Is this 'I won't if they don't' argument a little akin to taking your football home if you're not winning? - as an advanced clinical practitioner in ED I know that I may be working at times when specialty nursing colleagues in radiology departments or operating theatres may not be, or may be on call from home. Increasingly this is also the case with physiotherapy practitioners, paramedic practitioners and physician assistants in ED all of whom work with me on a similar basis. What would seem of paramount importance is what is in the patients best interests. Perhaps emergency physicians could set both a precedent and a good example for their specialty colleagues by going out on a limb here? Lead by example
Jim Bethel
-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of ACAD-AE-MED automatic digest system
Sent: 18 October 2013 00:02
To: [log in to unmask]
Subject: ACAD-AE-MED Digest - 16 Oct 2013 to 17 Oct 2013 (#2013-57)
There are 11 messages totaling 5615 lines in this issue.
Topics of the day:
1. ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54) (6)
2. Weekend Staffing - Squaring the Circle
3. Rota and antisocial hours. (4)
----------------------------------------------------------------------
Date: Thu, 17 Oct 2013 18:37:09 +1100
From: Andrew Stearman <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
I can tell you about my part of Australia
We have 11 FTE and cover every weekend with 2 consultants
Covering 8 am till midnight
It works out about 1 in 7
Every other in patient specialty is on call from home at the weekend
We have been under some pressure to increase our weekend cover
And have said we are happy to be involved in the whole hospitals
Plan to increase specialist cover at the weekend but will not do it
In isolation
Andy stearman
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Prescott Mark
Sent: Thursday, 17 October 2013 5:05 AM
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Interested to know from Mark about the system now in Australia that he refers to - what are the working arrangements at weekends of all the In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and attention is focussed into our departments and so much less into ward-ways of OOHs working
Mark P
________________________________
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
is it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff specialists) working every day of every weekend, my current NHS post with similar pt numbers but fewer consultants has 1 consultant proactively job planned for 3 PAs each day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing extra DPCare, and coming in on days off important meetings which all too often are poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the trust, I have not been remunerated for travel, parking, time off in lieu, business travel insurance
my study leave budget has been cancelled for the foreseeable future..unless we can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates or divisions are not unified in collaborative working out of hours nor at weekends, they r disengaged from proactively seeing patients and adhere to old school hierarchical approach to pt assessment....why should I break a gut when colleagues in other disciplines do not
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS TRUST) <[log in to unmask]<mailto:[log in to unmask]>> wrote:
While I agree that we do not work anything like the number of weekend / night shifts of our nursing colleagues, we work considerable more antisocial hours than our in patient consultant colleagues. Although I accept that our departmental work load is higher at weekend than during the week (we routinely use locums to support our weekend working). Our in patient colleagues work considerably less weekends, and with a lower intensity of working than we do in EM. Until the in patient specialities start to work a similar intensity of weekend working, I think we will make our profession even less appealing if we increase our weekend frequency / intensity, compared to our in patent colleagues. I could offer my patients a better service with 7 day a week access to clinic / investigations, which would also help to manage some of the pressure for beds.
Yours
Jules
On 15 Oct 2013, at 14:19, "Bethel, Jim" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
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
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------------------------------
Date: Thu, 17 Oct 2013 08:58:46 +0100
From: Prescott Mark <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
I absolutely agree with your stance - I am quite prepared to be in my
department working at weekends, evenings and might even consider
overnight (despite being 65!) provided that all the other Consultants in
the hospital work exactly the same. I do not want their inexperienced
junior representatives joining me in the resuscitation room or taking
over subsequent care of my patients - I want the Consultant with as much
experience as myself.
What particularly pigs me off is that there are far more Consultant
Surgeons, Orthopaedic surgeons, Anaesthetists, Physicians and
Paediatricians employed in this hospital trust than Emergency Physicians
- yet who is being targeted to work antisocial hours?
