PHT Junior Doctors Rotas and Monitoring Arrangements Policy

POLICY FOR THE MANAGEMENT OF JUNIOR DOCTOR ROTAS AND MONITORING ARRANGEMENTS

Reference Number HR/JDRM

Version 5

Name of responsible (ratifying) committee HR Policy Group

Date ratified 7.6.11

Document Manager (job title) Junior Doctors Hours Manager

Date issued 1.7.11

Review date September 2015

Electronic location

Related Procedural Documents Junior Doctors Rebanding Policy New Deal, Working Time, Banding Supplement, Rotas, Key Words (to aid with searching) Rebanding, monitoring, Junior Medical Staff

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 1 of 9 CONTENTS

QUICK REFERENCE GUIDE...... 3 1. INTRODUCTION...... 3 2. PURPOSE...... 3 3. SCOPE...... 3 4. DEFINITIONS...... 3 5. DUTIES AND RESPONSIBILITIES...... 3 6. PROCESS...... 3 7. TRAINING REQUIREMENTS...... 3 8. REFERENCES AND ASSOCIATED DOCUMENTATION...... 3 9. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS...... 3

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 2 of 9 QUICK REFERENCE GUIDE

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

1. It is the intention of the Trust to protect the health, safety and well being of all Junior Doctors and to provide the best standard of care for patients.

2. All Junior Doctor rotas within Portsmouth Hospitals NHS Trust must meet the requirements of the New Deal and European Working Time Regulations (EWTD).

3. Any change to a Junior Doctor rota within Portsmouth Hospitals NHS Trust should follow the nationally and regionally agreed process to maintain compliance with New Deal, EWTD and provide the required education for its Junior Doctors whilst maintaining a high standard of patient care.

4. All Junior Doctor posts will be monitored twice a year in accordance with AL (MD) 10/1 and under the guidelines laid down in HSC 2000/031.

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 3 of 9 1. INTRODUCTION

1.1 Portsmouth Hospitals NHS Trust (“the Trust”) is responsible for ensuring all Junior Doctors work to New Deal and European Working Time Directive (EWTD) requirements though the implementation and maintainance of rotas. All rotas are implemented via the rebanding process (please see Junior Doctors Rebanding Policy for more information).

1.2 In order to ensure compliance with New Deal and EWTD is maintained there is a mutual obligation for the Trust and Junior Doctors to monitor their hours of work and rest. The administration of the monitoring is carried out by the Trust.

2. PURPOSE

2.1 The principles of monitoring are set out in accordance with AL (MD) 10/1 (point 15 to 22), Junior Doctors Terms and Conditions of Service, Junior Doctors Hours – Monitoring Guidance (published by NHS Executive, October 2000), and Junior Doctor Guidance, 2009 held by the SHA (or successor body). The Trust will adhere to these principles.

2.2 In order to meet these requirements the Trust will:

 Monitor each Junior Doctor post twice annually as a minimum. Junior Doctor posts will be monitored by rota within each department or specialty. The Junior Doctors who are working the same rota but who are in different specialties or tiers will be monitoring as one group.

 Use the same process for each monitoring exercise. The Trust will have an agreed monitoring programme in place.

 For all valid monitoring exercises the results will be reviewed and if the results differ from the actual rota, investigations will be undertaken to ensure the health and well being of the Junior Doctors and patients they care for.

 Junior Doctors are expected to participate in any monitoring exercise organised by the Trust. Junior Doctors who fail to participate will be reported to their Educational Supervisor. Persistent offenders will be reported to the Medical Director.

3. SCOPE

3.1 The Policy applies to all those training and non training grade Doctors working on a Junior Doctor rota within the Trust. It also applies to all specialties within each Clinical Service Centre who have a Junior Doctor rota.

In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety.

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 4 of 9 4. DEFINITIONS

4.1 SHA

South Central Strategic Health Authority has ownership of a guide to Junior Doctor’s hours, which includes monitoring. The guide is an interpretation of the sections of the Terms and Conditions of Service for medical staff which relate to Junior Doctors hours and monitoring of those hours.

4.2 Training grade Doctors

These are Doctors who are working in a Wessex Deanery educationally approved post. The time spent at this Trust will count towards their training and career progression.

4.3 Non training grade Doctor

There are two types of non training grade Doctor:

 A Doctor working in a non-educationally approved (Trust Doctor) post. The time spent in this post does not count towards their overall training or career progression.

 A Doctor who is no longer working within Deanery training programmes, for example specialty Doctor or clinical fellow, but will undertake a function on the Junior Doctor rota.

For the purposes of this policy both types of Doctors will be called Junior Doctor.

