In the middle of a busy day shift at Croydon University Hospital, Emergency Medicine Consultant Oliver Spencer pauses to reflect on the pressures that the NHS is experiencing right now.
“The NHS is seeing a surge in demand for services, not least due to the backlog that has mounted over the last two years,” he says.
“With capacity squeezed, the conditions for overwork are growing across the system, but we must remember that the rules and regulations that govern how many hours doctors can work are there for a reason.”
Dr Spencer is one of hundreds of Guardians of Safe Working Hours in England, who in addition to their day job are responsible for monitoring junior doctors’ compliance with working time regulations.
Providing assurance through a system of exception reporting and rest monitoring, Guardians of Safe Working Hours ensure that junior doctors do not exceed the many working limits within their contract, and that rest breaks and educational opportunities are not being missed.
Increasingly under strain
With the NHS increasingly under strain, a trend toward excessive working hours among foundation grade doctors is a worrying prospect for Trusts and their Guardians.
At the height of the pandemic, at many Trusts, exception reporting fell by the wayside, leading to concerns that F1 and F2 doctors may have fallen out of the habit of filing exception reports.
While staff and patient safety is of course the primary aim of the Guardians of Safe Working Hours scheme, failure to file accurate exception reports on time also comes at a cost to employers.
NHS Trusts fined for burnt-out doctors
Guardians have the power to issue fines to NHS Trusts for breaching rules designed to shield their junior doctors from burnout.
Last year a Trust was fined £30,000 for one non-compliant shift alone, having gone unnoticed by the staffing department for months.
Figures show that most trainee doctors in England have worked beyond their contracted hours at some point or another, meaning that the total value of fines issued by Guardians is likely to be greatly overshadowed by the cost of staff absence, sick pay and agency fees as a result of overwork.
Key to reinvigorating exception reporting amongst junior doctors, according to Dr Spencer, is to engage them with the process more and lessen the time taken to file a report at the end of a busy night shift for example.
“Medics always put patients first”
“But unfortunately, there can be times when this is to the detriment of themselves.” he adds.
“Exception reports are there to protect doctors and patients. Nevertheless, it is all too easy to forget to file one, or to view the obligation as an unnecessary burden for instance, if you’ve gotten out of the habit as a result of the pandemic.
“To overcome this, junior doctors must be engaged with exception reporting. For that to happen, they must see that exception reporting is a tool used to protect them, patients and the Trust from potential harm resulting from working non-compliantly.”
Paul Walker, Chief Technology Officer at Skills for Health, a not-for-profit organisation which supplies rostering systems to the NHS, agrees.
“Exception reporting must be easy and convenient to do, and doctors must believe that positive action will result from their reports.” he said.
“Convenience is key, which is why we have developed our Custom Rostering System (CRS) in close consultation with Guardians of Safe Working Hours to ensure that exception reporting fits seamlessly into junior doctors’ busy schedules.”
Launched last year, Skills for Health’s Custom Rostering System is the successor to its Doctor Rostering System (or DRS) which has been used by more than sixty NHS employers across England.
Typically spending 6-7 hours a week on analysing exception reports, Dr Spencer is hopeful that once fully implemented CRS will free him and his fellow Guardians up to spend on other duties.
“CRS is a huge step towards achieving compliance and safe working hours for doctors.” he said.
While its exception reporting will provide vital information for the Guardians of Safe Working Hours, CRS actually protects doctors, patients and the trust from the effects of working unsafe hours from the very start of the rostering process.
CRS benefits
Paul Walker explains, “As work patterns are being built, CRS provides pre-emptive warnings of non-compliance, highlighting that part of the plan and providing the reason for non-compliance.
“Also, in CRS, planners can move smoothly from building compliant patterns to eRostering, with the obvious efficiency and safety benefits of eliminating the switching between systems or rostering in spreadsheets.”
Other key features of CRS include: the option to notify multiple members of staff that an exception report has been filed; pre-populated reporting fields and real time additional payment or time off in lieu (TOIL) calculations.
Find out more about CRS and how Guardians of Safe Working are key to preventing doctors working unsafe hours.
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