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Working Time – an NHS perspective
Bill McMillan
Head of Medical Pay and Workforce
NHS Employers
21 October 2011
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EWTD in the NHS
Doctors in Training
Reducing hours 1991 until 2010
Rotas compliant but training damaged
Modernising services/reconfiguration/new ways of working
Simap/Jaeger – compensatory rest/ what’s work when on call
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European Working Time Directive in the NHS - Doctors in Training
• 1991
– 83 hours per week max; training in 72 hours
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European Working Time Directive in the NHS - Doctors in Training
• 2000
– 40 hours basic
– 40-48 hours – pay supplements of 20%, 40% and 50%
– 48 -56 hours – pay supplements of 50% and 80%
– >56 hours – pay supplements of 100%
– Strong financial incentive for employers to reduce hours
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European Working Time Directive in the NHS - Doctors in Training
2009 – rotas compliant except for 273 derogations (86 left as at January 2010 – roughly 1.3% of all 6646 rotas across 247 employers) until 31 July 2011
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European Working Time Directive in the NHS - Doctors in Training
2010
GMC report on postgraduate training – EWTD becoming routine and accepted
Temple – training can be delivered in a 48 hour week... But .. Consultant delivered services
Collins – working beyond their competence / comfort zone; mortality poorer at nights and weekends
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2011
GMC State of medical education and practice
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Positive impact
• Reduced hours
• Compliance with Working Time Regulations (EWTD)
• Has driven solutions – eg Hospital at Night
• Healthy recruitment and retention
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Negative impact
• Burdensome – monitoring and appeals
• Single breaches disproportionately expensive –banding applies to all doctors on a rota
• Constrains rota design and flexibility (exacerbated by differing EWTD limits and requirements and ECJ SIMAP/Jaeger rulings)
• Rigid shift patterns make training less of a priority
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What next
Change contract to reduce variability of pay and structure contract in same way as other doctors
Get more flexibility in EWTD particularly in relation to Simap /Jaeger
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http://www.nhsemployers.org/