.0 All (n=620) 5.0 3.0 1.25 to 6.0 1.3 1.0 0.0 to 1.0 234.2 180.0 120.0 to 300.0
Note: Respondents separated into two groups according to the priority given by their employing trust to progression towards seven day services in the NHS England survey.
IQR: Inter-quartile range. 100 90 80 70 60 50 40 30 20 10 0 Medical specialties
Required to attend Not required to attend Paediatrics and
child health Clinical oncology and radiology specialtiesSurgical Anaesthetics
115 38 29 38 23 35 34 82 24 67 Per cent
10 BMA survey of consultant working patterns and on call service
Respondents that were on call and required to attend hospital during the Monday to Friday were asked on how many nights, if at all, they were required to break their normal sleep pattern (to attend hospital). Approximately equal proportions of respondents replied that their sleep had been disturbed either not at all or on a single occasion. There were no differences according to NHS employer (figure 3).
Figure 3 – Frequency of sleep disturbance when on call during Monday to Friday
On call – Weekends
68.1 per cent of respondents reported being on call during a Saturday or Sunday in the last week (496 of 728). Respondents were asked equivalent questions to those for being on call on Monday to Friday concerning number of calls received, number of times attended hospital and total amount of time spent attending hospital.
At weekends, respondents received a median 5.0 calls although this varied across specialties from 11.0 for clinical oncology and radiology to 3.0 for anaesthetics (table 6). Average values for clinical oncology and radiology are more subject to skew due to its smaller sample size relative to other specialties in table 6.
Approximately one-third of respondents (32.8 per cent) on call at the weekend reported not having to attend hospital at all. Almost two-thirds (63.3 per cent) reported being called to attend between one and six times (figure 4). This is notably higher than the equivalent proportion for Monday to Friday on call (47.4 per cent). Collectively, consultants were required to attend hospital when on call on a single occasion, on average, although attending twice was more representative for surgical specialties and clinical oncology and radiology. The likelihood of being called to attend hospital at the weekend at least once was greatest for surgeons (88.0 per cent) and anaesthetists (82.1 per cent) (figure 5).
50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0
None One night Two nights Three nights Four nights Five nights 42.8 Per cent 44.5 8.3 2.8 0.7 0.9
As with Monday to Friday, anaesthetists recorded the highest number of minutes spent attending hospital when on call at weekends (530.0 minutes) compared to an average 360.0 minutes for all consultants.
Table 6 – Frequency of calls, attendance and total time spent at hospital when on call at the weekend
Specialty (n)
Frequency of calls received (Sat and/or Sun)
Frequency of attendance at hospital (Sat and/or Sun)
Total time (mins) in attendance (Sat and/or Sun)
Mean Median IQR Mean Median IQR Mean Median IQR
Medical specialties (n=132) 5.4 4.0 2.0 to 7.0 1.4 1.0 0.0 to 2.0 440.9 360.0 230.0 to 645.0 Surgical specialties (n=86) 8.7 6.0 4.0 to 10.0 2.5 2.0 1.0 to 4.0 466.1 300.0 120.0 to 680.0 Anaesthetics (n=67) 4.0 3.0 2.0 to 5.0 1.7 1.0 1.0 to 2.0 560.4 530.0 285.0 to 745.0 Paediatrics and child health (n=58) 6.4 5.0 2.0 to 8.0 1.2 1.0 0.0 to 2.0 378.1 300.0 170.0 to 545.0 Clinical oncology and radiology (n=47) 12.8 11.0 3.5 to 20.0 3.5 2.0 0.8 to 5.0 543.7 480.0 345.0 to 720.0 All (n=493) 6.7 5.0 2.0 to 8.0 1.7 1.0 0.0 to 2.0 441.4 360.0 180.0 to 600.0
IQR: Inter-quartile range
Figure 4 – Distribution for the number of calls requiring attendance at hospital (Saturday and/or Sunday)
50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 Per cent 32.8 26.8 19.5 6.0 6.4 3.1 1.5 0.2 1.2 1.7 0.2 0.2 0.4
BMA survey of consultant working patterns and on call service 12
Figure 5 – Likelihood of being called and required to attend hospital at least once by specialty (Saturday and/or Sunday)
There were no systematic differences in average minutes spent attending hospital when on call by NHS employer. Any differences were relatively small and very likely a function of normal variation and the group sizes (table 7).
