In South East Scotland we want to ensure doctors in training are living and working safely, on a rota that is compliant with the necessary rules and regulations. The aim is to facilitate excellent training, and for us to have a work-life balance, sufficient rest and for us to be safe above all things.
Apart from those on national contracts, NHS Lothian is the employer for trainee doctors across SE Scotland (NHS Borders, NHS Fife and NHS Lothian).
Our working patterns must comply with two sets of regulations:
New Deal for Junior Doctors: is a package of measures designed to improve the conditions under which doctors in training worked. It provides guidance on hours of work, living and working conditions for all doctors in training.
Working Time Regulations (WTR): is a directive from the Council of Europe enshrined in UK law in 1998, to protect the Health and Safety of workers by setting minimum requirements for working hours, rest periods and annual leave.
There are 3 main types of working pattern:
1. Full Shift Rota (most doctors in training work on this pattern)
The work that is carried out is intensive and continuous throughout the 24-hour period.
Shifts do not exceed 14hours.
At least 8 hours of rest between shifts is required.
Natural breaks are required (at least 30 minutes of continuous rest after 4 hours of continuous working).
2. On Call Rota
Work is considered to be low intensity, particularly during OOH.
Normal working pattern exists Monday-Friday for all trainees on the rota, and then an on-call person takes over to cover the remainder of each 24hour period.
The frequency of on call cover depends on the number of trainees on the rota.
Duty periods cannot exceed 32 hours on weekdays, or 56 hours at the weekend.
At least 12 hours of rest between duty periods is required.
Doctors are expected to spend half of their on call duty period undisturbed, of which a minimum of 5hours is continuous rest between 10pm and 8am.
Work is considered to be higher intensity than on call, but less so than shift working.
Duty periods do not exceed 16hours.
Natural breaks are required during normal working hours, and at least ¼ of the out-of-hours duty period should be spent undisturbed.
Doctors in training must follow a rota template which has been approved. The rota is agreed, prior to being put in place, by the department in which it will be implemented, the compliance teams at the NHS board (for New Deal and WTR) and is reviewed by the Scottish Government. Changes in your working pattern (e.g. swapping a shift) could result in non-compliance (for example, insufficient rest period after a run of nightshifts). Therefore, any changes must be discussed in advance with the rota master to ensure that they will not lead to problems.
In order to ensure all rotas comply with both New Deal and Working Time directive NHS Lothian use the following local guidelines for rota design and sign off
Prospective cover is when trainees cover the full annual and study leave entitlement (including public holidays) of their colleagues on a rota. All rotas are designed to allow each person on the rota to be able to take their annual leave entitlement. Occasionally, Locum staff may be obtained to cover some study leave. Prospective cover arrangements do NOT cover any other type of leave (e.g. sick leave or carer’s leave).
You may be asked to assist your department by covering a shift at short notice due to a colleague’s absence, for locum pay or time in lieu.
Working patterns should be designed to meet the minimum rest requirements of the WTR. Where this is not possible, or where circumstances have not allowed daily rest to be achieved, compensatory rest should be given.
You qualify for compensatory rest if you:
Work a full shift, which extends beyond 13 hours.
Work on-call from home and your 5 hours of continuous rest is interrupted.
Work resident on call for more than 12 continuous hours.
The rest provided should make up for the rest missed on a minute by minute basis. For example, if a doctor fails to get 1 hour of the 11-hour continuous rest period, the individual should either be let away from work 1 hour early or start their next shift one hour late. Payment (instead of rest) is forbidden by the WTR. Ideally, rest will be taken immediately after the end of the non-compliant shift, or as soon as is practicable.
The banding supplement that is paid reflects the number of hours worked, the intensity of that work, and the proportion of it that takes place out-of-hours. Each rota is allotted a pay banding according to:
The following table provides information on the type of banding and supplement allocation:
There are 3 circumstances that lead to pay banding protection:
When a rota is down-banded, post-holders are protected on the higher band for the duration of the post or end of contract, whichever is sooner.
When a trainee is given less than six weeks’ notice of a change in banding on acceptance of a post, the trainee is protected on the higher band that was in place when they accepted the post, for the duration of the post or end of contract, whichever is sooner.
When a band 3 rota is improved and shown to be compliant following a valid set of monitoring, post holders are pay protected at band 2A until the end of their current placement. Doctors rotating into the position within 1 month of re-banding will be pay protected for the duration of their rotation on band 2A