Junior Doctors Hours

1
Junior Doctors Hours in 12 easy steps

• Jayn Ammantoola
• Medical Personnel Specialist /
• Project Manager for Junior Doctors Hours Barts
  and the London

2
Painting the historical picture

• 1990 and before 1 in 2 on call UMTs shoe
  polishing breakfast waiters Thursday evenings
  off
• 1991 Heads of Agreement ADHs full partial
  shifts goodbye goodwill
• EL(96)10 for those working on call, but at a
  partial shift intensity hours limits
• HSC 1998/227 claims for intensity at full shift
  level, paid at Class 1
• HSC 1998/240 rest defined more intensity
  negotiations between DoH and BMA
• July 2000 the NHS Plan modernisation, -gt
  Shifting the Balance of Power April 01 and Jan
  02
• October / November 2000 pay banding blue
  questionnaires
• Jan 2001 for December 2000 AL(MD)1/01

3
Banding

• AL(MD)1/01
• Band 2, and 1 hours
• Band ..a, ..b unsocial hours
• Band 3 non compliant punitive financial
  penalties for the Trusts
• Annual multiplier
• Mutual Obligations
• Allocating a band through the RAT
• It was aimed to be simple, fair, recognising
  intensity, unsocial hours, and would put an end
  to hours counting.
• Pensions changes contributions assessed on 40
  hours

4
Banding - Incentives Sanctions

• Annual Pain - the multipliers Dec 2000, 2001,
  2002
• The mutual obligation to ask and to do
• The clinical governance / tired doctors / non
  compliant doctors vs the service issues
• Disciplinary procedures for not monitoring
• RAT assistance
• Withdrawal of Educational approvals
• Stars

5
Practicalities - pay protection

• Para 32 39 of the circular AL(MD)1/01
• The question When were you appointed?.
• No cheating
• Compliance earlier less pay protection problems
  later

6
Practicalities in your Trust

• Board level backing ( not just lip service)
• Departmental angels
• Written work patterns
• Consultants genuine
• The training questions addressed seriously

7
August 2003

• August 2003 all SHOs and SpRs compliant
• How have we done so far?
• More Trust doctors
• A few nurse practitioners
• Some doctors helpers
• And next???

8
Next, Working Time Regs

• The European Working Time Directive is European
  law that was implemented into UK law in 1998.
• It is legislation designed to protect the Health
  Safety of Workers

9
EWTR key issues.

• Reduce the overall weekly working hours for
  junior docs first to 58 (well 56 actually
  well keep the New Deal rules here), and then to
  48 hours by 2009.
• 11 hours rest in every 24 hours, from August
  2004.
• Minimum rest of 24 hours each week.
• Rest break of 20 minutes per 4 hours of work.
• Paid holidays of 4 weeks per year.

10
EWTR other issues

• SIMAP the Spanish doctors who went to court
  if you are resident on call in hospital, you are
  deemed to be working for the whole of the on call
  period (sleeping, watching TV, eating)
• Education what time for teaching?
• Service delivery

11
Derogation?

• Derogation to disapply or modify
• Cannot be done for targets but can be done for
  soft issues by national or local agreement.
  Workers will be given equivalent periods of
  compensatory rest.
• Article 3, (rest break 11/24)
• Article 4, (minimum rest 20 mins gt6 hours)
• Article 7 (minimum rest 24 hrs in 7 days)
• Article 8, Night workers
• Article 16, (length of time for average hours 1
  year)

12
What to do?

• Implement new work patterns
• Use good monitoring data
• Remove inappropriate duties
• Plan for training, and service provision
• Design it with the juniors
• Implement with plenty of time to tweak and modify
• Remonitor after 6 weeks.
• Do all this before August 2004

13
What else to do?

• Think differently - in conjunction with all
  participants transform (throw it all in the
  ring, mix, and see what comes out)
• Hospital at Night
• The Front Door (TIS) (see and treat)
• New working practices
• Skills escalator