Table 7 – Frequency of calls, attendance and total time spent at hospital when on call by NHS employer type2 (Saturday and/or Sunday)
Specialty (n)
Frequency of calls received (Sat and/or Sun)
Frequency of attendance at hospital (Sat and/or Sun)
Total time (mins) in attendance (Sat and/or Sun)
Mean Median IQR Mean Median IQR Mean Median IQR
Normal priority NHS Trust (n=299) 6.5 5.0 2.0 to 8.0 1.8 1.0 0.0 to 2.0 412.8 340.0 170.0 to 550.0 High priority NHS Trust (n=193) 7.1 5.0 3.0 to 10.0 1.7 1.0 0.0 to 2.0 487.3 360.0 240.0 to 720.0 All (n=493) 6.7 5.0 2.0 to 8.0 1.7 1.0 0.0 to 2.0 441.4 360.0 180.0 to 600.0
Note: Respondents separated into two groups according to the priority given by their employing trust to progression towards seven day services in the NHS England survey.
IQR: Inter-quartile range. 100 90 80 70 60 50 40 30 20 10 0 Clinical oncology and radiology
Required to attend Not required to attend Paediatrics and
child health specialtiesMedical Anaesthetics specialtiesSurgical
29 9 40 17 65 67 12 55 10 73 Per cent
Almost half of respondents (48.1 per cent) that were on call on the Saturday or Sunday in their most recent full working week did not have their sleep interrupted. However, one-third of respondents (33.6 per cent) were required to break their sleep pattern (to attend hospital) and approaching one-fifth (18.3 per cent) reported their sleep had been interrupted on both nights at the weekend. In common with working on call during Monday to Friday, there was no difference in rate of sleep disturbance by respondents’ NHS employer (figure 6).
Figure 6 – Frequency of sleep disturbance when on call at the weekend (Saturday and/or Sunday)
Compensatory rest
All respondents were asked if they had access to compensatory rest following a night spent on call when their sleep has been disturbed. Seven in 10 of all respondents (71.1 per cent) reported they never had access to compensatory rest while a further one in 10 (10.2 per cent) replied that such rest was rare. Just one in 10 respondents (10.5 per cent) reported that they always or most of the time had access to compensatory rest. There were no differences according to respondents’ employer (figure 7).
60.0 40.0 30.0 20.0 10.0 0.0
None One night Two nights
48.1
Per cent
33.6
18.3 50.0
BMA survey of consultant working patterns and on call service 14
Figure 7 – Access to compensatory rest following a night spent on call when sleep has been disturbed
NHS Employer core hours of work
The survey asked respondents what, to the best of their knowledge, was considered to be ‘core’ hours at their NHS employer. The basis for these questions was to examine any potential differences in core hospital hours that might be associated with whether the employer was currently giving seven day services a high or normal priority.
Figures 8 and 9 suggest a slight difference in when respondents believed core hours began and ended, according to NHS employer. Figure 8 shows there is a slight difference in the start time of core hours where respondents in high priority trusts were slightly more likely to report core hours beginning at, or before, 08.00 hours (high priority: 58.9 per cent; normal priority: 44.8 per cent). Figure 9 shows respondents from high priority trusts were also slightly more likely to report core hours as ending at 18.00 hours or later (high: 45.7 per cent; normal: 36.7 per cent). Taken together, the responses offer tentative evidence of a trend for core hours in high priority employers to start earlier and finish later on a typical working day.
