A holistic, multidisciplinary approach to achieving WTD compliance
Northampton General Hospital (NGH) is a district general hospital serving a local population of 360,000 and employing just under 200 junior doctors. A Hospital at Night (HaN) team, as a solution to reducing junior doctors’ working hours, was successfully introduced into the trust in 2004. The success of HaN was a driver for the current project.
It was originally proposed that the success of the HaN team could be extended to provide a single, multidisciplinary team to cover the whole hospital during the daytime, out of hours (OOH) periods at weekends. It was felt that this approach would achieve a cost effective solution for WTD 2009 compliance, while maintaining (if not enhancing) patient safety and high standards in the education and training of junior doctors. However, after collecting baseline data, it was determined that a single, multidisciplinary team would be inadequate to cover the demanding needs of the hospital during busy weekend periods. As a result, the project focus shifted towards providing multiple, multidisciplinary teams across specialties to provide 24 hour hospital cover, all week.
A baseline measure of workforce and working practices was performed in November 2006. The exercise identified 184 junior doctors working on 30 different rotas (providing an OOH service) across NGH. 128 of these doctors were identified as working an average 56 hour week, with 106 receiving an 80% supplement banding (2A). Only nine rotas were identified as 2009 New Deal and WTD compliant.
A project steering group (comprising the project team, the clinical director, the medical HR manager, a finance representative and senior clinicians with an interest in medical education and training), met regularly with each directorate to identify how they could reduce junior doctors’ hours while maintaining appropriate levels of service, OOH cover and education and training opportunities. Input from others was sought as appropriate (for example, from nurse leads and junior doctor representatives). This collaborative approach has resulted in multiple, specialty specific solutions across the hospital. Three ‘types’ of approach have been established (with some solutions involving a mix of the three):
The development of multidisciplinary teams
The introduction of cross specialty cover
Rota redesign.
Changes to working patterns have been carefully designed to ensure less time at work is not to the detriment of training. Strategies include more focused clinical exposure, better access to formal teaching sessions and exploitation of opportunities for multidisciplinary team working.
The project is on course to achieve trust wide compliance with WTD 2009 by August 2008. Moreover, the solutions have proved to be cost neutral. That is, by reducing the average working week for doctors, the OOH banding supplement is reduced to a maximum of 50% (1A). By reducing 128 junior doctors’ working hours, 106 of which are paid 80% (2A) supplements, a saving of 30% can be made per doctor, which equates to the equivalent saving of 31.8 whole time equivalent (WTE) posts. It was agreed that these savings would be ring fenced and reinvested in additional resources (it was also important to redesign and approve as many directorate changes before April 2008 to reduce the interim pay protection costs that the trust would incur).
As solutions are implemented on a rolling basis, the project team is closely monitoring their impact on patient care and on education and training. A project dissemination event is currently being planned for the autumn, while a final project report is due at the end of August.
Working Time Directive 2009 
