Annualization is the way forward. I think you're underselling your 7pm
to midnight work but ...
Ooh work is weekend and as defined 7pm onwards. Past the witching hour
even higher pas would be appropriate.
Put it this way, shift work shortens your life, fact.
Ask the jealous physicians to start a clinic at 12am of 12 new patients
while supervising 20-60 reviews... to quote our supermodel colleagues (
another occupation with a short life span), we wouldn't get out of bed
for anything less than (?). Therein lies the rub.
We as a specialty have proved ourselves again and again, I don't value
my life or indeed time any less than the sebaceous cyst clinic surgeons at
500/hr. Though im still willing to concede a little for the sake of the
nhs
-------- Original message --------
From:
Paul Ransom <
[log in to unmask]>
Date:
To:
[log in to unmask]
Subject: Rota and antisocial hours.
In Brighton,
one of our enterprising ED colleagues has come up with an annualised self -
rostering rota. This has been allied to a scheme
incentivizing consultants not primarily with money but with PAs / time
off.
Standard daytime PA = 4 hours, 19.00
evening until midnight = 3 hours per PA, and from midnight
to 08.00 = 2 hours per PA. Thus, those on an 8PA DCC
contract can get through 4.75 of their DCCS in one 22.00 - 08.00 night shift
and two other evening shifts until 22.00 or 24.00 can work off your weekly
PA debt to the Trust in three shifts. Alternatively, a
burst of lates in a row can give you 2 or 3 weeks off, allowing
you to plan other life activities, or, as some
do, working locum shifts in other Trusts for exhorbitant amounts of
money.
In our three per year rota meetings, we have no problem
filling the night shifts and evening shifts, in fact there is
usually friendly competition to fill these shifts, due to the
subsequent amount of time off these allow.
Advantages of this rota
are that individuals are incentivised to work ' antisocial'
shifts, while the Trust does not have to set the dangerous
example of direct financial remuneration to one group.
With 16
consultants we are covering the MTC 24 hours for 4 days, with three
consultants on every weekend including for our sister satellilte hospital
with a 1: 5 weekend cover.
I would think that this rota
could also work for smaller numbers of consultants, though cutting the
cloth to suit, with fewer hours covered.
There was some
disgruntlement initially from other specialties that we were getting this PA
rate, but when comparisons of work intensity are made it is very
clear how we deserve a bit of 'specialling'.
It
does seem that this is a good time for ED consultants to propose imaginative
ways of working antisocial hours which still give us adequate recompense and
I would think that the public, government and Trust mood for accepting
these proposals is better now than it has ever been.
My
understanding of the BMA consultant contract was that if consultants were to
undertake a more than 1:5 weekend rota this would need special arrangements
between the Trust and consultant workforce, which could mean either
payment in money or in time, i.e. a negotiated 2 / 2.5 / 3
hours per PA for weekend day time work.
I believe that the concept
of this rota has been shared with CEM and I understand will soon be
available on the website.
Paul
Ransom
On 15 Oct 2013, at 14:19, Bethel, Jim
wrote:
> Weekend staffing
>
> Nurses do not
necessarily suffer a poverty of aspiration from working 1:3 weekends or even
1:2 - from 27 years of working in emergency care I can say that most nurses
would have felt fortunate to have every other weekend off and 1 weekend off
a month was considered usual and most people were happy with that
> I
do think that to some extent there has to be a shift in the expectations of
medical colleagues in this respect - we were providing 24 hour senior nurse
(band 7) cover in ED 15 years ago and that was with 7.0 WTE - this was
spreading it a bit thin but in the same department at the same time 10.0 WTE
consultant medical staff could provide only 16 hour cover 6 days a week and
8 hours on a Sunday
> I think we need to meet in the middle
somewhere
>
> Jim Bethel
>
>
________________________________________
> From: Accident and
Emergency Academic List [
[log in to unmask]] on
behalf of ACAD-AE-MED automatic digest system [
[log in to unmask]]
>
Sent: 15 October 2013 00:03
> To:
[log in to unmask]>
Subject: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
>
> There are 2 messages totaling 653 lines in this issue.
>
> Topics of the day:
>
> 1. Weekend Staffing -
Squaring the Circle (2)
>
>
----------------------------------------------------------------------
>
> Date: Mon, 14 Oct 2013 08:35:41 +0000
>
From: "McCormick Simon Dr, Consultant, A&E" <
[log in to unmask]>
>
Subject: Weekend Staffing - Squaring the Circle
>
> Weekend
staffing has become a real problem for us and I'm wondering if anyone else
has come up with a way of solving the issue without throwing numerous locums
at it from the increasingly shallow pool available.
>
> The
fundamental problem as I see it is:
>
> Weekend attendances are
often equal to or exceed weekday attendances BUT we know staff 'need'
weekends off more than weekdays
>
> Traditionally we've reduced
the number of shifts done by regular staff at weekends by filling the posts
with locums or lengthening the shifts. However, as the number of
attendances have risen, so have the number of staff/shifts needed to see the
patients BUT the tolerance for working weekends hasn't really changed.
This is particularly true of longer term staff (MGs and consultants) where
anything less than a 1:4 weekends isn't tolerated, either by choosing to
work elsewhere or by Deanery threatening removal of SpRs. We'd need
massive expansion in our MG/consultant tiers to provide the same weekday
cover as we do for weekends unless these tiers work 1:2/1:3 weekends.
Given the current state of EM recruitment, one can't help wondering what
further impact that would have.
>
> Interestingly, nurses seem
to accept working 1:3 including nights much better...a cultural/historical
thing? Perhaps their aspirations are set lower earlier in their career
as they work these sorts of frequency rotas from day one.
