Talk Health and Care

Rotas - Why don't we allow Doctors to plan their lives?

I'm a junior doctor. I'm 25. I have friends who work for all types of businesses. They work long hours, not as many nights but they do work hard. 

But they're treated with respect. They get their rotas on time, they know when they'll be expected to work and can plan holidays. 

I found out my rota for August-December at the start of July. I have no idea what I will be doing after the 4th December this year. I don't know if I can plan a holiday with my partner for April, I can't book flights, I don't know if I can go to my best friend's wedding on the 8th December - the list goes on. 

There is absolutely no reason this has to be the case. 

Your NHS managers will tell you that it allows them workforce planning. Makes them more flexible, agile and allows them to change rotas if they need to. They never do this in the middle of a year, and they shouldn't. They'll tell you they can't give rotas until all their trainees are confirmed. They'll say they can't be fixed because things change. All of this is nonsense. 

A commitment to providing doctors with a year's worth of rota in advance, to ensure they can plan their lives would do much to boost morale. It would do much to make them feel valued and realise that their job is compatible with their personal lives. We should not pretend that the current alternative is acceptable, because it really isn't. 

 

 

 

Chloe Gillum 6 months ago

This is exactly the same case for Nurses I have no rota past the first week of October, trying to plan dinner for a family members birthday is a nightmare with such short notice given in regards to our rotas. The only way I can ensure I can go to friends weddings is by using my annual leave and booking it a year in advance.

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Mark Johnson 5 months ago

Luckily you can use your annual leave like this. Doctors don't even get this opportunity.

If I want to have a friend's wedding off work I just have to sacrifice a lamb to the gods, send a pigeon to Zeus and hope that the gods look down on me kindly. It shouldn't be this way.

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Jamie 6 months ago

Give an ultimatum? "either you give me my shifts now, or I won't do any"

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Mark Johnson 5 months ago

But realistically this doesn't work, because most doctors aren't 'bold' enough to do this. Why would I compromise patient care? That's the issue, doctors are too nice and we rely upon people such as the Health Secretary to do something about this crap... because realistically the options open to ourselves are minimal.

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Matt Hancock 5 months ago

Mark, you are absolutely right that the current situation isn’t great and we need to make it work better. I share your concern that many NHS staff don’t have the ability to plan or make commitments in their life due to a number of the challenges you highlight.

For junior doctors, we’re aware that the ability of rota managers to plan rotas may depend on the logistics of rotations (recruitment timing and length of placements) but some trusts are able to give greater notice and I want to see other trusts following suit.

Regarding flexible rostering more generally, we are working with trusts to ensure that they are establishing effective rostering practices and using electronic rostering and mobile shift-booking apps to give healthcare staff more control and flexibility over their lives. We know there are some trusts doing excellent things to promote this across different staff groups and working to improve rota management for doctors.

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Mark Johnson 5 months ago

Hi Matt,

Many thanks for your reply.

My trust does have e-rostering in place, and it works well - useful app, and ok interface to use. However, importantly it doesn't solve the problem I outline. I still do not have a rota for my placement starting in December. I still cannot tell my best friend I can attend her wedding, or take holiday with my partner.

I also would urge you not to be taken in by the standard 'NHS excuse' of 'recruitment timing and length of placements'. My trust knows how many trainees there will be in my department in December, and they have done since at least August. Similarly, they do for my colleagues in other departments. It is all about planning. You would actually find there are savings to be had if NHS trusts were forced to plan their workforce at least a year in advance. Many trusts appear to 'suddenly' realise they have a rota gap when they come to issue rotas 6 weeks out (the statutory amount of time contained within the 2016 Junior Doctor contract) - requiring them to at least attempt to cover with high-cost locum posts, rather than 'trust grade' posts which are significantly cheaper.

Matt, you will know how volatile the contract disputes became. But the key issue for most Juniors is not about the money - it is about the conditions they are put under. Rotas come top of that list. If you put them close to the top of yours, you'll find a lot of your workforce problems (retention, sickness, goodwill) start to disappear!

I'd be more than happy to discuss this further - it's a really important topic for most doctors planning their future lives and considering whether it's really worth continuing in medicine to 'keep being treated like this'.

