New roles supporting the 48 hour week

The development of new roles and ways of working is a key element to moving towards the Working Time Directive. Changing traditional roles and responsibilities can have a significant impact on the working of particular departments. Two organisations in South Yorkshire have introduced new roles to streamline ways of working that have also had the knock on effect of supporting the move towards WTD compliance.

New roles in the ambulance service reduce pressure on acute sector

The emergency care practitioner (ECP) is a new role developed and introduced across South Yorkshire by the former South Yorkshire Ambulance Service in collaboration with local hospitals, PCTs and the wider healthcare community.

It provides a new role and model for urgent response to particular emergencies by providing enhanced skills to ECP personnel who can then treat particular patients in their home or the community – with the ability to quickly transport them to hospital or refer them to other services if needed. A typical example would be a situation in which a person was experiencing breathing difficulties; an ECP would be able to assess and, where possible, treat the patient in their home and avoid hospital admission.

The objective of developing the new role was to address the growing demands on all aspects of healthcare by providing a new form of emergency service that would reduce hospital attendance and admission rates by tackling emergency cases in the community that would have typically gone to hospital.

Academic research has found that whilst nearly 70% of patients treated by the ECP had contact with healthcare in the subsequent 28 days, 90% of these were with community services rather than secondary care. As a result of this, the ECP role had a positive impact on the pressures facing junior doctors in acute care and specifically supports the WTD requirement in acute trusts. Demand for unscheduled care in South Yorkshire has been increasing by up to 10% annually so the introduction of the ECP role has helped to stem the increase and reduce further pressure on junior staff in hospital.

Role flexibility in cardiac testing reduces the burden on juniors

The section of Nuclear Medicine at Sheffield Teaching Hospitals NHS Foundation Trust uses myocardial perfusion scanning to assess the degree of coronary heart disease amongst patients. The investigation is in two parts so that the patients heart can be assessed under stress conditions and under resting conditions. The stressing is performed using intravenous pharmacological stressing agents and previously was performed in clinician-led sessions run in collaboration with doctors from the trust’s cardiothoracic directorate. To increase the flexibility of the service, shorten waiting times and reduce the burden on junior cardiac doctors, the Nuclear Medicine department developed an extended health care professional role to take over the pharmacological stressing sessions. This involves working within clear protocols and - although a cardiothoracic doctor is on standby in case they are needed - the need for a doctor to be present during this stressing session itself has been removed.

The development of a health care professional-led myocardial perfusion pharmacological stress test presented many challenges. This included a culture change to overcome the different working methods employed by the two departments, nuclear medicine and cardiology. A key element to the project was developing new protocols. A single protocol was developed across the trust, with the assistance of the different staff groups involved in this process (including medical consultants). This has resulted in a clearly defined health care professional-led stress protocol which is written to cover a wide set of scenarios.

As a result of introducing the role; the service is now managed more effectively. The number of patients having the test has increased as the departments are no longer reliant on busy doctors to do the test and there is increased capacity. Four years ago the waiting list was 18 months and now is on target to meet the national 13 week waiting list target in early 2007. The pressure on junior doctors has been released and this helps to contribute to the move towards WTD 2009 readiness.

Key lessons from South Yorkshire ambulance

1. Engage - collaborative working is important as is ensuring that you have buy in from stakeholders
2. Initiation – be clear about how the project will be initiated, in this case, clarity was needed around the referral pathway
3. Agreement- don’t rely on good will, formalise agreements
4. Recruitment – Be clear about where and how the recruitment will take place
5. Focus – Retain the focus of the original objective whilst retaining an awareness of the pressures of other organisations.

Key lessons from Sheffield Teaching Hospitals

1.Realistic plans – Don’t underestimate the length of time an initiative like this can take
2.Engage- ensure all key stakeholders are involved and there is a shared objective at the start of the project
3.Training – the department found itself dependent on other groups and departments for training. A 'train the trainer' approach would have been useful in the initial tranche of learning.