Junior Doctor Contract Research Articles

1091 Trends in Exception Reporting (ER): Medicine vs Surgery

Abstract Aim ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality. Method A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel. Results 125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall, there is no difference in number of reports submitted by sex (p = 0.1). F1s are more likely to report than any other grade (p<0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery. Conclusions Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.

Genesis and prospects of the shortage of specialist physicians in Italy and indicators of the 39 schools of hygiene and preventive medicine.

In Italy, the number of physicians decreased in recent years due to retirements not being replaced by young specialists. To address this shortage of medical personnel, proper planning is needed, taking into consideration the number of accesses in medical schools and residency contracts. The main objective of this study is to deepen the data on the number of physicians, provide a prospective picture and make some suggestions for future planning. Materials and Methods: Estimates of the number of physicians, contracts, assignments, and abandonments for specialist schools are based on data from the General Medical Council, the Ministry of University and Research, Eurostat and the "Associazione Liberi Specializzandi". Results: Estimates of the number of physicians for the period 2023-2032 predict the minimum availability of active doctors between 2028 and 2029. While there has been an increase in the number of contracts for residents in recent years, there are concurrently high dropout rates and non-assignment of contracts, varying across Schools of Specialization. An examination of the available data for the 39 Schools of Specialization in Hygiene and Preventive Medicine shows lower than-average abundance rates. Conclusions: In recent decades, poor planning and early retirement have led to a shortage of doctors, particularly specialists, that will not be resolved until after 2030. Proposed solutions to this 'health emergency' include importing doctors from abroad, delaying the retirement age, recruiting junior doctors to the National Health Service and changing the distribution of junior doctor contracts.

FTP8.4 Trends in Exception Reporting (ER): Medicine vs Surgery

Abstract Aim ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality. Methods A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel. Results 125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall there is no difference in number of reports submitted by sex (p=0.1). F1s are more likely to report than any other grade (p<0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery. Conclusions Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.

363 A Comparative Analysis of Night-Time General Surgical Training

AimThe aim of surgical training is to ensure trainees acquire competencies to perform as a Day 1 Consultant. The last decade has seen the introduction of European Working Time Directive, NELA guidelines and the revised Junior Doctor Contract. All of these, as well as the COVID 19 pandemic, have caused concerns regarding training. Our aim was to examine any changes to night-time on call activity during this time.MethodWe retrospectively analysed prospectively collected data from 2011, 2018, and 2021, in a busy District General Hospital. The data collection period was 31 days, looking at night-time (8pm to 8am) operative experience, supervision, and non-operative activity. A regression analysis was conducted to compare outcomes. A qualitative survey was used to assess attitudes and confidence.ResultsOn average, trainees spent 11% of their time operating independently, 2% operating supervised, 11% attending trauma-calls and 73% clerking/non-educational activities. There was a significant difference between the hours spent on operative versus non-operative activity (P 0.00046) with no differences over the years. Junior trainees did not feel confident operating at night and only 33% of all trainees found night-time training effective.ConclusionsNightshifts comprise a substantial proportion of potential training opportunities and managing the unselected emergency take is one of the Capabilities in Practice. Effective solutions must be implemented to help improve night-time surgical experience and confidence in order for this time to be effective for training of both operative and non-operative competency attainment.

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade.

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or 'being a doctor'. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

Millennials - The Missing Piece in the NHS Workforce Puzzle?

UK healthcare is in the throes of a workforce crisis. There are 10,000 fewer doctors and over 50,000 fewer nurses than are required to run a safe and sustainable service. Multiple factors from removal of nursing bursaries, introduction of university fees, poor working conditions, under-resourcing of healthcare services, unmanageable workloads, learned helplessness of clinical risk and a culture of incivility or blame is driving the workforce of the future away from NHS. Several governmental agencies, arm’s length bodies and trade unions have been grappling with this challenge. A few solutions have been recommended under the new contract for junior doctors, reintroduction of support for nurses and expansion of medical school places, but some are yet to be implemented. NHS leaders continue to support blue-sky thinking in terms of workforce innovations but tend to drag their feet when it comes to adoption. This reluctance by senior clinicians, managers and policy makers may be related to a lack of understanding of the values that drive the millennial generation that most younger healthcare workforce belong to. This article will explore the challenges and solutions from a generational perspective and offer an insight to guide future decision-making.

A review of exception reporting practices and understanding at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Following the implementation of the 2016 junior doctor contract, exception reporting was introduced as a tool to improve junior doctor training, morale and patient safety by monitoring working hours. Thus far there has been minimal study into its effectiveness and acceptance in the NHS workforce. This audit assessed the use …

Promoting less-than-full-time (LTFT) training in your local trust: a workshop in conjunction with your champion of flexible training.

Recent Royal College of Physicians data have shown a continued increase in the proportion of trainees working less than full time (LTFT) to 15%.1 Despite this increase, the latest GMC survey data have shown that only about 15% of LTFT medical trainees feel very supported in their decision to train flexibly, versus 33% of GP trainees.2 What can be done at the grass roots level to improve LTFT training for all and to support trainees positively in their decision to work LTFT? As part of the new junior doctor contract in 2016, flexible champions were put forward as a local point of contact for …

Barriers to the implementation of exception reporting at a busy district general hospital.

