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QUARTERLY AND ANNUAL REPORT BY GUARDIAN FOR SAFE WORKING

HOURS: DOCTORS AND DENTISTS IN TRAINING – January 2018

Executive summary This is the fifth quarterly report to the Trust Board which incorporates the first annual report. As our doctors in training below SpR grade started in August, the period covered by this report is from months three to six for these trainees in our Trust. As anticipated the number of exception reports has dropped in this quarter. The vast majority of the exception reports were related to late finishing. There were two exception reports relating to missed educational opportunities due to commitments in the ward. There was no repeating pattern. The Annual Report which forms the second part of this report provides an annual data summary in particular in relation to rota gaps, the annual summary of the exception reports and the actions taken. Introduction

During the past quarter the number of exception reports has dropped from 76 in the

previous quarter to 54. This is likely to be related to doctors in training being more

familiarised with their work and therefore less likely to finish late to complete their

tasks. There were two exception reports relating to missed educational opportunities

and one exception report relating to missed days in lieu due to a trainee rotating to

another firm. They will be discussed in the main part of this report.

High level data

Number of doctors /dentists in training (total)

202 posts/212 trainees. (We have less than full time trainees as slot shares). Figure also includes those on maternity leave.

Number of doctors / dentists in training on 2016 TCS (total)

173

Amount of time available in job plan for Guardian to do the role

1PA

Doctors Working Hours/2016 Doctors Contract Coordinator

1WTE

Amount of job planned time for educational supervisors

0.25PA per trainee

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a) Exception reports (with regard to working hours)

The analysis of the exception reports from 17th October 2017 to 17th January 2018 is

as follows:

Exception reports by department

Specialty No. exceptions carried over from last report

No. new exceptions raised

No. exceptions closed

No. exceptions outstanding

General Surgical

4 26 21 5

General Medicine

8 19 17 2

T&O 5 0 0

O&G 0 2 0 2

Paediatrics 2 3 2 1

ENT 0 4 4* 0

Total 19 54 44 10

*There is a possible inaccuracy regarding a small number of exception reports

extracted from DRS4 programme in this quarter (4 reports in ENT).

Exception reports by grade

Specialty No. exceptions carried over from last report

No. exceptions raised

No. exceptions closed

No. exceptions outstanding

FY1 12 38 32 6

FY2 & ST1 & ST2

7 13 9 4

ST3+ 0 3 3 0

Total 19 54 44 10

**The Exception Report by Rota is not included in this report as the information on

DRS4 is unreliable.

Please also see appendices 1 & 2

The main theme of the exception reports in this quarter, again, related to doctors in

training having to stay on later than the scheduled finish time in the evening due to

the volume of the workload. There was one exception report from an FY1 trainee in

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general surgery raising concern regarding the support from more senior members of

the team in attending to an unwell patient. The clinical lead for general surgery has

confirmed that a review of the situation with the trainee concerned has taken place

and escalation approach agreed with the trainee.

There were two exception reports citing missed educational opportunities. Those

were related to clinical commitments preventing the trainee from attending teaching

sessions. There was no clear repeating pattern in relation to this.

An exception report was made as a trainee had lost the opportunity to have days off

after nights on call due to a scheduled rotation to another firm. This is the first

exception report of this nature at SaSH. However this is likely to be a repeating

pattern when rotation takes place. I have therefore consulted with other Guardians

at the KSS Guardian Forum. The overall opinion was that trainees who lose out in

this way should be compensated. A number of other trusts also indicated that they

have provided compensation in this respect. The compensation could involve

payment as well as the new firm may not be able to allow time off in lieu for the

incoming trainee. This could mean a small additional cost on the budget of each

department each year. I am in consultation with the Chief of Education and the

Medical Education Manager to ensure that the repetition of this issue is minimised in

the subsequent rotations.

Similarly to the last quarter, there was no clear pattern of the exception reports of a

problems of systemic nature such as the timing of the ward rounds or assignment of

inappropriate tasks to trainees.

The cardiology firm has since the last report been able to employ staff into the

vacant posts and as a result the exception report number in cardiology has dropped

satisfactorily.

