West Dorset Emergency Care Project

Achieving WTD 2009 ahead of time with a direct approach

Why go for early compliance?

The medical HR committees chaired by the medial director set up a working group to implement MMC and WTD. The remit of the group was to make all rotas 2009 compliant as early as possible. It was decided to do this as the staged approach was considered to be more disruptive both in terms of rota changes and the length of time the working group would need to exist to meet the changing regulations.

WTD and MMC Working group

The working group has expert advice from medical staff that thoroughly understand the rules of MMC and WTD. A BMA representative is also present in the group who is open and honest in discussing the challenges each rota presented.

Designing the rotas

The project lead designed the rotas following meetings with consultants in their specialty to explain the rotas and rules. The rotas were discussed and agreed at clinical meetings. Consultants and clinical directors were brought on board to think of flexible solutions and members of the medical staffing team checked the rotas to ensure that the correct implementation process was followed.

Top tips from Dorset County Hospital NHS Foundation Trust

• You have to know New Deal and WTD rules inside out - a rota that makes logical sense and fits the service well might not fall in line with a particular rule
• Do not do blocks of seven nights - the Working Time Directive National Stakeholder Group, discourages the use of 7 x 13 hour shift patterns
• Aim to keep all shifts at 8 hours or less, and where possible, have late shifts starting later on in the day
• Agree what cover is needed during the day
• In busy areas like A&E, avoid shifts longer than 10 hours
• Decide what you need first eg how many doctors need to be on call, look at the number of admissions, patterns and times etc. Looking at your organisations baseline and then deciding on the activity
• Consider scenarios which might have an effect on rotas eg 2 arrests at once, neonatal and PICU admission
• Aim for 1B rotas, except where the service is the same at weekends and weekdays when it would probably be 1A.

Paediatrics

There were not enough SpRs for a full middle grade rota so different options were considered - more staff grade doctors, resident consultants or reconfiguration.

The staff grade model proved to be more expensive than resident consultants. Resident consultants kept to less that 48 hours in total, gave whole days off in lieu to keep balanced job plans and proved to be the most viable option.

With the SHO posts, now considered ‘Family services' (to now include O&G) training is for 1 or 2 years and GP trainees are used in full shifts to cover paediatric duties. ANNP (advanced neo-natal nurse practitioners) or midwives replaced all of the SHO O&G out of hours work helping to create enough people to do the full shifts. F2s were used in out of hours and un-banded F1s to give daytime continuity.

Dorset County Hospital NHS Foundation Trust will reach full compliance by September 2008.

For further information, please contact Vanessa Read, project manager vanessa.read@wdgh.nhs.uk