Mark P
________________________________
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andrew Stearman
Sent: 17 October 2013 08:37
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
I can tell you about my part of Australia
We have 11 FTE and cover every weekend with 2 consultants
Covering 8 am till midnight
It works out about 1 in 7
Every other in patient specialty is on call from home at the weekend
We have been under some pressure to increase our weekend cover
And have said we are happy to be involved in the whole hospitals
Plan to increase specialist cover at the weekend but will not do it
In isolation
Andy stearman
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Prescott Mark
Sent: Thursday, 17 October 2013 5:05 AM
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Interested to know from Mark about the system now in Australia that he
refers to - what are the working arrangements at weekends of all the
In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and attention is focussed into our
departments and so much less into ward-ways of OOHs working
Mark P
________________________________
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
is it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff
specialists) working every day of every weekend, my current NHS post
with similar pt numbers but fewer consultants has 1 consultant
proactively job planned for 3 PAs each day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend
frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing
extra DPCare, and coming in on days off important meetings which all too
often are poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the
trust, I have not been remunerated for travel, parking, time off in
lieu, business travel insurance
my study leave budget has been cancelled for the foreseeable
future..unless we can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates
or divisions are not unified in collaborative working out of hours nor
at weekends, they r disengaged from proactively seeing patients and
adhere to old school hierarchical approach to pt assessment....why
should I break a gut when colleagues in other disciplines do not
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS
TRUST) <[log in to unmask]> wrote:
While I agree that we do not work anything like the number of weekend /
night shifts of our nursing colleagues, we work considerable more
antisocial hours than our in patient consultant colleagues. Although I
accept that our departmental work load is higher at weekend than during
the week (we routinely use locums to support our weekend working). Our
in patient colleagues work considerably less weekends, and with a lower
intensity of working than we do in EM. Until the in patient specialities
start to work a similar intensity of weekend working, I think we will
make our profession even less appealing if we increase our weekend
frequency / intensity, compared to our in patent colleagues. I could
offer my patients a better service with 7 day a week access to clinic /
investigations, which would also help to manage some of the pressure for
beds.
Yours
Jules
On 15 Oct 2013, at 14:19, "Bethel, Jim" <[log in to unmask]> wrote:
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
************************************************************************
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sender that you have received the message in error before deleting it.
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take any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
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************************************************************************
********************************************
------------------------------
Date: Thu, 17 Oct 2013 09:17:48 +0100
From: Mark Nicol <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Nambour ED in SE Queensland, information recent and up to date as my boss there, now retired, came over few weeks ago
I think they have similar WTE to andrew stearmans dept.
it should b noted that there is financial incentive in queensland for weekend work...I am not sure whther same / similar bonus payments apply in NSW Andy?
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Wednesday, 16 October 2013, 19:05, Prescott Mark <[log in to unmask]> wrote:
Interested to know from Mark about the
system now in Australia
that he refers to - what are the working arrangements at weekends of all the
In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and
attention is focussed into our departments and so much less into ward-ways of OOHs
working
Mark P
________________________________
From:Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf
Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest -
9 Sep 2013 to 14 Oct 2013 (#2013-54)
is
it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff specialists)
working every day of every weekend, my current NHS post with similar pt numbers
but fewer consultants has 1 consultant proactively job planned for 3 PAs each
day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend
frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing extra
DPCare, and coming in on days off important meetings which all too often are
poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the trust,
I have not been remunerated for travel, parking, time off in lieu, business
travel insurance
my study leave budget has been cancelled for the foreseeable future..unless we
can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates or
divisions are not unified in collaborative working out of hours nor at
weekends, they r disengaged from proactively seeing patients and adhere to old
school hierarchical approach to pt assessment....why should I break a gut when
colleagues in other disciplines do not
dr
mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On
Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS TRUST)
<[log in to unmask]> wrote:
While
I agree that we do not work anything like the number of weekend / night shifts
of our nursing colleagues, we work considerable more antisocial hours than our
in patient consultant colleagues. Although I accept that our departmental work
load is higher at weekend than during the week (we routinely use locums to
support our weekend working). Our in patient colleagues work considerably less
weekends, and with a lower intensity of working than we do in EM. Until the in
patient specialities start to work a similar intensity of weekend working, I
think we will make our profession even less appealing if we increase our
weekend frequency / intensity, compared to our in patent colleagues. I
could offer my patients a better service with 7 day a week access to clinic /
investigations, which would also help to manage some of the pressure for beds.
