NLG(20)161

DATE OF MEETING August 2020

REPORT FOR Trust Board of Directors – Public

REPORT FROM Bryony Simpson MBE, Guardian of Safe Working Hours (GoSWH)

CONTACT OFFICER Dr. Kate Wood, Medical Director

SUBJECT Report from the GoSWH

BACKGROUND DOCUMENT (IF ANY)

PURPOSE OF THE REPORT:

Annual reports are required by the 2016 Junior Doctor contract to monitor the Junior Doctor implementation of the contract and performance of the Trust against the standards within. This is intended to provide up to date information and assurance to the Board regarding safe working.

EXECUTIVE SUMMARY (PLEASE INCLUDE: A SUMMARY OF THE REPORT, KEY POINTS & / OR ANY RISKS WHICH NEED TO BE BROUGHT TO THE ATTENTION OF THE TRUST BOARD AND ANY MITIGATING ACTIONS, WHERE APPROPRIATE)

1. Fill rates remain strong and this is reflected in the reduction in

need for locums.

2. In August 2019, the Trust changed the systems used to

Exception report from DRS4 to Allocate. This has resulted in a

disengagement of Educational supervisors that needs

addressing.

3. There have been 2 fines imposed for the breach of the Junior

Doctor Contract. Both relate to a breach of 72 hours worked in

168 hours.

4. There have been reports of some negative behaviours regarding

the discouraging of doctors completing Exception Reports. This

is a small minority and we have investigated each report. It is

important that senior leadership models the importance of ER

and data gathering regarding pressure areas within provision

5. There is a need to build on the previous work regarding Fatigue

and Facilities monies. The Trust was granted £60,000 of national

money to improve facilities for Junior doctors over a year ago

and this has still not been spent so a focus is needed to ensure

effective use of this resource. The GoSWH attends meetings

between the Trust and HEE to monitor the learning environment.

During the past year these meetings have concentrated on

Medicine and Gastroenterology.

6. The Covid19 Pandemic has presented challenges to medical

staffing and rotas were carefully constructed in consultation

with Junior Doctors. This is reflected in the sharp reduction in

Exception reports during the Quarter April to June end.

TRUST BOARD ACTION REQUIRED

1. To support and encourage the work of the DME in engaging

Educational Supervisors and Consultants in the ER system

2. To ensure a positive regard for the education of trainee

doctors recognizing the importance of the medical

workforce and safeguarding the balance of service

provision and education. This applies particularly to

Medicine.

3. To support initiatives to improve the Junior Doctor

experience at NL&G in Medical areas removing the HEE

requirement for improvement and strengthening the Trust’s

reputation and attractiveness as a training

provider/employer.

4. To pursue the effective use of the Fatigue and Facilities

monies and ensure conditions are improved for Junior

Doctors.

To continue with efforts to attract Junior Doctors to NL&G as a

placement of choice

ANNUAL REPORT ON ROTA GAPS AND VACANCIES:

DOCTORS IN TRAINING

June 2019- May 2020

Executive summary

The Annual Report of the Guardian of Safe Working Hours will present the Rota gaps and

vacancies from June 2019 to end of May 2020.

There are no Trainees within the Dentistry service at NLG and so the Annual Report applies

only to Junior Doctors.

We are now in the fourth year of the 2016 national contract for junior doctors which aimed to

encourage stronger safeguards to prevent doctors working excessive hours. Exception

Reporting (ER) of extra unplanned hours, missed breaks and missed education is now well

established in NL&G NHS FT and is positively promoted via Induction, training and the

quarterly Junior Doctors’ Forum for Safe Working Hours.

The 2016 contract was subject to review in 2019 and although largely unchanged there are

some notable differences which the Trust has implemented.

Exception reporting is a valuable instrument that provides frontline information regarding

pressure points in the system, ensures safe working hours, improves junior doctor morale,

the quality of medical training and patient safety. It is also the agreed contractual mechanism

for ensuring that trainees are paid for all work done.