4.4 New Deal

This is a set of rules governing the hours and work patterns Doctors in training must adhere to. New Deal is contained within the Junior Doctors Terms and Conditions of Service

4.5 Working Time Regulations

This is a European regulation, forming part of Health and Safety legislation. European Working Time Directive (EWTD) stipulates hours and work patterns for all employees.

4.6 Junior Doctor Rota

All Junior Doctors (either educationally approved or Trust Doctor posts) will work according to a set rota within a given specialty. The rota will include all the hours a Doctor must work and will also include education and training time.

5. DUTIES AND RESPONSIBILITIES RELATED TO THE ROTA

5.1 Clinical Service Centre

The role of the department is to own the rota, and take responsibility for managing the day to day running of the rota, which includes enforcing the shift times, supporting the monitoring process and assisting in any investigations following monitoring.

5.2 Junior Doctor

The role of the Junior Doctor is to participate in a monitoring exercise request. Monitoring should be completed on a daily basis and provide a true and correct picture of the working hours of the Junior Doctor.

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 5 of 9 5.3 Medical Personnel

The Medical Personnel Team is responsible for establishing and carrying out the monitoring process, monitoring each post twice a year and facilitating investigations and actions following monitoring exercises, if required.

6. PROCESS

6.1 Establishing a Monitoring plan

6.1.1 The Trust has an agreed standard 6 monthly monitoring programme. The standard programme is handed out at Trust induction. At the beginning of each 6 month period the exact monitoring dates for each rota will be established and a copy sent out to all Junior Doctors and CSC’s via the Trust email. Monitoring will not be undertaken at change over, bank holidays or in exceptional circumstances (i.e. flu epidemic).

6.1.2 All Junior Doctors who work a rota, including Less Than Full Time Trainees, Training Doctors, Specialty Doctors and where possible locum Doctors will participate in monitoring.

6.1.3 Each department must identify a consultant who will take responsibility for ensuring that the trainees in that dept. comply with their monitoring obligations. This will usually be the college tutor, but this can be delegated to another consultant, who’s name will be given to the monitoring team.

6.1.4 The majority of rotas are monitored for a two week period. Where there is only one Junior Doctor on the rota, or the Junior Doctors work a low, non resident on call commitment the rota may be monitored for one month.

6.2 Distribution of monitoring information

6.2.1 Two weeks prior to monitoring, the monitoring exercise will be set up. Monitoring is recorded electronically via the Doctor’s Rostering System (DRS).

6.2.2 Once the exercise has been set up, all Junior Doctors participating will receive two e-mails. One e-mail will contain the login and password details to access the DRS, and the other will formally notify the Doctor of the monitoring, remind them of the reasons for monitoring and include a step-by-step guide to completing the on line diary card and a list of Frequently Asked Questions.

6.2.3 The department leads (Clinical lead for monitoring, rota coordinator, HR lead and Operational Manager) for the rota being monitoring will be e-mailed, informing them of the monitoring date and requesting support to ensure Junior Doctors complete their monitoring data.

6.2.4 Posters will be placed in suitable areas advertising the monitoring taking place.

6.3 The Monitoring Exercise

6.3.1 On the first day of the monitoring exercise Junior Doctors will receive a reminder e-mail regarding monitoring.

6.3.2 At the beginning of the second week of monitoring (or for month long monitoring – week 3) the DRS monitoring will be checked to ensure Junior Doctors are completing their data. If

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 6 of 9 Junior Doctors have not been completing their data they will be contacted via e-mail and reminded of their responsibilities; the department leads will also be informed.

6.3.3 Towards the end of the monitoring period all Junior Doctors undertaking monitoring will be reminded of the date all monitoring data must be submitted by. Reminder posters will be placed around the Trust.

6.4 Completion of Diary Cards

6.4.1 Junior Doctors have three working days from the end of the monitoring period to submit their on line monitoring data. During this period those Junior Doctors not completing will be e- mailed, bleeped and telephoned to remind them of the process. Department leads will also be kept up to date of those Junior Doctors not completing all their monitoring data.

6.5 Non-Returns

6.5.1 If a Junior Doctor has not completed data for the whole period, this will be queried with the Doctor. Only where no valid reason is provided for missing data will the return not be counted.

6.5.2 The Trust will report any non returnees to their relevant Educational Supervisor for this to be discussed at the next meeting. Medical Staffing will request feedback from the meeting.

6.5.3 The monitoring lead will be required to comment on the returns from their department allowing for any valid reasons to be appended before the information is passed to the medical director.

6.5.4 Any logistical difficulties the trainee reports on providing the data must be commented on by the lead and an action plan to resolve the issue enclosed.

6.5.5 Junior Doctors who fail to return all their monitoring data will be informed of the non return and the consequences of this. The Junior Doctor’s name will then be recorded.