Yours
Jules
On
15 Oct 2013, at 14:19, " Bethel ,
Jim" <[log in to unmask]> wrote:
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
********************************************************************************************************************
This message may contain confidential information. If you are not the intended
recipient please inform the
sender that you have received the message in error before deleting it.
Please do not disclose, copy or distribute information in this e-mail or take
any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available for all NHS staff
in England and Scotland
NHSmail is approved for exchanging patient data and other sensitive information
with NHSmail and GSi recipients
NHSmail provides an email address for your career in the NHS and can be
accessed anywhere
*********************************************
------------------------------
Date: Thu, 17 Oct 2013 08:24:38 +0000
From: Matthew Dunn <[log in to unmask]>
Subject: Re: Weekend Staffing - Squaring the Circle
Part of the nursing thing might be that Sundays are paid at a 60% supplement (although Saturdays at a 30% supplement). It may be that the way forwards would be to pay a rate substantially above the minimum for unsocial hours (indeed, the College has suggested that this is already done in some departments in a variety of ways). That certainly seems to work for some other specialties where consultants come in at weekends to do clinics and lists to clear waits. Worth noting that for both the consultant and SD contracts, the unsocial hours supplement is a minimum not a maximum. There is probably also a cultural thing with nurses. But it is also worth noting that nursing has a very high drop out rate. We tend to run with a significant majority of our nursing workforce under 40. We cannot afford that as consultants. The personal and societal costs of training in Emergency Medicine are such that we don't want doctors dropping out of the clinical side in their 30s or 40s.
Regarding the need for a massive expansion to achieve a 1: 4 weekends for consultants, I'm not sure this is the case (depending on how far you have already expanded). Standard consultant job plan has a 3:1 DCC to SPA split with the College recommended DCC split being 6 PAs shop floor/ 1.5 PAs clinical admin. Assuming all the SPA work and clinical admin is done Monday to Friday, to get the same level of cover each day you are looking at each consultant working 2/7 of their shop floor work at weekends. That is slightly over 1/6 of their total work time. So working 1 weekend out of 5 to achieve the same level of cover each day should be achievable. An example might be if you had 5 consultants; no locums to cover for leave, so effectively 4 consultants at any one time. Fairly busy on call so 2 PAs each for work done while on call. Means that in a given week you've got 16 PAs to play with. That gives you 8 hours a day Monday to Friday plus 9 hours a day at weekends.
Middle grade cover is more of an issue. Covering with registrars isn't going to be all that much as there are enough registrars to give an average of between 1 and 2 per department. Actually getting enough middle grades to cover 24/ 365 (with two, three or more for much of that period particularly in larger departments) is going to be tricky. It is also more of a problem with middle grade doctors as the smaller proportion of work that can be scheduled during office hours means that a higher proportion of work is weekend work.
Another issue with consultants working unsocial hours is that hospitals tend not to be quite signed up to the idea- there still seems to be a view that you are available to the hospital to work flexibly during office hours rather than that if you do some work outside office hours, then there will be periods during office hours that are your own time when you don't expect to be available to attend meetings.
I am not so sure about the other specialties stuff. It is pretty common for Acute Physicians to have scheduled sessions at weekends and these days weekend trauma lists are increasingly done by orthopaedic and anaesthetic consultants. I think that specialties like EM, Acute Medicine and ITU will always have a disproportionate amount of weekend work relative to other specialties as we don't have the elective work that can be used to give us a large amount of office hours work.
Matt Dunn
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of McCormick Simon Dr, Consultant, A&E
Sent: 14 October 2013 09:36
To: [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
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------------------------------
Date: Thu, 17 Oct 2013 20:57:16 +1100
From: Andrew Stearman <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Yes
Saturday is 1.5 times normal pay
Sunday is 1.75 times normal pay
Public holidays are 2.5 times normal pay
Normal pay in NSW is $ 93 an hour which is about 55 pounds at the moment
We work 10 hour shifts so working the weekend gives you an extra $1200 ( 700 pounds )
So I does make quite a difference
We have a few people who do work more weekends purely because it pays better than the weekdays
andy
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: Thursday, 17 October 2013 7:18 PM
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Nambour ED in SE Queensland, information recent and up to date as my boss there, now retired, came over few weeks ago
I think they have similar WTE to andrew stearmans dept.
it should b noted that there is financial incentive in queensland for weekend work...I am not sure whther same / similar bonus payments apply in NSW Andy?