We still have to chase up clinical supervisors to complete the response to exception

reports in a timely way. This is a new culture that all clinical supervisors need to

adopt. Having said that, judging from the anecdotes obtained at the Guardians KSS

Forum, the level of cooperation from the clinical supervisors in our Trust is

comparatively good. At the time of the completion of this report there were ten open

exception reports, three of these are in processed of being closed.

b) Work schedule reviews

There has not been a need for a formal work schedule review during the past three

months.

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c) Fines

There was no infringement that resulted in a fine during the past three months. One

junior doctor did work 72 hours on a period of rolling 7 days. Had he worked any

longer than that a fine would have been imposed.

Fines by department

Department Number of fines levied Value of fines levied

General Surgery 0 0

General Medicine 0 0

Paediatrics 0 0

Total 0 0

Fines (cumulative)

Balance at end of last quarter

Fines this quarter Disbursements this quarter

Balance at end of this quarter

0 0 0 0

Qualitative information

Issues arising

1. Rota Gaps

The current gaps on the rotas are as follows:

Rota name Gaps Action

A&E Junior 2 Two clinical fellows to be appointed

A&E Middle .6 2 x LTFT trainees.

Anaesthetics middle 1.5 Internal or external locums ad hoc

Paediatric Junior .4 Internal or external locums ad hoc

Obs & Gynae Junior 1

Filled with MTI

Obs & Gynae Middle .7 Internal or external locums ad hoc

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2. Poor attendance at the Guardian’s Forum Meetings

The attendance at the Guardians Forum meetings has remained poor. The provision

of light lunch to the attendees has helped but we still consistently had less than ten

junior doctors attending. Those who attended have contributed quite significantly to

the quality of the discussion. I feel that it is important that we continue to provide

lunch for those who attend as it was clear that the trainees came to attend the

meeting and when straight back to work subsequently.

Summary

The pattern of exception reports in the past quarter has been as expected. The

number of exception reports dropped from the previous quarter as trainees are more

familiar with the work at their level. There was no requirement for the Guardian to

intervene in relation to any of these exception reports except to encourage the

clinical supervisors to attend to the reports in a timely manner.

There has not been any need to require any department to produce an action plan to

remedy a systemic problem.

The problems related to loss of days off due to trainees moving from one post to

another need to be addressed further which I intend to do so in consultation with the

Chief of Education.

Learning from the experience in August 2017 when new trainees joined the Trust,

the Chief of Education and I have been in consultation as to what preparation we

could undertake in advance of the new intake in August 2018 in order to assist the

newly qualified trainees in their first month here.

Dr Virach Phongasthorn

Consultant Physician &

Guardian For Safer Working

January 2018

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Appendix 1.

Number of exception reports per quarter

0

10

20

30

40

50

60

70

80

Apr-17 Jul-17 Oct-17 Jan-18

Number of exceptions

Number of exceptions

7

Appendix 2.

Pattern of exception reports this quarter.

0

1

2

3

4

5

6

7

8

9

10

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ANNUAL REPORT ON ROTA GAPS AND VACANCIES FROM GUARDIAN FOR

SAFE WORKING HOURS – January 2018

Executive Summary

The annual report by the Guardian for Safe Working Hours is a requirement stipulated by NHS Employers. NHS Employers recommended that the annual report concentrated on rota gaps and vacancies. However I feel it would be right to bring to the attention of the Board the overall picture relating to the workload and educational opportunities in training over the previous 12 months along with a brief discussion related to particular issues which have arisen. As stated in the sections below, unfilled posts create additional pressure on doctors in training and it is important to minimise the rota gaps as far as possible. Overall the patter and number of exception reports are acceptable and compare favourably to our peers. The difficulty new doctors encounter when they first join our organisation in August would need to be addressed in a planned way and I intend to work with our Chief of Education to try to assist our newly qualified doctors during their first months of joining. High Level Data Number of doctors/dentists in training (total) 202 posts/212 trainees Number of doctors/dentists in training on 2016 TCS 173 Annual data summary Vacancies

Rota gap April 2017

General Surgery ST3+ 1 trainee and 1 Trust grade

Orthopaedic SHO 4 Trust grade

Obstetrics & Gynaecology ST3+ 3 Trainees (all on maternity leave)