One change implemented with the 2016 junior doctor contract was the advent of a system of exception reporting. This enables doctors to report either loss of educational opportunities or breaches of safe working hours (including working extra hours, inability to take breaks and unsafe conditions). The outcomes of exception reporting could include compensation (with time or pay), with the process enabling unsafe working conditions to be flagged up to relevant stakeholders. The novelty of exception reporting means that there is a paucity of data regarding uptake or improvement outcomes. One recent study from Barts Health NHS Trust explored this issue.1 The authors surveyed junior doctors within the trust and found that 35% had submitted an exception report, with 29% of respondents reporting being told not to exception report by their seniors. Following discussions with junior doctors, it was observed that the numbers of submitted exception reports might not reflect those anticipated, given known issues with staffing levels and rota gaps. Therefore, this study was designed to establish what percentage of eligible shifts are exception reported by junior doctors in a busy district general hospital, and the reasons behind any discrepancies in the observed pattern of exception reporting.

Promoting less-than-full-time (LTFT) training in your local trust: a workshop in conjunction with your champion of flexible training

Recent Royal College of Physicians data have shown a continued increase in the proportion of trainees working less than full time (LTFT) to 15%.1 Despite this increase, the latest GMC survey data have shown that only about 15% of LTFT medical trainees feel very supported in their decision to train flexibly, versus 33% of GP trainees.2 What can be done at the grass roots level to improve LTFT training for all and to support trainees positively in their decision to work LTFT? As part of the new junior doctor contract in 2016, flexible champions were put forward as a local point of contact for …

Strategic Thinking to Improve Surgical Training in the United Kingdom.

Surgical training in the United Kingdom (UK) is facing crucial challenges. Multiple fundamental changes in recent years have meant the same high-quality training needs to be delivered in a shorter duration. In this review, we consider the current training pathways for surgery in the UK, the impact of the European Working Time Directive (EWTD), the ongoing issue of service delivery versus training, and briefly the new Junior Doctor contract and the effects of Brexit on surgical training.The purpose of the review is to attempt to apply strategic thinking and strategy development to improve the current state of surgical training given the current climate new trainees find themselves in. Strategic thinking and wicked issues are defined, and three umbrella suggestions to improve surgical training are explored. Whether these suggestions can be implemented with reference to different models of strategic decision making is discussed.Finally, despite a new pilot scheme aimed at improving surgical house officer (SHO) surgical training, little change is offered to current trainees. The impact this has on surgical trainees is discussed and suggestions on how they can make the most of the current climate are made in this article.

A brave new world: novel non-training posts to support career breaks, reduce rota gaps and reduce locum spend

Nottingham University Hospitals NHS Trust is suffering with significant junior doctor rota gaps; a result of the imposition of the new junior doctor contract, poor recruitment to core medical training and an increasing trend towards trainees taking a career break post-completion of the foundation programme (58% in 2017). These gaps are impacting on training opportunities and morale of trainees, and operationally are leaving wards short-staffed resulting in an increased reliance on locum doctors, particularly …

Junior doctor contract and postgraduate training

Junior doctors provide service to the NHS while learning under supervision. As employees, they are salaried to serve their patients. As learners, they must strike a balance between training and...

The junior doctor contract 2 years on: one trust's experience of exception reporting.

The new junior doctor contract allows trainees to exception report when they breach safe working hours. After a full year of foundation year 1 rotations, analysis from a large NHS trust in London showed that exception reporting works to highlight rota and working issues. It is unsurprising that trainees are busy but simple things such as competent infrastructure and senior support could go a long way to improving working conditions. In addition, results from a local survey suggest that trainees think the new contract is less safe for both doctors and patients, with inflexibility of rota patterns having a significant impact on the ability to take annual and study leave. A drive to modernise the way health care is delivered in hospitals is needed as a shortage of doctors will only worsen the situation.

Holding on to medical students and junior doctors

The strikes over the new junior doctor contract and low morale are having a damaging effect on medical students' and junior doctors' attitudes and willingness to work in the NHS. In this opinion piece, Oliver Ralph gives his perspective and describes how it has impacted his view of his future.

Foundation Year 2 doctors’ reasons for leaving UK medicine: an in-depth analysis of decision-making using semistructured interviews

ObjectivesTo explore the reasons that doctors choose to leave UK medicine after their foundation year two posts.SettingAll four regions of Scotland.ParticipantsFoundation year two doctors (F2s) working throughout Scotland who were...

“How has the new junior doctor contract changed opinions on oral and maxillofacial training amongst current and prospective trainees?”

Introduction: The new junior doctor contract imposed by the government from 2016 has been highly controvertial. Changes to pay structure and working patterns have the potential to significantly affect trainees in oral and maxillofacial surgery, with the loss of banding and a move to an on call availability allowance available. We sought to canvas the opinion of people already in training, those dual qualifying and those singly qualified who are interested in a career in OMFS on whether the contract has influenced their career plans.

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

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.

Regulation among leaders for service improvement

The NHS consistently appears in our national news. High profile headlines about poor care and avoidable deaths, alongside the junior doctor contract dispute and the most recent winter crisis, have exposed low morale and a service under immense pressure. There is a mistrust between clinical staff and senior leaders, with the former being responsible for clinical care within a work environment and culture dictated by the latter. Doctors, nurses and allied health professionals must register, at their own expense, with their respective regulatory bodies to practice and face sanctions for breaches of their codes of conduct. Although healthcare organisations are regulated and monitored, no such mandatory licensing is required to manage UK healthcare. This article highlights that policy and strategic decision making by senior leaders and politicians directly impacts on patients. In this commentary, the authors argue that, to protect patients, it should become necessary for policy and strategic decision-makers in healthcare to adhere to the same mandatory regulatory standards that healthcare professionals do. Otherwise, we fail to place patients at the heart of policy decision making and reforms.

Offline: Is the NHS in crisis?

Offline: Is the NHS in crisis?