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Wednesday, 16 October 2013, 19:05, Prescott Mark <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Interested to know from Mark about the system now in Australia that he refers to - what are the working arrangements at weekends of all the In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and attention is focussed into our departments and so much less into ward-ways of OOHs working
Mark P
________________________________
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
is it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff specialists) working every day of every weekend, my current NHS post with similar pt numbers but fewer consultants has 1 consultant proactively job planned for 3 PAs each day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing extra DPCare, and coming in on days off important meetings which all too often are poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the trust, I have not been remunerated for travel, parking, time off in lieu, business travel insurance
my study leave budget has been cancelled for the foreseeable future..unless we can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates or divisions are not unified in collaborative working out of hours nor at weekends, they r disengaged from proactively seeing patients and adhere to old school hierarchical approach to pt assessment....why should I break a gut when colleagues in other disciplines do not
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS TRUST) <[log in to unmask]<mailto:[log in to unmask]>> wrote:
While I agree that we do not work anything like the number of weekend / night shifts of our nursing colleagues, we work considerable more antisocial hours than our in patient consultant colleagues. Although I accept that our departmental work load is higher at weekend than during the week (we routinely use locums to support our weekend working). Our in patient colleagues work considerably less weekends, and with a lower intensity of working than we do in EM. Until the in patient specialities start to work a similar intensity of weekend working, I think we will make our profession even less appealing if we increase our weekend frequency / intensity, compared to our in patent colleagues. I could offer my patients a better service with 7 day a week access to clinic / investigations, which would also help to manage some of the pressure for beds.
Yours
Jules
On 15 Oct 2013, at 14:19, " Bethel , Jim" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
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
********************************************************************************************************************
This message may contain confidential information. If you are not the intended recipient please inform the
sender that you have received the message in error before deleting it.
Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available for all NHS staff in England and Scotland
NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients
NHSmail provides an email address for your career in the NHS and can be accessed anywhere
********************************************************************************************************************
------------------------------
Date: Thu, 17 Oct 2013 11:20:04 +0100
From: phillipoconnor <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Is it not true that nsw remuneration is the most conservative in Australia?
Still looks a lot more appropriate than nhs. Find it amusing that a few surgical mates of mine are currently getting paid by nhs to clear minor ops waiting lists at £70-80 per patient and yet going rates for emergency is about 60-70 hr busting on the floor.
If I have an emergency plumbing issue its minimum 120 for call out before work. Im alot cheaper for any replumbing in the nhs.
Sent from Samsung Mobile
-------- Original message --------
From: Andrew Stearman <[log in to unmask]>
Date:
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Yes
Saturday is 1.5 times normal pay
Sunday is 1.75 times normal pay
Public holidays are 2.5 times normal pay
Normal pay in NSW is $ 93 an hour which is about 55 pounds at the moment
We work 10 hour shifts so working the weekend gives you an extra $1200 ( 700 pounds )
So I does make quite a difference
We have a few people who do work more weekends purely because it pays better than the weekdays
andy
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: Thursday, 17 October 2013 7:18 PM
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Nambour ED in SE Queensland, information recent and up to date as my boss there, now retired, came over few weeks ago
I think they have similar WTE to andrew stearmans dept.
it should b noted that there is financial incentive in queensland for weekend work...I am not sure whther same / similar bonus payments apply in NSW Andy?
