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Junior Doctors Hours – in 12 easy steps. Jayn Ammantoola Medical Personnel Specialist / Project Manager for Junior Doctors Hours – Barts and the London. Painting the historical picture:. 1990 and before: 1 in 2 on call; UMTs; shoe polishing; breakfast waiters; Thursday evenings off

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Junior doctors hours in 12 easy steps l.jpg
Junior Doctors Hours –in 12 easy steps

Jayn Ammantoola

Medical Personnel Specialist /

Project Manager for Junior Doctors Hours – Barts and the London


Painting the historical picture l.jpg
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, -> 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


Banding l.jpg
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


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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


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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


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Practicalities – in your Trust

  • Board level backing ( not just lip service)

  • Departmental “angels”

  • Written work patterns

  • Consultants genuine

  • The training questions addressed seriously


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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???


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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


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EWTR – key issues…….

  • Reduce the overall weekly working hours for junior docs – first to 58 (well 56 actually – we’ll 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.


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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


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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 >6 hours)

  • Article 7 (minimum rest 24 hrs in 7 days)

  • Article 8, Night workers

  • Article 16, (length of time for average hours: 1 year)


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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


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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


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