Swap proposed teaching sessions for foundation doctors at ELHT
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ELHT has historically ran FY2 teaching on Tuesdays 1-5 & FY1 teaching on Thursdays 1-5. From August the trust has made the decision to change this to: FY2 Thursdays 8-12 & FY1 Thursdays 1-5.
Many juniors are concerned that this change poses a significant threat to patient safety. In addition it threatens contractual rights of protected lunch & teaching time.
The trust have explained that this change is necessary as the new contract requires 48hrs rest after working weekends. As a result, Tuesday teaching would be missed too frequently & no other day is a viable option.
We are not currently aware of any other North West Trusts making this change.
What do we propose?
Having discussed this with juniors we feel an effective solution to limit possible damage would be to swap the proposed teaching slots around. This would permit FY2s, who have more experience with handover & task prioritisation, to: collect ward jobs, work through them during ward round and deliver a succinct, task prioritised, handover.
In addition to this we ask the trust to:
- Commit to working with juniors to: implement alternative ways of working prior to the implementation of these changes in August and communicate these to all departments. This will help to ensure that the transition causes the least disruption to patient care & contractual commitments.
- Consider reducing teaching hours to: 8:00 - 11:30 & 13:30 - 17:00
- Ensure all clinical teams at sites other than Blackburn are informed & committed to the plan for Foundation doctors to: not be required to provide handover and to leave early: e.g. 11:45 & return late, e.g. 1:15 as required to attend teaching, travel & have lunch. This may mean wards do not have a junior doctor for that period.
- Guarantee solutions will be put in place to ensure those juniors working a 12.5hr shift will be able the take their full entitlement of a 1 hour break during this period.
Why are we asking for this?
Even under the current teaching arrangements, Tuesdays and in particular Thursdays are strained and difficult to manage on the wards trying to ensure adequate handover and take a lunch prior to teaching.
Having not attended ward round in the morning F2s will be returning to the ward with no idea of: patient plans, which tasks are outstanding/require follow up, any sick patients, and complaints/social tissues, etc... This takes considerable time to go through properly and cannot be rushed to avoid missing anything. (Particularly if an FY1 is expected to give that handover) Even then, we are human and things are sometimes missed which end up rearing their head, usually around 4:30... To achieve a sufficient handover juniors have said they feel this could easily take 20-25 mins.
Despite working within a MDT the lunchtime handover largely takes place between F1s and F2s, sometimes core trainees. We often find this to be the expectation from nurses, who feel this is the most effective method & are often burdened by a heavy workload themselves. Also, due to the differences in our roles, other staff do not necessarily have the information we need about a patients plan/care.
*There are also safety concerns highlighted in the points below*
Lunch & Breaks
Juniors are entitled to a 30 min lunch after 5 hours of working. Even under the current system juniors struggle to achieve this on teaching days.
Tired doctors make mistakes; missing breaks is a safety issue and can put our patients are risk. If nothing else we are likely to: be less efficient, miss things, be less able to engage during teaching, etc...
Foundation doctors on a 12.5hr shift are entitled to 60 mins worth of break. If FY1s attend teaching in the afternoon they are likely to have difficulty taking this. There will not be adequate time at midday and the 5-8:30 period of these shifts is often the most busy.
Driving from Burnley to Blackburn takes more than 25 mins. Usually around 35 mins & up to 45 mins in bad traffic. (This isn't including parking & walking across sites) Even if handover is not required this is too tight to permit travel and lunch.
A simple solution would be to make it clear to all departments that Foundation doctors may need to leave before 12 and may arrive past 1 in order to allow them to travel and get a 30 min lunch.
All NHS staff are familiar with the current increased strain on our workforce & a colleague needing to be rescued with a hug & that magic cup of tea is unfortunately a common sight. It must be remembered that not only are Foundation doctors subject to this day-to-day environment, they are the fresh faces, who recently graduated. They are learning to navigate numerous new challenges whilst also often compromising their training to maintain service needs. Worrying about trying to squeeze handover, lunch & travel in between teaching is another unnecessary burden & isn't sustainable. Something has got to give.
Additional stress is not only bad for the health of staff it also makes staff prone to mistakes. Once again, threatening patient safety.
As doctors our first concern is for our patients, therefore we will prioritise a safe handover. However, teaching is compulsory & juniors will be marked absent on their Horus portfolio if late. This combination of pressures is likely to result in FY1s compromising their lunch break.
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