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Junior Doctors Hours – in 12 easy steps

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

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  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, -> 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 – 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.

  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 >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)

  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

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