6.5.6 If a Junior Doctor fails to return monitoring data on a future monitoring exercise, without valid reason, they will be reported to the Medical Director, who will contact the Doctor to discuss the issue. The Wessex Deanery may also be informed of this breach.

6.6 Diary Card Analysis

6.6.1 In order for monitoring to be considered representative, a return rate of 75% or above is required.

6.6.2 For valid monitoring exercises, Medical Staffing will review the data collected against the agreed rota. The analysis will highlight the average hours of duty worked, rest periods and will highlight compliance against New Deal and EWTD. Any differences will be investigated.

6.6.3 The analysis and any recommendations will then be sent to the department leads for their consideration and agreement. As rotas are departmental responsibilities, they must agree the monitoring results and confirm the Junior Doctors’ bandings.

6.6.4 The Trust has 15 working days in which to review the monitoring data and for the department to agree the results. Junior Doctors will be informed if there is a reasonable delay in issuing the results. Monitoring results are sent out via the Trust e-mail system. The summary report of each monitoring exercise will be set out in a simple, easy to understand format through which duty and working hours can be clearly assessed against New Deal requirements and pay banding criteria.

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 7 of 9 6.7 Re-monitoring

6.7.1 For those monitoring exercises that fail to achieve a 75% return rate, remonitoring will take place within 4 weeks (taking into account unsuitable times to monitor; see section 6.1).

6.8 Trust reporting of monitoring results

6.8.1 Monitoring results

A summary of each monitoring exercise will be recorded on the Junior Doctors Hours internal website page. This will be updated on a monthly basis.

6.8.2 Monthly HR updates

A monthly exception report is circulated to the HR Business Partner highlighting any generic issues in relation to monitoring and Junior Doctors rotas in general.

6.8.3 Doctors and Dentist Negotiation Committee

A monitoring summary is produced for each meeting. This provides the results for all monitoring exercises carried out in the previous two months, and provides a platform to highlight other issues in relation to rotas and Junior Doctors.

A list of departmental monitoring leads will be presented to the committee and updated as roles change.

6.8.4 Quarterly Reports

Each CSC will receive a quarterly report on Junior Doctor Hours. This will provide confirmation on recent monitoring exercises, any rota issues raised during the quarter and any changes being undertaken with the rota. These issues and any rebanding or associated issues will be dealt with and reports made to the medical director and the DDNC.

7. TRAINING REQUIREMENTS

7.1 The Medical Staffing Team will have the required knowledge to undertake monitoring exercises. All rota coordinators, clinicians, HR Business Partners, operational managers and Junior Doctors will receive 6-monthly updates regarding monitoring and the process. Information about monitoring will be sent to those involved in each monitoring exercise undertaken (for example how to complete the monitoring diary card, the importance of monitoring and the process for those who do not return diary cards).

8. REFERENCES AND ASSOCIATED DOCUMENTATION

Terms and Conditions of Service for Hospital medical and dental staff:

http://www.nhsemployers.org/SiteCollectionDocuments/Hospital_Medical_and_Dental_Staff_T CS_March_08_cd_160209.pdf? bcsi_scan_22797A92F5A626A6=l3P6HaHBmqtp4AD+Xzqqhsx1GpMKAAAArAcrBg==&bcsi_s can_filename=Hospital_Medical_and_Dental_Staff_TCS_March_08_cd_160209.pdf

Advance Letter (MD)1/01, pay and conditions of service of Hospital Medical and Dental Staff and Doctors in public health medicine and the Community Health service: Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 8 of 9 http://www.nhsemployers.org/SiteCollectionDocuments/al_md_1-01)cd_070201.pdf

Modernising pay and contracts for hospital Doctors and dentists in training (HSC 2000/031) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalas set/dh_4012186.pdf

Junior Doctors Hours – Monitoring Guidance http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalas set/dh_4053882.pdf

Guidance on Junior Doctors Hours, South Central SHA, published March 2006

Trust Policy for Junior Doctors Rebanding

9. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS

9.1 A questionnaire will be sent out with each monitoring exercise. Areas covered will include rota design and the monitoring process. A summary of responses will be sent to the rota leads and the Director of Postgraduate Medical & Dental Education. Depending on the comments returned rota leads may be asked to undertake actions.

9.2 At the end of each 6 month period, all those involved in the monitoring process (for example rota coordinators, monitoring lead, clinical leads and so on) will receive a questionnaire and will be given the opportunity to comment on the monitoring process and provide suggestions for improvement.

9.3 The policy will be reviewed on at least a bi-annual basis by the Medical Staffing Team and the Trust’s DDNC; however, any changes to the national monitoring process will be acted upon and the policy changed accordingly.

Policy for the Management of Junior Doctor Rotas and Monitoring Arrangements Version 5 Issued: 1st July 2011(review date September 2015) Page 9 of 9