>
>
Is the only answer for medics to accept more frequent weekend working or has
anyone come up with an alternative.
>
> Simon
>
>
> "Hospitals with overcrowded Emergency Departments are overcrowded
hospitals that have chosen to manifest the overcrowding in a single
location"
> Full Capacity protocol: an end to double standards in
acute hospital care provision Emerg Med J 2011;28:547-549
>
>
> ------------------------------
>
> This e-mail and any
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exempt from disclosure. If the reader is not an intended recipient, any
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>
>
>
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your system and notify the sender immediately. Any views or opinions
presented do not necessarily represent those of the Trust. Any unauthorised
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>
>
------------------------------
>
> Date: Mon,
14 Oct 2013 13:27:39 +0200
> From: william niven
<
[log in to unmask]>
>
Subject: Re: Weekend Staffing - Squaring the Circle
>
>
Interesting points about the nursing rotas. There are a few differences that
I would highlight though.1. They work 37,5 hours a week generally in 3 or 4
shifts. It is a rarity for consultants or middle grades to work 4 days a
week let alone 3.
> 2. They work days or nights, not evenings. ED
doctors' shift patterns are designed to mirror the peak attendance times
which makes sense from a clinical and management point of view. The problem
is, that quite aside from weekends, the rest of the world is off work in the
evening. Coming home and debriefing with friends and family, going out to
the cinema, theatre or pub to unwind and shift the focus away from work is
something that happens outside the hours of 9-5. When one arrives home at
midnight or later, it still takes a concious effort to let go of the
day, exhale and NOT eat a greasy take out, smash a couple of beers and watch
too many episodes of whatever serialised TV programme Netflix has to offer.
Even when one does get the weekend 'off', it is rare enough to have the
Friday night (premium socialising time) to oneself or family.
> 3.
Nurses 'scope of practice' is better defined than doctors and by that I mean
that they do take their entitled breaks, they do get out on time and they
are more aware than we are of where their remit starts and ends. I think we
as a group are still feeling out where our remit starts and ends, and that
particular lack of certainty is a recipe for taking on too much, staying
late and getting involved in 'fixing stuff' that wiser people may
delegate.
> 4. Nurses do not do the ePortfolio, are not as involved in
QIPs, audits and research projects, and do not have the same degree of
academic pressure put on them by virtue of specialisation.
> I do not
in any way wish to belittle what nurses do, they are a vital and integral
part of the service, but they are nevertheless a separate discipline with
different work patterns. Weekends are gold, and the more evenings we work,
the more we value them. If there is to be a serious dialogue about expanding
numbers and recruiting doctors, then the only way forward is by paying
a premium rate to shift workers and financially resourcing departments
adequately enough that the speciality becomes attractive. Its having the
money available within the department to fund projects and carry out
research that gives docs a sense of progress and of actually being invested
in the overall improvement of the institution - including working
weekends!RegardsWill NivenSenior Clinical FellowHomerton University
Hospital
> Date: Mon, 14 Oct 2013 08:35:41 +0000
> From:
[log in to unmask]>
Subject: Weekend Staffing - Squaring the Circle
> To:
[log in to unmask]>
>
>
>
>
>
>
>
>
> Weekend staffing has become a real problem for us and I’m wondering
if anyone else has come up with a way of solving the issue without
>
throwing numerous locums at it from the increasingly shallow pool
available.
>
> The fundamental problem as I see it is:
>
> Weekend attendances are often equal to or exceed weekday
attendances BUT we know staff ‘need’ weekends off more than weekdays
>
> Traditionally we’ve reduced the number of shifts done by regular
staff at weekends by filling the posts with locums or lengthening
the
> shifts. However, as the number of attendances have risen,
so have the number of staff/shifts needed to see the patients BUT the
tolerance for working weekends hasn’t really changed. This is
particularly true of longer term staff (MGs and consultants) where
>
anything less than a 1:4 weekends isn’t tolerated, either by choosing to
work elsewhere or by Deanery threatening removal of SpRs. We’d need
massive expansion in our MG/consultant tiers to provide the same weekday
cover as we do for weekends unless these
> tiers work 1:2/1:3
weekends. Given the current state of EM recruitment, one can’t help
wondering what further impact that would have.
>
>
Interestingly, nurses seem to accept working 1:3 including nights much
better…a cultural/historical thing? Perhaps their aspirations
>
are set lower earlier in their career as they work these sorts of frequency
rotas from day one.
>
> Is the only answer for medics to accept
more frequent weekend working or has anyone come up with an
alternative.
>
> Simon
>
>
>
>
"Hospitals with overcrowded Emergency Departments are overcrowded hospitals
that have chosen to manifest the overcrowding
> in a single
location"
> Full Capacity protocol: an end to double standards in
acute hospital care provision
> Emerg Med J 2011;28:547-549
>
>
>
>
> ------------------------------
>
> This e-mail and any files that accompany it are intended only for
the appropriate use of the addressee/s, and may contain information that is
privileged, confidential or exempt from disclosure. If the reader is not an
intended recipient, any disclosure, distribution or any action taken or
omitted to be taken in reliance on it, is prohibited and may be
unlawful.
>
>
>
> If you have received this
e-mail in error, please delete it from your system and notify the sender
immediately. Any views or opinions presented do not necessarily
represent those of the Trust. Any unauthorised disclosure of the information
contained in this e-mail is strictly prohibited, as is use or application of
its contents other than for its intended purpose . Neither Rotherham NHS
Foundation Trust nor the sender accepts responsibility for viruses. It is
your responsibility to scan the email and any attachments.
------------------------------
>
>
>
>
> ------------------------------
>
>
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>
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