Junior doctors - 48-hour maximum working week (without averaging): expert working group report

Appendix 3: Comparison of pre-existing and revised 48 hour maximum (without averaging) working week rotas for Hairmyres pilot study.

An initial numerical comparison was made between the rotas comparing the current rotas and the newly formulated 48hour version. This allowed analysis of many of the parameters as outlined above. As each rota is hugely different they have been analysed individually, both in one revolution of the rota and then as a trainee who experience it in placements over 4/6/12m depending on seniority.

Emergency Medicine Junior (8 week rota cycle/26 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	10	32	11.5	37	↑1.5	↑5
Weekend	5	16	7	23	↑2	↑7
Night to Day/ D to N changes	2/2	7/7	2/2	7/7	=	=
Standard days	10	32	9.5	31	↓0.5	↓1
Annual Leave	1	6	0	0	↓1	↓6

Emergency Medicine Senior (3 week rota cycle/52 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	2	35	6	104	↑4	↑69
Weekend	2	35	2	35	=	=
Night to Day/ D to N changes	1/1	17/17	2/2	35/35	↑1/1	↑18/18
Standard days	1	18	1	18	=	=
Annual Leave	0*	0*	0*	0*	?	?

*Only 1 standard day on rota – unclear which shifts can be taken as annual leave

FY1 Medicine (10 week rota cycle/17 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	6	10	12.5	22	↑6.5	↑12
Weekend	3	5	3	5	=	=
Night to Day/ D to N changes	0*	0*	0*	0*	=	=
Standard days	29	50	22	38	↓7	↓12
Annual Leave	3	5	1	2	↓2	↓3

*FY1s in Lanarkshire do not do nightshift

Junior Medicine (17 week rota cycle 26 week placement (except FY2)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	10	15	19	29	↑9	↑14
Weekend	4	6	5	8	1	2
Night to Day/ D to N changes	2/2	3/3	3/3	5/5	↑1/1	↑2/2
Standard days	50	77	41	63	↓9	↓14
Annual Leave	10	15	3	5	↓7	↓10

Senior Medicine (8 week cycle, 1 year placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	7	46	11.5	75	↑4.5	↑29
Weekend	2	13	3	20	↑1	↑7
Night to Day/ D to N changes	2/2	13/13	3/3	20/20	↑1/1	↑7/7
Standard days	23	150	18.5	120	↓4.5	↓30
Annual Leave	2	13	1	7	↓1	↓6

FY1 Surgery (9 week rota cycle/17 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	4	8	7	14	↑3	↑6
Weekend	3	6	4	8	↑1	↑2
Night to Day/ D to N changes	N/A*	N/A*	N/A*	N/A*	N/A*	N/A*
Standard days	22	44	20	40	↓2	↓4
Annual Leave	4	8	2	4	↓2	↓4

*FY1s in Lanarkshire do not do nightshift

Junior Surgery (7 week rota cycle/26 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	5	19	11.5	43	↑6.5	↑24
Weekend	2	8	2	8	=	=
Night to Day/ D to N changes	2/2	8/8	3/3	12/12	↑1/1	↑4/4
Standard days	20	75	13.5	51	↓6.5	↓24
Annual Leave	2	7	2	7	=	=

Senior Surgery (9 week rota cycle/52 week placement)

	Original		48h absolute		Difference
	In Rota Cycle	In placement	In Rota Cycle	In placement	In Rota Cycle	In placement
Zero days	7	41	14	82	↑7	41
Weekend	2	12	2	12	=	=
Night to Day/ D to N changes	2/2	12/12	3/3	18/18	↑1/1	↑6/6
Standard days	28	162	20	116	↓8	↓46
Annual Leave	2	12	2	12	=	=

Teaching Attendance

Teaching sessions are an integral and often mandatory part of postgraduate medical training. The following are the attendance requirements at departmental and hospital teaching varies across levels and departments.

FY1

Weekly bleep free teaching Tuesday lunch time; with 70% attendance required over the year to meet curriculum requirements.

	Original			48h absolute			Effect
	In Rota Cycle	In placement	%	In Rota Cycle	In placement	%
Surgical block	5*/9	10/18	55%	5/9	10/18	55%	=
Medical block	6*/10	11/18	60%	4/10	6/18	40%	↓20%
Overall Percentage attendance**			58%			45%	↓13%

• *Excluding shifts on call for receiving.
• ** Presuming FY1 rotation of 2 medical and 1 surgical block

Medical Senior Rota

Medical teaching across all levels takes the form of:

• Wednesday lunchtime bleep free teaching, in the form of grand round
• Thursday lunch time medical meeting

In order to allow for clarity we will assess the impact for a medical senior trainee over a year in placement, in line with ARCP requirements. This analysis does not take into account any regional or specialty training specific teaching that may be mandatory as part of core or higher surgical training.

	Original			48h absolute			Effect
	In Rota Cycle	In placement	%	In Rota Cycle	In placement	%
Wed GR	6/8	39/52	75%	4/8	26/52	50%	↓25%
Thurs Med meeting	4/8	26/52	50%	4/8	26/52	50%	=

Surgical Senior Rota

Surgical teaching across all levels takes the form of:

• Friday morning (1130-1230) unit teaching
• Wednesday lunchtime bleep free teaching, in the form of grand round

In order to allow for clarity we will assess the impact for a surgical senior trainee over a year in placement. This does not take into account any regional or specialty training specific teaching that may be mandatory as part of core or higher surgical training.

	Original			48h absolute			Effect
	In Rota Cycle	In placement	%	In Rota Cycle	In placement	%
Friday Unit	5/9	29/52	56%	4/9	23/52	44%	↓12%
Wed GR	6/9	35/52	67%	4/9	23/52	44%	↓23%