WTD 2009 Pilots Update

University Hospitals of Morecambe Bay NHS Trust

Background

University Hospitals of Morecambe Bay NHS Trust (UHMB) is committed to improving services for patients, through service modernisation, reconfiguration, the adoption of role redesign and skill mix review. This is at the forefront of the trust’s strategic vision, “to provide first class healthcare to the population we serve”.

To assist in the process of service modernisation and change, UHMB has embraced the best practice recommendations contained within the National Service Frameworks, the 10 High Impact Changes for service improvement and delivery of the Working Time Directive (WTD) regulations. UHMB successfully achieved the WTD 56 average weekly hours target for all doctors in training in August 2004, and continues to move towards finding innovative solutions as well as adopting best practice and learning from the 2004 pilot site programme (of which UHMB was one of the 20 WTD national pilots).

UHMB is a split site trust, encompassing 1000 square miles of North Lancashire and South Cumbria. The two district general hospitals in Lancaster (Lancaster Royal Infirmary) and Barrow-in-Furness (Furness General Hospital), are 50 miles apart, with a travel time in excess of 75 minutes. Westmorland General Hospital in Kendal provides acute medical services with a diagnostics and treatment centre.

The geographic spread of UHMB provides some unique challenges for the utilisation of cross cover practice within surgery, both with the surgical sub-specialities and across the foundation years.

Project Objectives

UHMB is looking to develop surgical solutions to the WTD across a multisite organisation, with a large geographic spread, encompassing urban deprivation and extreme rurality. This will be achieved through the implementation of service reconfiguration, skill mix review and role redesign to redefine roles and areas of responsibility across all staff groups involved in surgical health care provision (for example, occupational therapist assessments in A&E, corporate clinical support worker development programme, combined FY1 & FY2 rota). Consultant job plans will be reviewed to reflect the changes to junior doctor job rotas and Modernising Medical Careers (MMC) requirements, and to actively challenge the accepted norm of how surgical care has been traditionally provided. UHMB is also planning to implement a wireless technology across the trust.

Expected outcomes / benefits

The attainment of WTD in surgery across the whole of UHMB split site localities by March 2008 so that a comprehensive dissemination process to the wider NHS can be undertaken. This would be achieved through a period of action planning as a precursor to the acute services review public consultation outcomes, together with recommendations from the royal colleges reflecting working practice and service reconfigurations. This will include the development and expansion of nurse / practitioner / therapist led services, to enable the cascade of skills and tasks to free up junior doctor time for learning opportunities, theatre sessions, assessments and hours reductions. Areas of focus to include:

• Complex discharge planning in rural areas
• Therapist / practitioner lead triage
  - Admission avoidance
  - Triage to most appropriate area for example: continuing care / physiotherapy / diagnostics / specialist admission
• Direct delivery of elements of junior doctor training with sign off.

UHMB would be looking for a greater adoption of nationally recognised integrated care pathways, with prescriptive discharge to facilitate an expanded nurse / practitioner / therapist directed service.

Rota redesign to review the whole of the out of hours cover with combined FY1 and FY2 rotas, and a subsequent review of the consultants’ roles and job plans will be undertaken, along with the separation of acute and elective work across the organisation. This will be supported by the reconfiguration of the clinical specialities into divisions with a ‘hot’ or ‘cold’ service focus. Patient safety is at the forefront of service reconfiguration and redesign and will be subject to rigorous risk assessment inline with the National Patient Safety Advisory guidelines.

UHMB recognises that it is vital that they are able to provide sustainable and transferable solutions of WTD adherence, and are comitted to reinvestment of any recurrent realised savings from:

• Service review and modernisation
• Reduction in junior doctors bandings
• A recent foundation trust diagnostic review has committed to additional funding to address the complex challenges of WTD.

For further information contact Alison Cole at Morecambe Bay Hospitals NHS Trust at alison.c.cole@mbht.nhs.uk