working time – an nhs perspective bill mcmillan head of medical pay and workforce nhs employers 21...
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Working Time – an NHS perspective
Bill McMillan
Head of Medical Pay and Workforce
NHS Employers
21 October 2011
EWTD in the NHS
Doctors in Training
Reducing hours 1991 until 2010
Rotas compliant but training damaged
Modernising services/reconfiguration/new ways of working
Simap/Jaeger – compensatory rest/ what’s work when on call
European Working Time Directive in the NHS - Doctors in Training
• 1991
– 83 hours per week max; training in 72 hours
European Working Time Directive in the NHS - Doctors in Training
• 2000
– 40 hours basic
– 40-48 hours – pay supplements of 20%, 40% and 50%
– 48 -56 hours – pay supplements of 50% and 80%
– >56 hours – pay supplements of 100%
– Strong financial incentive for employers to reduce hours
European Working Time Directive in the NHS - Doctors in Training
2009 – rotas compliant except for 273 derogations (86 left as at January 2010 – roughly 1.3% of all 6646 rotas across 247 employers) until 31 July 2011
European Working Time Directive in the NHS - Doctors in Training
2010
GMC report on postgraduate training – EWTD becoming routine and accepted
Temple – training can be delivered in a 48 hour week... But .. Consultant delivered services
Collins – working beyond their competence / comfort zone; mortality poorer at nights and weekends
2011
GMC State of medical education and practice
Positive impact
• Reduced hours
• Compliance with Working Time Regulations (EWTD)
• Has driven solutions – eg Hospital at Night
• Healthy recruitment and retention
Negative impact
• Burdensome – monitoring and appeals
• Single breaches disproportionately expensive –banding applies to all doctors on a rota
• Constrains rota design and flexibility (exacerbated by differing EWTD limits and requirements and ECJ SIMAP/Jaeger rulings)
• Rigid shift patterns make training less of a priority
What next
Change contract to reduce variability of pay and structure contract in same way as other doctors
Get more flexibility in EWTD particularly in relation to Simap /Jaeger
http://www.nhsemployers.org/