80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
Never Rarely Ocassionally Most of the time Always
71.1
10.2
8.2 7.3
3.2
Figure 8 – To the nearest half hour, at what time do ‘core’ hours begin at your main NHS employer? (by ‘normal’ or ‘high priority’ NHS employer status)
Figure 9 – To the nearest half hour, at what time do ‘core’ hours end at your main NHS employer? (by ‘normal’ or ‘high priority’ NHS employer status)
45.0 40.0 35.0 30.0 20.0 15.0 10.0 5.0 0.0 7.00 7.30 8.00 8.30 9.00 9.30 10.00 6.5 25.0 Per cent
Normal priority High priority 8.4 5.2 8.7 33.1 41.8 15.817.0 38.3 24.1 0.8 0.2 Hours (am) Hours (pm) 40.0 35.0 30.0 20.0 15.0 10.0 5.0 0.0 16.00 16.30 17.00 17.30 18.00 18.30 19.00 1.5 25.0 Per cent 0.3 45.0 19.30 20.00 2.1 2.0 43.7 33.4 15.9 18.5 19.3 23.5 3.4 2.0 10.412.6 1.7 2.3 1.9 5.3
BMA survey of consultant working patterns and on call service 16 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Befor e 7am 7.16 to 7.30 7.46 to 8.00 8.16 to 8.30 8.46 to 9.00 9.16 to 9.30 9.46 to 10.00 10.16 to 10.30 10.46 to 11.00 11.16 to 11.30 11.46 to 12.00 12.16 to 12.30 12.46 to 13.00 13.16 to 13.30 13.46 to 14.00 14.16 to 14.30 14.46 to 15.00 15.16 to 15.30 15.46 to 16.00 16.16 to 16.30 16.46 to 17.00 17.16 to 17.30 17.46 to 18.00 18.16 to 18.30 18.46 to 19.00 19.16 to 19.30 19.46 to 20.00 20.16 to 20.30 20.46 to 21.00 21.16 to 21.30 21.46 to 22.00 22.00 or later Per cent
Start time Finish time
d Planned time was defined as hours of work explicitly agreed in a consultant job plan.
e Wednesday was chosen as a representative example of planned consultant presence at hospital on a weekday in preference to days at the beginning and end of the week which could be more impacted by the proximity to weekend shift patterns.
Planned consultant presence in hospitals
WeekdaysRespondents were asked to record the start and finish times of their planned shiftsd between
Monday and Sunday of their most recent full working week. Figure 10 shows the total distribution of start and finish times for 764 consultants during an entire 24 hour period on a Wednesday. Wednesday was chosen as a representative example of planned consultant presence at hospital on a weekday.e The vast majority of consultants began their planned shift between
07.00 and 09.00 hrs in the morning (blue columns) and finished between 17.00 and 20.00 hrs (green columns). Only approximately 1 per cent of consultants reported starting a planned shift at work outside of 07.00 to 20.00 hrs. When start and finish times are combined, no more than 5 per cent of consultants were present at work outside of 07.00 to 20.00 hrs.
After analysing working patterns for any effect of NHS employer, there were no systematic differences in the start and finish times reported by consultants.
Figure 10 – The 24-hour distribution of start and finish times for planned consultant shifts on a weekday (n=764)
Note: Figure 10 includes all respondents to the survey with complete data for start and finish times. Both full and part time workers are included.
Weekends
The majority of consultants working planned shifts on Saturday reported starting their shift between 07.00 and 10.00 hrs in the morning. Finishing times for shifts, and therefore presence at work, was comparatively evenly spread throughout the remainder of Saturday and until midnight. By comparison to data for weekday planned presence, the distribution of start and finish times on Saturday lack granularity, due to sample size.
Figure 11 – The 24-hour distribution of start and finish times for planned consultant shifts on Saturday (n=101)
The overall distribution of start and finish times of planned consultant shifts on Sunday is similar in resemblance to Saturday working. The vast majority of consultants began their planned shift between 07.00 and 10.00 hrs in the morning with finish times relatively evenly spread through the rest of Sunday. The same caveats concerning sample size for consultants working on Saturday also apply to Sunday. There were no systematic differences in start and finish times of consultants working at weekends according to their NHS employer.
35.0 30.0 20.0 15.0 10.0 5.0 0.0 Befor e 7am 7.00 to 7.59 8.00 to 8.59 9.00 to 9.59 10.00 to 10.59 11.00 to 11.59 12.00 to 12.59 13.00 to 13.59 14.00 to 14.59 15.00 to 15.59 16.00 to 16.59 17.00 to 17.59 18.00 to 18.59 19.00 to 19.59 20.00 to 20.59 21.00 to 21.59 22.00 or later 25.0 Per cent
BMA survey of consultant working patterns and on call service 18
Figure 12 – The 24-hour distribution of start and finish times for planned consultant shifts on Sunday (n=90) 40.0 30.0 20.0 15.0 10.0 5.0 0.0 Befor e 7am 7.00 to 7.59 8.00 to 8.59 9.00 to 9.59 10.00 to 10.59 11.00 to 11.59 12.00 to 12.59 13.00 to 13.59 14.00 to 14.59 15.00 to 15.59 16.00 to 16.59 17.00 to 17.59 18.00 to 18.59 19.00 to 19.59 20.00 or later 25.0 Per cent
Start time Finish time 35.0
Appendix
Demography
Country of workRespondents from Northern Ireland were oversampled and are considerably over represented in the survey in comparison with respondents from England. If the workforce consisted of consultants in England and Northern Ireland only, consultants in Northern Ireland would nominally constitute 3.7 per cent2 rather than 17.6 per cent as in this survey (figure A1).
