Quarterly Report on Safe Working Hours for Doctors and Dentists in Training

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Quarterly Report on Safe Working Hours for Doctors and Dentists in Training Q4 1st _{February 2021 – 30}th _{April 2021}

Royal Berkshire NHS Foundation Trust

Guardian of Safe Working- Miss Hanna Thomas

Executive summary 1. Introduction

This report is presented to the trust workforce committee. It contains data on the exception reporting, trends and outcomes within the trust over the last quarter, with comparison with similar data for preceding periods. Significant themes have been described in additional detail, with qualitative analysis and assessment of the working patterns of junior doctors and related issues also included.

2. High level data

Number of doctors in training (total): 311

Number of doctors in training on 2016 TCS (total): 289 Numbers of GPST trainees on honorary contracts: 88

Number of trainees on dental contracts: 1

Amount of time available in job plan for guardian to do the role: 2 PAs Admin support provided to the guardian (if any): none

Amount of job-planned time for educational supervisors: 0.25 PAs per trainee 0.125 Pas if the trainee is off site for part of their training

2.1 Exception Reports

There have been 72 exception reports in the past quarter.

Reporting is now only via Doctors rostering system (DRS) which appears to have been accepted by trainees and most consultants. There continue to be issues with the system, particularly in obtaining the guardian of safe working report.

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This number of exception reports is in keeping with a similar number last year and have remained steady throughout the past 3 quarters.

2.2 Working hours’ and Education exception reports  Exception reporting for hours and rest: 59

 Exception reports for hours and rest and missed educational opportunities: 10

Reason to exception report Number

Late finish 60

Early start 6

Unable to take breaks 10

Difference in working pattern 3

 Exception reports for missed educational opportunities: 3 Unable to attend teaching – 2

Inadequate experience / exposure - 2

2.3 Reports by trainee grade

Grade Number

F1 31

F2 – CT2 23

ST3+ 18

In this quarter, exception reporting seems to be more evenly split between all grades or junior doctors and not just the F1 doctors.

3 2.4 Exception reports by department

4 2.5 Exception Reporting Outcomes

Payment for Additional hours: 62 Time off in Lieu: 3

No action required: 7

3. Breaches and fines relating to safe working

Type of Breach Number

A breach of the 48 hour average working week 0 A breach of the max 72 hour limit in any consecutive 168 hour period

0

A breach of the maximum 13 hour shift length 0 Breach that the min 11 hours rest requirement

between shifts has been reduced to fewer than 8 h 0

Where 5 hours of continuous rest between 2200 and 0700 during non-resident on call has not been achieved

0

Breaks have been missed on at least 25% of occasions across a 4 week period

10

Four Immediate safety concerns were raised. These are all from Cardiology where staffing levels have been very low. I will discuss this further later on in the report.

Total amount in the junior doctor’s fund relating to fines £9422.

4. Work schedule review

Trauma and Orthopaedics requested a work schedule review following the previous quarterly report and exception reporting has subsequently reduced significantly, which is very good.

5 5. Locum Bookings

There were 1528 locum shifts during this 3-month period (compared to 2037 in the previous

quarter). This reduction would reflect in the increased requirement needed during the COVID surge. No shifts were filled by agency – all shifts were filled by the staff bank.

There were 278 Unfilled Shifts

5.1 Locum Booking by Department

Numbers in brackets are from the previous quarter

Department

Shift

Number

A&E Bank 632 (457)

AMU Bank 514 (619)

Obstetrics Bank 72 (52)

Gynaecology Bank (30)

Paediatrics Bank 57 (50)

ICU - Trainees Bank 65 (93)

Respiratory Bank 9 (33) Cardiology Bank 47 (13) T&O Bank 40 (89) Oncology Agency (56) Anaesthetics Bank 11 (18) Urology Bank 1 (32) ENT Bank 7 (18)

General Surgery Bank 85 (52)

Ophthalmology Bank 74 (95)

Elderly Care Bank 75 (57)

Neurology Bank 2

Gastroenterology Bank 8

GUM Bank 14 (15)

6

Renal Bank (2)

5.2 Locum booking by Grade

Grade Filled Bank Shift

FY1 247

FY2 / CT1 / CT2 804

ST3 + 773

5.3 Reasons for Locum Shift requests  Rota Gap with 856

 COVID-19 (Additional demand) with 428

 Sickness with 152

 Additional Hours with 86

 COVID-19 (Staff sickness/isolation cover) with 69

 Additional Clinic with 44

 Research with 39

 Casualty Cover with 20

 Maternity Leave with 19

 Covid Virtual Clinic with 17

6. Qualitative Information

7 6.1 Cardiology

Cardiology have been very short staffed since January being two SHOs down due to sickness and a rota gap. This has put significant pressure on the remaining junior doctor staff, particularly the F1 doctors. A number of safety concerns have been raised in relation to staffing levels on Whitley Ward. I have met with Dr. Elkington, Dr. Bull and HR in order to try to find a solution for this. From next week there are two locum SHOs starting and Cardiology have written a business case for two F3 posts to try to improve overall staffing levels from August. I would advise the workforce committee to encourage this business case.

6.2 GP Trainees

From August, the trust is losing a number of GP trainees due to a change in the way that GP trainee is being delivered. This will have a significant impact on rota numbers and additional staff will be required in order to fill these gaps.

6.3 Junior Doctor’s Forum

The Junior Doctor’s Forum met on 22nd _{April 2021.} The following points were brought to the meeting

- Questions about additional pay during the COVID surge - GP trainees raising issues about the start time in Paediatrics

- Loss of the Chief Registrar from General Surgery who had been a positive role model for the junior doctors in the department

- Low staffing levels on Whitley Ward

7. Summary

Exception reporting has remained steady overall, with a significant increase in those from Cardiology reflecting low staffing levels. However, only 9% of the overall junior doctor cohort have submitted an exception report in the quarter, indicating that more engagement with the process is still required. Locum bookings continue to only be filled internally and I am still awaiting break down of this from HR to ensure that safe working is being followed. The loss of GP trainees from August will have significant impact on the staffing levels. Forward planning by departments to reflect this staff reduction will be very important to ensure continued safe working within the trust.

Hanna Thomas