Report on a novel approach to foundation year 1 doctor workforce planning

Abstract

In early 2020, North Manchester General Hospital took steps to increase the number of doctors providing out-of-hours cover in response to the COVID-19 pandemic. This included introducing higher intensity rota patterns. Following positive feedback, it was decided that maintaining an increased level of staffing at foundation year 1 level across the site was beneficial for both patient safety and junior doctor working conditions. A new workplan was designed to maintain this higher level of out-of-hours cover by foundation year 1 doctors without an unmanageable financial impact on the trust, while complying with workforce regulations. In this model, foundation year 1 doctors work across multiple areas when providing out-of-hours cover, across medicine, surgery, urology and trauma and orthopaedics, rather than staying in their own current parent department. This whole-site model spanned the full 52-week period of the foundation year. In addition to increasing staffing numbers, this structure was also designed to provide foundation year 1 doctors with more stability in their rota pattern and monthly income, while improving their ability to prospectively plan their personal lives. The new model led to 20% additional cover during weekday evenings, 50% additional cover during nights and 60% additional cover on weekend daytimes, at an additional cost of £61 383 per year to the trust, excluding additional employer costs associated with a salary (‘on costs’). Foundation year 1 doctors reported that this model gave them educational opportunities and allowed them to take more breaks. This article describes this model, its implementation, key considerations and the potential to expand it across other NHS trusts.