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Wednesday, 16 October 2013, 19:05, Prescott Mark <[log in to unmask]> wrote:
Interested to know from Mark about the system now in Australia that he refers to - what are the working arrangements at weekends of all the In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and attention is focussed into our departments and so much less into ward-ways of OOHs working
Mark P
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
is it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff specialists) working every day of every weekend, my current NHS post with similar pt numbers but fewer consultants has 1 consultant proactively job planned for 3 PAs each day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing extra DPCare, and coming in on days off important meetings which all too often are poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the trust, I have not been remunerated for travel, parking, time off in lieu, business travel insurance
my study leave budget has been cancelled for the foreseeable future..unless we can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates or divisions are not unified in collaborative working out of hours nor at weekends, they r disengaged from proactively seeing patients and adhere to old school hierarchical approach to pt assessment....why should I break a gut when colleagues in other disciplines do not
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS TRUST) <[log in to unmask]> wrote:
While I agree that we do not work anything like the number of weekend / night shifts of our nursing colleagues, we work considerable more antisocial hours than our in patient consultant colleagues. Although I accept that our departmental work load is higher at weekend than during the week (we routinely use locums to support our weekend working). Our in patient colleagues work considerably less weekends, and with a lower intensity of working than we do in EM. Until the in patient specialities start to work a similar intensity of weekend working, I think we will make our profession even less appealing if we increase our weekend frequency / intensity, compared to our in patent colleagues. I could offer my patients a better service with 7 day a week access to clinic / investigations, which would also help to manage some of the pressure for beds.
Yours
Jules
On 15 Oct 2013, at 14:19, " Bethel , Jim" <[log in to unmask]> wrote:
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
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Date: Thu, 17 Oct 2013 21:32:53 +1100
From: Andrew Stearman <[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
I really don’t know about other states
The awards are completely different
I do hear that Queensland is the best though
andy
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of phillipoconnor
Sent: Thursday, 17 October 2013 9:20 PM
To: [log in to unmask]
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Is it not true that nsw remuneration is the most conservative in Australia?
Still looks a lot more appropriate than nhs. Find it amusing that a few surgical mates of mine are currently getting paid by nhs to clear minor ops waiting lists at £70-80 per patient and yet going rates for emergency is about 60-70 hr busting on the floor.
If I have an emergency plumbing issue its minimum 120 for call out before work. Im alot cheaper for any replumbing in the nhs.
Sent from Samsung Mobile
-------- Original message --------
From: Andrew Stearman <[log in to unmask]<mailto:[log in to unmask]>>
Date:
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Yes
Saturday is 1.5 times normal pay
Sunday is 1.75 times normal pay
Public holidays are 2.5 times normal pay
Normal pay in NSW is $ 93 an hour which is about 55 pounds at the moment
We work 10 hour shifts so working the weekend gives you an extra $1200 ( 700 pounds )
So I does make quite a difference
We have a few people who do work more weekends purely because it pays better than the weekdays
andy
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: Thursday, 17 October 2013 7:18 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
Nambour ED in SE Queensland, information recent and up to date as my boss there, now retired, came over few weeks ago
I think they have similar WTE to andrew stearmans dept.
it should b noted that there is financial incentive in queensland for weekend work...I am not sure whther same / similar bonus payments apply in NSW Andy?
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Wednesday, 16 October 2013, 19:05, Prescott Mark <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Interested to know from Mark about the system now in Australia that he refers to - what are the working arrangements at weekends of all the In-patient specialities when the ED Consultants are working 3-up.?
It is funny how so much pressure and attention is focussed into our departments and so much less into ward-ways of OOHs working
Mark P
________________________________
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Mark Nicol
Sent: 16 October 2013 17:43
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
is it all about incentives and disincentives
my previous ED in Australia now has three consultants (staff specialists) working every day of every weekend, my current NHS post with similar pt numbers but fewer consultants has 1 consultant proactively job planned for 3 PAs each day of the weekend working 1:6 .
when I suggested that we go to 2 consultants each day, increase weekend frequency to 1;4, reducing oncall frequency to 1:8..it fell on deaf ears
what r the dissincentives...all on consultant tier find themeslves doing extra DPCare, and coming in on days off important meetings which all too often are poorly planned and poorly executed
I have on four recent occasions needed to travel for the benefit of the trust, I have not been remunerated for travel, parking, time off in lieu, business travel insurance
my study leave budget has been cancelled for the foreseeable future..unless we can clearly justify it towards appraisal revalidation
looking to the wider organization our colleagues in other directorates or divisions are not unified in collaborative working out of hours nor at weekends, they r disengaged from proactively seeing patients and adhere to old school hierarchical approach to pt assessment....why should I break a gut when colleagues in other disciplines do not
dr mark f nicol
emergency medicine consultant
The Flying Scotsman Ltd.
