Working patterns of junior doctors in the Intensive Care Units of the North West

1. Working patterns of junior doctors in the Intensive Care Units of the North West Dr S Laha, Dr R Challiner STC ICM Trainee Representatives ANWICU Trainee Representatives Dr J Goodall STC Chair Intensive Care Medicine ANWICU June 2006 HelloHello

2. S. Laha, R. Challiner, J. Goodall ANWICU Introduction Working patterns for junior doctors are changing due to: New Deal EWTD SiMAP Hospital at Night Modernising Medical Careers Comprehensive Critical Care Changes prob starting at beg of 1990�s with New deal � Drs no longer cheapest labour in hosps/ started changing working patterns. Changes prob starting at beg of 1990�s with New deal � Drs no longer cheapest labour in hosps/ started changing working patterns.

3. S. Laha, R. Challiner, J. Goodall ANWICU New Deal 1991 Agreement between representatives of junior doctors, consultants, the royal colleges, NHS managers and the government Both the New Deal and the EWTD apply simultaneously 56 hours of actual work per week (1994) Time at work may be a lot longer than 56hrs as rest/sleep time not counted etc.Time at work may be a lot longer than 56hrs as rest/sleep time not counted etc.

4. S. Laha, R. Challiner, J. Goodall ANWICU New Deal Since 1 December 2000 the New Deal has specified the maximum number of duty hours for all junior doctors� posts as: - 72 hours a week on on-call rotas on average- 64 hours a week on partial shifts on average- 56 hours a week on full shifts on average This is in conflict with the EWTD Pay banding meant that for trusts not to comply became hugely expensive.Pay banding meant that for trusts not to comply became hugely expensive.

5. S. Laha, R. Challiner, J. Goodall ANWICU European Working Time Directive Imposes minimum rest requirements minimum of 11 hours continuous rest in every 24 hour period minimum rest break of 20 continuous minutes after every six hours worked minimum period of 24 hours continuous rest in each 7 day period (or 48 hours in a 14 day period) minimum of 4 weeks paid annual leave maximum of 8 hours work in each 24 hours for night workers 1998 Consultants and career grade hospital doctors 2004 Doctors in training Nightshift 8 hrs limit v. diff to achieve - ICU problematic++Nightshift 8 hrs limit v. diff to achieve - ICU problematic++

6. S. Laha, R. Challiner, J. Goodall ANWICU EWTD Timetable August 2000 Timetable was set to incorporate juniors into the directive August 2004 Interim limit of an average 58 hour maximum working week and EWTD rest requirements August 2007 Interim limit of an average 56 hour maximum working week August 2009 Deadline for the average 48-hour maximum working week � this deadline may be extended by another three years with an interim limit of an average 52 hours maximum working week Led to increasing no. of Med Students/ government argued that needed time for the increased no of Drs required to be trained.Led to increasing no. of Med Students/ government argued that needed time for the increased no of Drs required to be trained.

7. SiMAP Judgement Did time spent by doctors "on call", either at the medical centre or away from it, count as "Working Time�? The Court�s judgement was as follows: "The characteristic features of working time are present in the case of time spent on call by doctors �.where their presence at the health centre is required. It is not disputed that during periods of duty on call under those rules, the first two conditions are fulfilled. Moreover, even if the activity actually performed varies according to the circumstances, the fact that such doctors are obliged to be present and available at the workplace with a view to providing their professional services means that they are carrying out their duties in that instance". This means that: "Time spent on call by doctors�.must be regarded in its entirety as working time�.if they are required to be present at the health centre. If they must merely be contactable at all times when on call, only time linked to the actual provision of � services must be regarded as working time." (DoH) Resident on-call rotas become unworkable Court � any hrs that may need to be at their place of work are counted as �working time� regardless of whether actually performing their actual service or not.Court � any hrs that may need to be at their place of work are counted as �working time� regardless of whether actually performing their actual service or not.

8. S. Laha, R. Challiner, J. Goodall ANWICU Hospital at Night: Tenets There is significant activity in the evening period but this falls off after midnight Activity varies by specialty - medicine in general continues to have activity throughout the night but surgery in general falls to a much lower level There are very low levels of activity in trauma, orthopaedics, medical and surgical subspecialties Few patients have life threatening conditions Around a quarter of junior doctors time is spent on tasks that do not require medical skills (eg requesting investigations, finding notes or information, some minor procedures) Nearly half of junior doctors' time is spent repeating tasks such as clerking or reviews ICU peak admission time is early evening � change in Cons working pattern.ICU peak admission time is early evening � change in Cons working pattern.

9. S. Laha, R. Challiner, J. Goodall ANWICU Hospital at Night: Results Work should be drawn into the extended day by: increasing support in the �twilight� hours ensuring test results are returned before the night shift ensuring the proactive risk assessment of patients improving handover arrangements. Emergency and elective capacity should be protected in order to support compliance with CEPOD and protect theatre time. Handovers must be improved to ensure continuity of information - this is vital, especially to full shift working. There should be senior input at handover and the handover should be hospital-wide. Some specialties require full-shift working (eg. paediatrics and maternity) but there is evidence to show that some specialties can function without this if senior assistance is 30 minutes away, provided that the night team is competent to maintain the patient. Planning for provision for emerg surgery etc in normal hrs / hosp at night team incl handover impt. Fewer Drs working harder and covering more of hospital.Planning for provision for emerg surgery etc in normal hrs / hosp at night team incl handover impt. Fewer Drs working harder and covering more of hospital.