Better rota planning
In the last twelve months I have worked in A&E, paediatrics and general practice in two different parts of the country. In theory, work schedules (rotas) should be released six to eight weeks in advance, but they are often late and are subject to last-minute changes.
I’ve received desperate requests for shift swaps from colleagues – for example, who have been rostered to work on their own wedding day – and it is common practice to be swapped onto nights or called back in to work at a moment’s notice.
It would be a great help to have the contact details of rota co-ordinators before starting a job. Accommodating leave requests in the rota rather than relying on individuals to swap would be much fairer. And distributing rotas with the advised six to eight weeks’ notice would help doctors in advance would help with planning other commitments. In future, using dedicated rota software would avoid human error.
Shadowing before my first job in psychiatry prepared me well for that role, but not for my acute medical job four months later. I went on my first ward round not knowing who anyone was, and my ‘smartcard’ was not set up to order tests. I was fortunate not to have started on a night shift, where I would have had only the support of a skeletal out-of-hours service. It is unsurprising that junior doctors can feel isolated and unsupported.
A mandatory, local, clinically focused induction should be arranged at the start of each new rotation, with locum doctors arranged in advance to ensure all new juniors can attend. This could be supported with a departmental ‘induction pack’ – this was invaluable to me in my last job, detailing essential information about the department, shifts and computer systems.
Night shifts usually last around 13 hours for up to four consecutive days. However, quiet, private break rooms are rarely available, and when they are, staff may be charged for their use. Having a 15-minute nap during breaks has been recommended by a leading consultant in sleep medicine, but I find these difficult to achieve on a cold, unclean sofa in the doctors’ mess.
Long commutes are inevitable as training deaneries cover vast geographical areas, and 50 per cent of anaesthetic trainees have had a near miss or accident when driving home from a night shift.
Quiet, clean rest rooms should be available for staff to help avoid dangerous fatigue overnight, and staff should be encouraged to use these rooms after a night shift if they do not feel safe to drive home due to tiredness.
Junior doctors working out of hours are contacted through a ‘bleep’ system, so that they can be reached anywhere across a sprawling hospital site. Answering a bleep requires interrupting workflow, finding a hospital phone, and calling the displayed extension number – by which point the bleep-sender may have left.
This system makes it impossible to prioritise work – while attending a cardiac arrest I was once bleeped to re-write a drug chart and prescribe an antihistamine.
‘Bleep screening’ senior nurses, who triage job requests to appropriate members of staff, have an invaluable role to play out of hours and could be more widely adopted. Portsmouth Hospitals NHS Trust has employed bleep screening, and sends jobs to clinical staff via a smartphone system rather than by bleep, halving the number of incidents putting patients at severe or moderate risk of harm in the first year of implementation.
Junior doctors rarely work regularly with the same on-call teams, and due to the short length of rotations they often feel poorly integrated within the multidisciplinary team.
I have often felt physically and mentally drained after managing multiple unwell patients, but it is hard to ‘shut down’ to get restful sleep before returning to work 11 hours later. Informal breakfast debriefs at the end of a run of nights could allow teams to decompress, reflect and air anxieties.
Work from the Fund has already identified frontline difficulties that erode staff morale and has noted that more could be done to draw on the experience of junior doctors, who are well placed to compare and contrast practices in different hospitals. But – to quote from the report – 'this requires trust leaders to genuinely value junior doctors’ insights and to challenge the hierarchies and tribal divisions that are longstanding barriers to teamworking’.
I hope this blog highlights some of the opportunities at a local level to make meaningful improvements to junior doctors’ working lives, despite the wider macro-political and economic climate.
Why oh why are we constantly seeing ways of improving doctors morale.
Always a cost neutral answer (but people are getting paid to meet and put this rubbish together).
You seem to have forgotten that
(a) they were on strike, yes on strike without pay, against a new contract that was just IMPOSED by Jeremy Hunt.
(b) they were told that patients would suffer due to their "selfish" strike because of delayed operations but funnily enough this winter thousands of urgent and elective operations have been cancelled by the government in a planned response to the winter crisis that was seems to be endless.
(c) they are hung out to dry and scape goated (Dr Bawa Gaba and Dr Day) when working in unsafe environments and now met with ending of their careers and manslaughter sentences rather than corporate manslaughter.
(d) Their pay is denuded year after year with sub inflationary pay rises and their hourly pay is poor whilst the costs of being a doctor rise. Starting salary is less than a nurse and they hold 5 years of student debt. Even when pay rise closer to inflation is recommended the DDRB are over rued by the government.
(e) They often do the work of more than one doctor in stressful and under resourced settings
(f) They are given the false pretence that they are being trained but actually it is service provision - the conditions, pay and training of doctors assistants is far superior to that of the doctor themselves!!!
(g) A recent review looked at morale and one of 10 options was to give them access to water - Jeez!!!
The treatment of junior doctors is abhorrent and tantamount to bullying/exploitation and shows that NHS management clearly failed basic Business studies or economics, if they even studied them.
Great article, but many of these changes are already happening, or more accurately, should be happening but aren't due to lack of funding, staff shortages, delays in implementation etc.
The systemic underfunding of the NHS is driving staff across hospitals, from nurses and doctors to managers and ward clerks away, and won’t be resolved without a concerted funding drive to pay staff fairly for hours worked, provide basic human needs such as hot drinks, food around the clock and proper rest areas, from staff rooms with fridges to clean on call rooms where staff on nights can sleep.
None of this is complicated, but all of it costs money. With the economy growing and tax revenues likely to increase, now is the time for the government to announce a significant increase in funding to ease the current situation. Whether this happens remains to be seen.
Read the detailed case of the situation with the doctor recently struck off by the GMC and found guilty of homicide.
Do you think that this an important factor?
In order that change is effectively undertaken all levels of government and other public funded organisations need to demonstrate good management
Independent management accreditation is required to achieve this
The recent assault to doctors’ morale are the imposed new contract and the case of Hadiza Bawa where a trainee was charged for manslaughter and struck off the GMC. In this case, a trainee was unfairly held responsible for multiple system failure.
Trainees need to be paid appropriately for the hard work they do. They need to feel supported and protected whilst doing their jobs.
I agree with the other comments posted here, especially Russell Barber's. A healthcare system cannot be safe or effective when underfunded. Yet somehow there's always enough money to pay the managers 6 figure salaries! I've been an NHS doctor for nearly 10 years now, it still isn't clear what most of these managers do. Articles like this are simply a useful distraction from the core problem of underfunding and insufficient staffing.
Is this a blog series? If not, it should be. I would love to read the next installment on this subject.