working time – an nhs perspective bill mcmillan head of medical pay and workforce nhs employers 21...

Working Time – an NHS perspective

Bill McMillan

Head of Medical Pay and Workforce

NHS Employers

21 October 2011

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

European Working Time Directive in the NHS - Doctors in Training

• 1991

– 83 hours per week max; training in 72 hours

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

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

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

2011

GMC State of medical education and practice

Positive impact

• Reduced hours

• Compliance with Working Time Regulations (EWTD)

• Has driven solutions – eg Hospital at Night

• Healthy recruitment and retention

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

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

http://www.nhsemployers.org/