The extra pressure of the Covid19 Pandemic in 2020 has brought with it surge rotas that

have been carefully constructed in consultation with Junior Doctors and their

representatives. This has resulted in a reduction in the number of Exception reports as hours

were carefully monitored and staff aware of the need to balance time at work with rest.

The safety of patients is a paramount concern for the NHS. Significant staff fatigue is a

hazard both to patients and to the staff themselves. The safeguards around working hours of

doctors in training are outlined in the terms and conditions of service (TCS) and are

designed to ensure that this risk is effectively mitigated, and that this mitigation is assured.

Fill rates for Junior Doctors at the Trust continue to be strong which has helped with rotas

and working hours. The Trust continues in its efforts to increase the diversity of the work

force recruiting ACPs and offering Apprenticeships thus reducing reliance on medical staff.

Rota design and co-ordination has changed in the past year and Caroline Taylor who leads

on the Allocate System which is used for monitoring and exception reporting, has moved

from the Medical Director’s department to the Workforce Resource Centre . This enables her

to have regular oversight of rotas and issues arising so that they can be quickly and

effectively remedied.

High level data – Data as of November 2019

Number of doctors in training (total): 220.30

Number of doctors in training on 2016 TCS (total): 197.48

Annual vacancy rate among this staff group: 22.82

Annual data summary

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 42.22 44 32 14 65.8 16

WTE Contracted 33.2 45 24 11.68 50.23 17

Vacancies 9.3 0 8 2.32 15.57 0

0

10

20

30

40

50

60

70

June 2019 Vacancies

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 42.5 44 32 14 65.8 16

WTE Contracted 31.2 44 24 10.68 50.23 17

Vacancies 11.3 0 8 3.32 15.57 0

0

10

20

30

40

50

60

70

July 2019 Vacncies

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 42.5 44 32 14 65.8 16

WTE Contracted 38.86 50.3 29 5.52 64.71 13.53

Vacancies 3.64 0 3 8.48 1.09 2.47

0

10

20

30

40

50

60

70

August 2019 Vacancies

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 44.5 44 32 14 66.8 16

WTE Contracted 38.47 49.8 29 6.53 60.88 13.53

Vacancies 6.03 0 3 7.47 5.92 2.47

01020304050607080

September 2019 Vacancies

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 44.5 47 32 14 66.8 16

WTE Contracted 39.47 49.8 29 5.53 59.32 13.03

Vacancies 5.03 0 3 8.47 7.48 2.97

01020304050607080

October 2019 Vacancies

CT1 F1 F2St1

LowerSt2

UpperVTS

WTE Budget 44.5 47 32 14 66.8 16

WTE Contracted 40.47 49.95 26 5.53 60.32 13.53

Vacancies 4.03 0 6 8.47 6.48 2.47

01020304050607080

November Vacancies 2019

CT1 CT2 ST1 ST2 VTS F1 F2

WTE Budget 44.5 0 14 66.8 16 47 32

WTE Contracted 40.55 0 5.53 60.07 12.53 48.8 30

Vacancies WTE 3.95 0 8.47 6.73 3.47 0 2

0

10

20

30

40

50

60

70

80

December 2019 Vacancies

CT1 CT2 ST1 ST2 VTS F1 F2

WTE Budget 44.5 0 14 66.8 16 47 32

WTE Contracted 41.55 0 4.53 62.07 11.53 48.8 29

Vacancies WTE 2.95 0 9.47 4.73 4.47 0 3

0

10

20

30

40

50

60

70

80

January 2020 Vacancies

CT1 CT2 ST1 ST2 VTS F1 F2

WTE Budget 44.5 0 14 66.8 16 47 32

WTE Contracted 40.6 0 6.69 58.49 10.57 46.8 29

Vacancies WTE 3.9 0 7.31 8.31 5.43 0.2 3

0

10

20

30

40

50

60

70

80

February 2020 Vacancies

CT1 CT2 ST1 ST2 VTS F1 F2

WTE Budget 44.5 0 14 66.8 16 47 32

WTE Contracted 38.6 0 6.53 55.49 10.57 46.8 29

Vacancies WTE 5.9 0 7.47 11.31 5.43 0.2 3

0

10

20

30

40

50

60

70

80

March 2020 Vacancies

CT1 CT2 ST1 ST2 VTS F1 F2

WTE Budget 44 0 14 66.8 16 47 32

WTE Contracted 37.54 2 6.53 55.51 9.57 46.8 29

Vacancies WTE 6.46 0 7.47 11.29 6.43 0.2 3

0

10

20

30

40

50

60

70

80

April 2020 Vacancies

CT1 ST1 ST2 VTS F1 F2