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Matt Hancock 2 months ago

Dear Mark,

Thanks for the really helpful reply. It was great to meet you at Milton Keynes on your shift before Christmas and discuss these issues further. Having rotas in good time for your next placement is an issue that I have heard a number of times on #TalkhealthandCare and is so important so you are able to plan your life. I completely get how important this is and when to get this right. And part of e-rostering is not just to inform you of your rota on new technology, but allow you to choose your slots. Does it do that yet?

NHS Improvement, in collaboration with NHS employers and Health Education England have been working to improve this on the back of the junior doctors’ dispute as part of their ‘Streamlining’ workstream. While there has been progress, there is still work to do to and I have asked my team to look into this further to see what can be done to ensure an improved process is in place.

Again, thank you for your input and I will keep you updated.

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Mark Johnson 1 month ago

Hi Matt,

Thanks for your reply. It was great to meet you and speak to you about this issue in person. Rotas have a significant effect on junior doctors’ quality of life and this important issue needs to be addressed.

I agree that eRostering is a great resource and that more trusts should use it, given that it is relatively simple to use and does make requesting study leave and holiday easier. However, there are some difficulties, such as building in details of specific ‘on call’ duty areas, or where a specialty has a rota with highly variable shift types ie. acute general medicine, which requires work in different areas with different teams on a daily basis. It is also unfortunate that each trust purchases its own rota and exception reporting software separately, with the result that there is no systemic improvement across trusts and the NHS fails to make use of its huge economies of scale.

I know that many junior doctors love the idea of ‘picking their shifts’ and that there are examples of trusts in the UK that have implemented this well, Brighton being the one that springs to mind. A Consultant there has written a Talk Health & Care post about this project: https://dhscworkforce.crowdicity.com/post/608216 This is not currently the situation at Milton Keynes and my concern with this proposal is that most trusts would be trying to run before they can walk.

When we met, we discussed the implications of the current rota time limit, namely the mutual understanding between NHS Employers and the BMA that you receive your rota 6 weeks in advance of a shift. There are significant implications for doctors who cannot book holiday until they receive their rota ie. being unable to plan for yours or a friend’s wedding, unable to plan a holiday or co-ordinate time off with your partner. This is at odds with other NHS staff, such as nurses, who can request their annual leave in advance of rotas being released.

The implications for the trust and NHS are also significant; 6 weeks becomes a target that trusts work towards, meaning they don’t plan their staffing any further ahead of time. This results in a greater reliance on locum staff, something that could be prevented by appointing trust grade doctors to fill in the ‘known gaps’, or using cheaper in-house locum doctors rather than agency staff. A lack of long-term rota planning increases these costs for the NHS.

I fully understand the ambition for flexible e-rostering for doctors, but think that there are simpler short-term solutions. Why not make the 6 week rule a 3 month rule? Why not introduce penalties for trusts that breach this rule, in the same way that guardians of safe working penalise trusts where doctors breach their safe working hours? Why not provide an absolute guarantee that, if a doctor needs a day off for their own wedding, they will be given it?

It might sound unusual, but I know of 3 instances in the last year where a doctor - who informed their trust a year in advance of the date, and repeatedly reminded them of it - was told they were expected to work on their own wedding day. Previously, I had always expected these were urban myths, or at least situations confined to history. Upsettingly, in not one of the situations did the trust’s HR department/rota co-ordinators provide the solution. In two, other doctors personally covered the shifts between them, and in one the consultant in charge instructed the trust to provide a locum.

I fully stand by my discussion with you during the night shift: there is much that could be done to improve the morale and working lives of doctors for little or no cost. For example, my current employing trust, Milton Keynes, has been one of the first to offer rest facilities for all doctors, and free on-site accommodation for those on long shifts on top of a long commute home between shifts. The accommodation already exists and the cost is minimal, namely a quick clean and some fresh bed linen. In return, the trust has well-rested doctors who are more likely to want to stay at MKUH, reducing staff shortages by increasing retention.

When I compare my career to those of my friends, I am disappointed that the NHS fundamentally lacks the ability to motivate its staff. As an employer, it relies on goodwill and rarely provides anything in return. Many NHS staff will tell you that small things can make a massive difference to how valued they feel; for doctors, being unable to plan our lives has a huge impact on our goodwill, a negative influence that you have the power to change.

It was great to speak to you in person and hear that you understood the importance of improving this situation. Many thanks for your reply; it is reassuring to hear about your positive action in this direction so far and more to come, I’m sure!

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