Royal Bolton Hospital NHS Foundation Trust has been innovative in its approach to the future of the medical workforce.

The hospital won an award at the NHS North West EWTD Awards 2008 in July for ‘Best Whole System Approach to EWTD’.

The Hospital at Night project has been in place for the past three years. The drivers for change were the desire to improve patient care while at the same time complying with the European Working Time Directive (EWTD) 2009 and to develop a multidisciplinary team to achieve this. The project started in 2006 and the hospital reached 100% EWTD compliance in August 2008.

Clare Blaydon, Hospital at Night manager at the trust said: “For any trust considering looking at the Hospital at Night (HaN) vision, the risk of deterioration to patients and scoping of the workload generated in the out of hours period is pivotal to the exercise.”

An early warning scoring system was implemented across the trust, including the maternity service and a member of the Hospital at Night team provides a rapid response to patients at risk of deterioration.

During the scoping of the exercise, the workload of the doctors in out of hours was identified, and from this it was concluded that a senior skilled nursing team was required to provide a quality service to patients and to ensure EWTD compliance.

The normal daytime working hours of 9am to 5pm for medical and nursing staff has been expanded to 8pm, this is to ensure that daytime work and patient’s management plans are completed in the daytime period.

Nurse development has been a pivotal area of work for the project and there are now eleven nurse practitioners, including four who have completed the MSc in Advanced Practice. All members of the nurse practitioner team are undertaking the non medical prescribing course, the team provides a 24 hour nurse practitioner service to support the ward medical teams. From 5pm they triage calls to the FY1 and FY2 doctors in medicine.

Following restructuring of the Workforce Directorate in mid 2007, the centralised medical staffing department has been replaced with a medical staffing coordinator for each division who works closely with a divisional HR business manager. The Workforce Directorate and Hospital at Night team have played an integral part, working with divisions to achieve the EWTD 2009 requirements by August 2008. Leading on the overall trust wide EWTD compliance was the EWTD project team, part of the workforce transformation function.

To complement HaN and WTD compliance, an iBleep system was being implemented late in 2008, ensuring that doctor’s calls are triaged and dealt with by an appropriate team member, enabling doctors to have undisturbed breaks and teaching time. Clare said: “The vision for HaN at the trust is that it will continue to evolve to ensure a 24 hour seamless service.”

Annabel Stone, EWTD project manager said: “The support from the North West Medical Advisors in August 2008 was invaluable, we now need to sustain EWTD compliance by continuing to review rotas and develop/redesign medical and nursing roles.”