WTE Budget 44 14 66.8 16 47 32

WTE Contracted 36.54 11.68 55.55 9.57 45.8 30

Vacancies WTE 7.46 8.32 11.25 6.43 1.2 2

0

10

20

30

40

50

60

70

80

May 2020 Vacancies

Summary and Questions for consideration

1. The Covid19 Pandemic has presented extraordinary challenges to the NHS and NL&G

was no exception. The Covid rotas were carefully constructed in consultation with Junior

Doctors and this is reflected in the sharp reduction in Exception reports during the

Quarter April to June end.

2. There is a need to build on the previous work regarding Fatigue and Facilities monies.

The Trust was granted £60,000 of national money to improve facilities for Junior doctors

over a year ago and this has still not been spent so a focus is needed to ensure effective

use of this resource.

3. Fill rates remain strong and this is reflected in the reduction in need for locums.

4. There have been 2 fines imposed for the breach of the Junior Doctor Contract. Both

relate to a breach of 72 hours worked in 168 hours. These fines are imposed by the

Guardian spent at the direction of the Junior Doctor Forum on aspects not covered by

routine spending.

5. There have been reports of some negative behaviours regarding the discouraging of

doctors completing Exception Reports. This is a small minority of Consultants and we

have investigated each report. It is important that senior leadership models the

importance of ER and data gathering regarding pressure areas within provision

6. In August 2019, the Trust changed the systems used to Exception report from DRS4 to

Allocate. This required training for users, and it took some months to roll out this resulted

in a drop in performance by Education Supervisors but unfortunately this deterioration

has continued a year on.

7. This past year has seen a marked deterioration in the engagement with the Exception

reporting system by Consultants who are designated Educational Supervisors. This has

reached a point where none are responding to the ERs and this is not acceptable. Work

has been done with the Director of Medical Education and he has implanted a plan to

resolve this. We do need to show our commitment to safe working and Educational

Supervisors are a key part of this.

8. The GoSWH attends meetings between the Trust and HEE to monitor the learning

environment. During the past year these meetings have concentrated on Medicine and

Gastroenterology.

9. The GoSWH continues to hold Junior Doctor Forums every 3 months and these are a

valuable opportunity for Junior Doctors representatives to meet with the Guardian, MD

office, DME office, BMA and LNC in one place. Issues addressed over the past year

have included:

Rota difficulties

Provision of correct PPE

F and F monies progress

Problems with the new Allocate system

Access to training and supervision

Problems with payment

Frontline behaviours at work

Attendance at JDF by Trust staff

Disbursement of Fines

.

Recommendations

1. To support and encourage the work of the DME in engaging Educational Supervisors

and Consultants in the ER system

2. To ensure a positive regard for the education of trainee doctors recognizing the

importance of the medical workforce and safeguarding the balance of service

provision and education. This applies particularly to Medicine.

3. To support initiatives to improve the Junior Doctor experience at NL&G in Medical

areas removing the HEE requirement for improvement and strengthening the Trust’s

reputation and attractiveness as a training provider/employer.

4. To pursue the effective use of the Fatigue and Facilities monies and ensure

conditions are improved for Junior Doctors.

5. To note that the current GoSWH is retiring on 30th November this year after 4 years

in post.

Bryony Simpson MBE

Guardian of Safe Working Hours

Northern Lincolnshire and Goole NHS FT.

July 2020