Publication - Independent report

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

This report was led on by Professor Philip Cachia to consider the challenges of the maximum 48 hour working week and provide recommendations for the Scottish Government to consider.

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.

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%

Contact

Email: ceu@gov.scot