ENT SHO 1 trainee and 40% of another trainee

Paediatric ST4+ 2 trainees as some are less than full time

Rota Gaps July 2017

General Surgery ST3+ 1 Trainee and 1 Trust Grade

Orthopaedic Junior 2 Trust Grades

Orthopaedic Senior 2 Specialty Doctors

Obstetrics & Gynaecology ST3+ 3 Trust Grades

ENT SHO 1 Trainee and 40% of another Trainee

Paediatric ST4+ 2 Trainees as some are less than full time

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Rota Gaps October 2017

Rota name Gaps Action

A&E Junior 2 Two clinical fellows appointed

General Surgery Junior 1 Internal or external locums ad hoc

General Surgery ST3+ 1 Internal or external locums ad hoc

Orthopaedic Junior 3 Internal or external locums ad hoc

Orthopaedic Senior 2

Internal or external locums ad hoc

Ophthalmology 2 Ad hoc locums

Paediatric Junior 1 Internal or external locums ad hoc

Paediatric ST4+ 2 Internal or external locums ad hoc

Medicine (Cardiology) Junior

1 Two locums in post (one vacant PA post)

Rota Gaps January 2018

Rota name Gaps Action

A&E Junior 2 Two clinical fellows to be appointed

A&E Middle 0.6 2 x LTFT trainees.

Anaesthetics middle 1.5 Internal or external locums ad hoc

Paediatric Junior 0.4 Internal or external locums ad hoc

Obs & Gynae Junior 1

Filled with MTI

Obs & Gynae Middle 0.7 Internal or external locums ad hoc

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Trainees outside the Trust overseen by SASH Guardian

Trainee Grade Rotation 1 Aug 2017

Rotation 2 Dec 2017

Rotation 3 April 2018

Total Gaps

GP trainees

ST1/ST2/ST3 46(0)* 46(0) 0 0

Foundation

FY2 7 (0) 7(0) 0 0

Foundation

FY1 2(0) 2(0) 0 0

*Number in brackets is the number of unfilled posts. There are 5 five VTS ST2 posts unfilled at ST2 grade but they are posts for placement at SASH which are covered internally.

(1) Exception Reports

During the calendar year 2017 there were a total 176 exception reports of which 164

were closed by the end of the calendar year. Twelve remained open at that point.

Seven of these exception reports were due to missed educational opportunities the

remainders were to do with the working hours. The breakdown of the exception

reports by top five departments are:

General Surgery 88

General Medicine 68

ENT 8

Trauma & Orthopaedics 5

Paediatrics 4

The breakdown of the exception reports by grades are:

FY1 138

SHO 24

ST3+ 7

Seven were not classified by the Doctors Rostering System (DRS) recording.

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(2) Work schedule Review

There was no requirement for work schedule review during the previous calendar

year.

(3) Fines

There was no incident that triggered a fine by the Guardian of Safe Working Hours

during the previous calendar year.

Actions taken to Resolve Issues

(1) Timeliness of the closure of Exception Reports

The Medical Workforce Specialists involved and the Guardian have been in regular

communication with clinical supervisors who have exception reports to respond to.

While the number of exception reports being closed late is not worse than our

peers, the figure should be better. The culture of attending to exception reports

when they arise is still not as yet embedded amongst our clinical supervisors. This

needs to be improved further.

(2) Assistance to new FY1 trainees in the month of August

This is an issue identified in 2017 (please refer to the latest quarterly report) and we

will need to have a plan in place to assist FY1 trainees starting in August 2018.

(3) Rota Gaps (unfilled posts)

During the post year it was clear that unfilled posts put a great deal of strain on the

doctors in training in the respective departments. The HR team for each Division

needs to be very pro-active in addressing unfilled posts. Nationally this is seen as

a very significant concern in particular at middle grade level in certain specialties.

In the midland and northern regions, O&G and Paediatrics are the area of potential

shortage.

(4) Attendance at the Guardian for Safe Working Hours Meeting

The attendance by junior doctors is still too low. We will try to improve this through

more usage of electronic communications directly to the junior doctors’ phones and

the continued provision of light lunch at the meetings.

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(5) Appointment of Less Than Full Time Champion

The consultant appointed as the Less than Full Time Champion resigned because

of the increased requirement of the post stipulated by NHS Employers. The person

involved is a less than full time employee and will not be able to allocate enough

time to fulfill this post. We will therefore need to recruit a new Champion.

Determination needs to be undertaken as to whether this post should be

remunerated or not.