Alleviating costs and maintaining resilience under a new junior doctors' contract

Abstract

The 2016 junior doctors' contract comes into effect for all remaining trainees by October 2017. Overseeing compliance with the contract is the duty of the Guardian of Safe Working. NHS work pressures are a hot topic and the Royal College of Anaesthetists has recently published the results of the Morale and Welfare survey of 2300 trainee anaesthetists showing 85% at risk of burn out. Under 2016 junior doctor contract terms, the Guardian of Safe Working levies a fine if defined breaks are missed on at least 25% of occasions. We conducted a prospective study over the busy December–January period, to review the four anaesthetic on call roles' working pattern against the incoming contract as there are no intended changes in rota pattern. A cohort of 35 junior doctors, covering four on-call roles, over 180 shifts, missed breaks on 23% of shifts. The Senior Trainee, an ST6-8 doctor, missed breaks on 36% of 45 shifts, of which 62% occurred during weekend or bank holiday shifts. The total value of fines levied by a Guardian of Safe Working for five doctors missing breaks on 25% or more of their shifts equated to £907.82. To meet the terms of a new contract there needs to be a multifactorial approach that addresses: rota gaps; inter-specialty communications; effective guardianship; and reporting, as well as preparation for potential consequences of new contract implementation across all specialty groups.