EWTD for Junior Doctors
New technology rides to the rescue
Written by: Roy Pounder, Chairman, RotaGeek Ltd.. Published: 3rd June 2010
From 1st August 2009 almost all juniordoctors in the NHS are supposed to beworking an average week of less than 48hours, with perhaps 10% allowed to workup to a 52-hour week because of a transientderogation from the regulations. It will havebeen a difficult month for all concerned –the EWTD, a change-over of staff, summerholidays, unfilled posts, few locums orinternational medical graduates available,and swine influenza – though swine flu is theonly problem that failed to turn-up in August.
But there is some new technology –software as a service from RotaGeek.com –that does bring some new solutions that areready to be applied, now that the 48-hourimplementation phase is over.
There are two parts to the EWTD
It is important to realise that there are twodistinct parts to the EWTD, which are onlyslightly connected. The first is the strict,inflexible regulations that enforce everyworker having at least 11 hours of rest inevery 24 hours, and 24 hours once a weekor 48 hours in a fortnight. There is no wayaround this rule, and it is this regular restin the EWTD that provides almost all thebenefit in terms of safety. Rested doctorsmake less mistakes.
The second part of the EWTD limits theaverage working hours per week – and thenew limit is 48 hours. This has essentiallynothing to do with Health and Safety, and isall about manipulation of the labour marketin Europe – essentially making more jobsfor the workers. That is perhaps a good ideawhen there is a surplus of workers – but theNHS is still very short of doctors… so I haveno guilt about devising ways of allowingjunior doctors to volunteer to work longerhours.
The opt-out solution
All British workers are eligible to opt-outof the working hours regulations [that isthe 48-hour week], and this now includesall junior doctors. They’ve only needed toopt-out since 1st August, and their averagehours remain a maximum of 56 per week,limited by the New Deal. The rest provisionsof the EWTD remain absolutely intact.
So how does it work? The decision to optoutmust be made without coercion, andthe junior needs to sign a simple statement,requesting to opt-out and giving reasonablenotice if they later wish to opt-in. The junioris then available to work up to an extra 8hours per week, on average – how couldthis be used? The most obvious benefit forthe employer is to have each opt-out doctoreligible to work as an internal locum – stillrigorously enforcing the rules about rest. Butthe junior could be scheduled to provideextra sessions regularly during the day orevening – perhaps for service work, perhapsfor training.
What’s the catch, and why does technologyhelp? Well, it does make designing a rota abit more difficult – that’s where the softwarecomes in. The basic 48-hour rota is devisedfor a group of juniors, and agreed by allinvolved. Then those who have volunteeredto opt-out can – with their manager andsenior doctors – decide whether to allocatesome extra ‘personal’ sessions during thenormal working week, or to remain availablefor occasional locum sessions, or a mixtureof the two. The rule of the opt-out demandthat a full record is maintained of the hoursworked by these employees – and thisis made extremely easy by the software.Finally, these extra hours may trigger achange in banding and increased pay forthe junior – this is not inevitable, but it isusually far cheaper than hiring externallocums.
The management of internal locums can betransformed by RotaGeek’s ability to identifyin real-time those doctors who are rested andavailable for locum work – and contactingthem via text message and email.
Shiftwork, and covering 168hours per week
Medicine is a 24/7 business and some jobswork flat-out – for example, in Accident &Emergency or on-take for acute medicine ina busy hospital – such posts demand a freshdoctor who works continuously coveringfull-shift working - that is, the night.
But there are other posts where there is onlya need for a skilled doctor to be available atvery short notice in the evening and overnight, but not actually present on-site inthe hospital. Examples of such posts wouldbe most surgical or orthopaedic SpRs, orjunior physicians on-call for emergencyprocedures – for example, cardiac catheteror endoscopy. These less intense posts areoften suitable for the non-resident on-callsolution.
The non-resident on-call solution
This solution exploits the very realdifference between being on duty (thatis, ready for work) and actually working– whilst strictly obeying the EWTD restregulations, and the two court judgmentsSiMAP and Jaeger, and the New Deal.Despite all this red tape, junior doctorscan be on duty up to 72 hours / week andwithin those hours they may work for 48hours (or 56 hours, if they have opted-out).Hence, the apparently impossible demandsof the junior surgeons and their EnglishRoyal College are essentially met.
What’s the catch, and how does technologyhelp? Designing such rotas, recordingwork performed and, most importantly,automatically sending a doctor homeearly if there has been an unusually heavynight of work –can all be performed by theRotaGeek technology, for example, loggingovernight work via the junior’s mobilephone and/ or email plus maintainingrecords not only for Ministerial returns butalso the Health & Safety Executive.
Where does RotaGeek.com come from?
Dr Chris McCullough and I foundedRotaGeek in early 2009, and we havefunded the project after failing to get anNHS grant. Chris was recently an SpR inRenal Medicine in North London, havingqualified in medicine and completed aPhD in Edinburgh. He was seconded tocoordinate implementation of the New Dealin Scotland, was on the BMA’s junior doctorcommittee, and later was the first CEO ofRemedy – the juniors’ pressure group.My first job was as a house officer at Guy’sHospital in the 1969 influenza pandemic;
I trained in Gastroenterology and endedupas a Professor of Medicine at the RoyalFree Hospital, UCL. I was elected ClinicalVice-President of the Royal College ofPhysicians in 2002, and was its lead for theEWTD until I founded RotaGeek. I have beena member of most of the Government’scentral committees planning the EWTDimplementation.
We founded RotaGeek because we areboth committed to the NHS. We want toconsolidate the safety improvements thatare provided by the EWTD, but want topreserve the joy of doing the good, fulfillingjob of being a junior doctor – and thatincludes being properly trained. We believeour solutions provide a lifeline to assist thesafe implementation of the EWTD.
RotaGeek is ‘Software as a Service’ – thatis, users login via the Internet to a centralserver, and this provides an economic andefficient platform to plan and implementrotas. From free trial rotas, to rotas ofincreasing complexity and ‘intelligence’ – allare available via RotaGeek.com.
