WTD Pilots Update

Our first Working Time Directive 2009 pilots are up and running and beginning to look at different ways in which compliance can be achieved. Here are detailed updates from two of the co operative solutions pilots looking at the first steps they have taken in their projects.

North Central London Paediatric Network Solutions
Hospital at Night (H@N) was the cornerstone to achieving WTD 2004. The central principle of the H@N initiative is the ability to achieve economy of scale by cross cover between specialities –coupled with the fact that activity levels aregenerally much lower through the small hours.

Paediatric services face particular problems in achieving WTD. This is primarily because the diagnostic and technical skills needed to work with very young children and neonates necessitate more specialist training, so it is not possible for paediatrics to becovered by the H@N team. Secondly (as anyone with even a well child will know!), whilst adults generally sleep at night, children are more of a 24/7business. A Department of Health sample survey (2002) showed that one in six calls for a paediatrician out ofhours were to see a child in a severe or life-threatening condition.

This is far higher than for adult services, where the first Hospital at Night audits showed approximately one in 20 calls were to apatient in a life-threatening condition.The differences means that paediatricservices, even in large conurbations, are functionally very similar to small orisolated units in terms of the problemsthey face with junior medical staffing. There are no ‘simple fixes’ to this, but in North Central London (NCL), the paediatric units are working together todevelop a multi-modal approach, whichis critically dependent on functioning as a well-integrated collaborative network.

The programme is being hosted through Great Ormond Street Hospital, and theagenda is certainly a challenging one! However, the programme team and allthe provider units see this as more thana project about junior doctors’ hours; they are excited about being given theopportunity to improve patient careand safety through a novel approach to joint working. Hilary Cass, programme lead, cassh@gosh.nhs.uk.

Scarborough Health Community - Off to a flying start – “Working in Time for 2009”

The cooperative solutions pilot in the Scarborough HealthCommunity is looking at a multi organisational approach toproviding complaint healthcare services across geographicallyisolated sites. Gaining the understanding and support of themultiple partners involved has been a key first step.

The Scarborough health community covers a geographical area of nearly 2,000 square miles with a population of 230,000 that varies seasonally. Health services are configured around a districtgeneral hospital at Scarborough, acommunity hospital at Bridlingt on withresident medical staffing together withtwo smaller community hospitals in Malton and Whitby containing nurse ledand GP beds. Primary care services areprovided by 27 local GP practices. Inaddition the primary care trust(s) providean extensive range of communityservices including community nursing, physiotherapy, speech and languagetherapy, psychology, podiatry and other professions allied to medicine.

Phil Garnett general practitioner – Filey
“Prior to this project beginning I believeddelivering the Working Time Directive wasan acute trust challenge. I understandnow how the whole system can play itspart and as local GPs working withconsultant colleagues in the trust we canmake a big impact on who turns up tohospital and who gets admitted.”

A team including PCT, hospital trust,social services and the ambulance trustsuccessfully bid for WTD co-operativenational pilot status and have made aflying start with a benefits workshop. This workshop brought togetherrepresentatives from stakeholder groupswho then worked to define benefits forpatients, employees, clinical excellenceand financial gain. The 30 representatives involved were a mixture of consultants, GP’s, district and hospital nurses, social services, service managers, PCT managers, SHA/WDC and deanery colleagues. Speakers from the primarycare trust and Yorkshire Deanery outlined the challenges ahead.

• 480 hours of junior doctors’ hours per week to be removed from rotas
• Levels and patterns of hospital admissions are creating unsustainable pressures
• Financial recovery locally depends upon sustainable solutions

Paul Rice director – Scarborough, Whitby and Ryedale Primary Care Trust

“We have always recognised how our local geography presents significantadditional challenges on delivering the2009 directive. The excellent partnershipworking locally has delivered in the pastand we are confident it will deliver thisproject. The benefits realisationworkshop demonstrated the level ofclinical buy-in we have to the project and significant consensus existed as to how we would get the job done.”

The outcome of this workshop was abenefits map that is driving the projectalong the road to WTD 2009 compliance.The local team believes that focusing ondelivering benefits is the way to succeed.The process followed and outcomes from this workshop will be available on thehealthcare workforce portal in July. The next phases of the project are togather the evidence base and to workout how to involve patients effectively. Jonathan Brown, project manager jonathan.brown@yorksandhumber.nhs.uk

There are four key components to the NCL programme:

1 - The central philosophy is to work across organisational boundaries throughthe development of a virtual ‘acute paediatric unit without walls’. This willinvolve joint governance, workforce and contractual arrangements across allthe participating organisations, so that the workforce can be flexed night onnight to meet peak patient demands. The approach will be closely linked toseparation of ‘hot’ (or acute) and ‘cold’ (or planned) work, with staff beingmore consistently focused on one or other activity for blocks of time.

2 - Alongside networked clinical care, will be the development of a network ededucation structure to reduce the duplication of effort of teaching similarcurricula across multiple sites. E-learning strategies will obviously be animportant component of this.

3 - There has been a strong NHS focus on new role development, which undoubtedly improves access and quality of care. However, the NCL teamwill be asking more challenging questions about whether and how newroles are reducing dependence on junior doctors within paediatric services,and aiming to target new role development accordingly.

4 - Finally, and perhaps most relevant to current NHS policy, the team will belooking at which aspects of care can best be delivered outside hospital, andaiming to reduce dependence on the junior medical workforce bysupporting development of services in community and primary care settings.

Bids invited for ‘Taking Care 24/7’ working pilots

To help support WTD 2009 compliance Skills for Health - Workforce Projects Team are opening up a new set of pilots to NHS organisations. The pilots will focuson the way in which the hospital isorganised over the whole 24 hourperiod 7 days a week rather thantraditional approaches.

Funding will be made available for upto three Taking Care 24/7 pilot sitesup to the value of £300,000 each. The Workforce Projects Team are looking for an element of matched funding from trusts.This is the third tranche of WTD 2009 pilots following cooperative solutions earlier in the year and teamworking, handover and escalation pilots whichhave been announced in this issue.

Dissemination of lessons learnt acrossthe NHS will be a key part of thework for these high profile pilots. Nigel Burgess, portfolio projectmanager of the Workforce Projects Team cited examples of what would be looked for in thesenew pilots “It’s about how we takethe principles of new ways of working in hospitals such as Hospital at Night and make them work over the full day in the NHS in order to achieve 2009 compliance.”