CAA Aviation Medical Examiner 20161
On Tuesday, 15 October 2013, 20:33, Blackham Julian (NORTH BRISTOL NHS TRUST) <[log in to unmask]<mailto:[log in to unmask]>> wrote:
While I agree that we do not work anything like the number of weekend / night shifts of our nursing colleagues, we work considerable more antisocial hours than our in patient consultant colleagues. Although I accept that our departmental work load is higher at weekend than during the week (we routinely use locums to support our weekend working). Our in patient colleagues work considerably less weekends, and with a lower intensity of working than we do in EM. Until the in patient specialities start to work a similar intensity of weekend working, I think we will make our profession even less appealing if we increase our weekend frequency / intensity, compared to our in patent colleagues. I could offer my patients a better service with 7 day a week access to clinic / investigations, which would also help to manage some of the pressure for beds.
Yours
Jules
On 15 Oct 2013, at 14:19, " Bethel , Jim" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
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
********************************************************************************************************************
This message may contain confidential information. If you are not the intended recipient please inform the
sender that you have received the message in error before deleting it.
Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:
to do so is strictly prohibited and may be unlawful.
Thank you for your co-operation.
NHSmail is the secure email and directory service available for all NHS staff in England and Scotland
NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients
NHSmail provides an email address for your career in the NHS and can be accessed anywhere
********************************************************************************************************************
------------------------------
Date: Thu, 17 Oct 2013 12:30:56 +0100
From: Paul Ransom <[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 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.
------------------------------
Date: Thu, 17 Oct 2013 12:50:19 +0100
From: phillipoconnor <[log in to unmask]>
Subject: Re: Rota and antisocial hours.
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
Sent from Samsung Mobile
-------- 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 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.
------------------------------
Date: Thu, 17 Oct 2013 21:39:13 +0100
From: tom allen <[log in to unmask]>
Subject: Re: Rota and antisocial hours.
Phil your right as usual and paul was that mr evan couhhlan who came up with that nice rota?
Enjoying the emails just back from a shitty shift in ED enniskillen
Tom
Sent from my iPad
> On 17 Oct 2013, at 12:50, "phillipoconnor" <[log in to unmask]> wrote:
>
> 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
>
>
>
>
>
>
> Sent from Samsung Mobile
>
>
>
> -------- 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 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)
> > ***********************************************
------------------------------
Date: Fri, 18 Oct 2013 07:50:11 +1100
From: Andrew Stearman <[log in to unmask]>
Subject: Re: Rota and antisocial hours.
Well at least yours isn’t nearly on fire !!
http://www.smh.com.au/nsw/nsw-bushfires-continue-to-ravage-state-as-residents-forced-to-evacuate-20131018-2vqe2.html
Andy
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of tom allen
Sent: Friday, 18 October 2013 7:39 AM
To: [log in to unmask]
Subject: Re: Rota and antisocial hours.
Phil your right as usual and paul was that mr evan couhhlan who came up with that nice rota?
Enjoying the emails just back from a shitty shift in ED enniskillen
Tom
Sent from my iPad
On 17 Oct 2013, at 12:50, "phillipoconnor" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
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
Sent from Samsung Mobile
-------- Original message --------
From: Paul Ransom <[log in to unmask]<mailto:[log in to unmask]>>
Date:
To: [log in to unmask]<mailto:[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]<mailto:[log in to unmask]>] on behalf of ACAD-AE-MED automatic digest system [[log in to unmask]<mailto:[log in to unmask]>]
> Sent: 15 October 2013 00:03
> To: [log in to unmask]<mailto:[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]<mailto:[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]<mailto:[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]<mailto:[log in to unmask]>
> Subject: Weekend Staffing - Squaring the Circle
> To: [log in to unmask]<mailto:[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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> End of ACAD-AE-MED Digest - 9 Sep 2013 to 14 Oct 2013 (#2013-54)
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> Scanned by iCritical.
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End of ACAD-AE-MED Digest - 16 Oct 2013 to 17 Oct 2013 (#2013-57)
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