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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 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. ------------------------------ > > > ------------------------------ > > 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. ------------------------------ > > > > > ------------------------------ > > End of ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54) > ****************************************************************-- > Scanned by iCritical.