Figure A1 – Respondent’s country of work
Gender
More than six in 10 respondents (61.8 per cent) to the survey were male. Female respondents (37.4 per cent) were slightly over represented in the survey when compared with the current consultant workforce (33.2 per cent)2 (table A1).
146, 17.6%
682, 82.4%
BMA survey of consultant working patterns and on call service 20
Table A1 – Respondents’ gender
Frequency Per cent
Male 502 61.8
Female 304 37.4
Prefer not to say 6 0.7
Total 812 99.9*
No reply 19 –
*Total does not add to 100 per cent due to decimal rounding. Age
The mean age of respondents to the survey was 48.5 years (median: 48 years; lower quartile: 42 years, upper quartile: 54 years) (figure A2). This is in broad agreement with the age profile of respondents to the 2013 consultant survey and the wider consultant workforce.2
Figure A2 – Age distribution of respondents
Age when first appointed as a consultant
The mean age of respondents at their first consultant appointment was 36.6 years (median: 36 years; lower quartile: 34 years, upper quartile: 38 years) (figure A3). This is in close agreement with the 2013 BMA consultant survey which recorded a mean age at first appointment as 37.0 years.
6.0 5.0 4.0 3.0 2.0 1.0 0.0 Per cent Age (years) 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72
Figure A3 – Age distribution of first consultant appointment
Working status
More than eight in 10 respondents to the survey were in full time work (table A2). Table A2 – Current working status
Frequency Per cent
Working full time 694 81.9
Working part time 123 14.5
Working as a locum 14 1.7
On a career break 1 0.1
On maternity leave 4 0.5
Retired 11 1.3
Total 847 100.0
Note: Respondents that were on a career break, maternity leave or retired were removed from main survey questions.
Specialty
Assessing the representativeness of the response across hospital specialties is problematic due to variation in the method of data collection among professional medical bodies and the NHS. In the current study the General Medical Council (GMC) Definitive List of Approved Specialties and Sub-Specialties was used.2 There were relatively small differences between 2013 and 2014 surveys.
16.0 10.0 8.0 6.0 4.0 2.0 0.0 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 Per cent Age (years) 12.0 14.0
22 BMA survey of consultant working patterns and on call services
Table A3 – Main clinical specialty (including comparison with 2013 consultant survey) Frequency Per cent
(2014)
Per cent (2013)
Anaesthetics 132 15.9 12.3
Clinical oncology and radiology 72 8.7 8.0
Emergency medicine 41 4.9 4.3
Medical specialties 208 25.1 27.1
Obstetrics and gynaecology 49 5.9 4.6
Occupational medicine 3 0.4 0.3
Ophthalmology 11 1.3 2.3
Paediatrics and child health 85 10.2 8.5
Pathology 30 3.6 5.1
Psychiatry 51 6.1 12.9
Public health medicine 5 0.6 1.3
Surgical specialties 138 16.6 12.1
Other 5 0.6 1.3
Total 830 100.0 100.0
No reply 1 – –
Table A4 – List of NHS Employers in England identified as giving seven day services high priority2
NHS Employer
Whittington Hospital NHS Trust
King’s College Hospital NHS Foundation Trust Guy’s and St Thomas’ NHS Foundation Trust St George’s Healthcare NHS Trust
Dartford and Gravesham NHS Trust Frimley Park Hospital NHS Foundation Trust Hampshire Hospitals NHS Foundation Trust Kettering General Hospital NHS Foundation Trust South Warwickshire NHS Foundation Trust Buckinghamshire Healthcare NHS Trust City Hospitals Sunderland NHS Foundation Trust Colchester Hospital University NHS Foundation Trust Ipswich Hospital NHS Trust
Rotherham NHS Foundation Trust Royal Berkshire NHS Foundation Trust
University Hospital of South Manchester NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Central Manchester University Hospitals NHS Foundation Trust
References
1 British Medical Association. BMA consultant survey 2013. London. 2013. 2 NHS England. NHS Services, Seven Days a Week –Survey of acute hospitals 2013.
