Case Study - Dorset County Hospitals NHS Foundation Trust
Emergency Care Project
This pilot project encompasses West Dorset as a health and social care community, comprising of West Dorset General Hospitals NHS Trust, Dorset Primary Care Trust, