Royal College issues advice on rota design

Effectively planning rotas for junior medical staff is a key part of work towards readiness with the 48 hour week. However, there is evidence to say that some of the rota patterns currently being used across the NHS are not sustainable for the health and safety of staff working them.

The Royal College of Physicians (RCP) has published a guide called Designing Safer Rotas for Junior Doctors in the 48 Hour Week which aims to highlight some of these issues.

The guide discusses the evidence of hazards associated with shift work at night and the suitability of different rotas, in anticipation of the 48-hour week. It sets out six possible rotas, clearly assessing their safety, compliance with regulations, and practicality.

The main advice is to limit the number of night shifts worked in succession to no more than four, and to consider reducing the length of each night shift when possible. The guide encourages the testing of three nine hour shifts to cover the 24 hours, to achieve improved health, safety, teaching and efficiency.

The guide is not only for hospital administrators who design rotas for medical staff but also for junior doctors, who should be involved in planning the optimal rotas for their particular team and hospital.

The guide highlights why certain rotas are more appropriate than others, and to provide suggestions on how to design safe and acceptable work schedules for doctors who must work at night. It includes detailed tables of how the various rotas can be organised and outlines the benefits and drawbacks of each, with a summary of relative risks of each rota. Practical tips are included, with the emphasis on involving staff and ensuring continuity of care for patients.

The three nine-hour shift pattern, for a maximum of three successive nights, has been chosen as the optimal by the RCP as it has many advantages over other shift patterns. It includes:

• Shorter shifts which lead to less exhaustion, this being safer for patient care
• Compared to two 13-hour shifts, the nine-hour shifts increases the proportion of hours worked in the day from 50% to 66%, providing fresher doctors in the peak demand times of late afternoon and early evening
• Working five nine-hour shifts on average each week gives doctors more regularity, and it increases opportunities for daytime teaching and supervision
• Nine-hour shifts are particularly suited to those posts with almost continuous intensive work such as A&E, the acute medical take, critical care or a neonatal unit.

However the three nine hour shift is not seen as suitable for all trusts due to ‘cell’ size of junior doctors required. Skills for Health - Workforce Projects Team have commissioned a pilot study of the new work pattern and have been seeking trusts to pilot the model.

"The risk of accidents to workers increases with night shifts compared with daytime work; it increases with longer shifts, and also when working successive shifts,” says Professor Roy Pounder, RCP lead on EWTD, “The most common pattern for junior physicians at the moment in England is to work seven 13-hour night shifts in succession - and this has to stop. The new guide suggests a much safer pattern of work.”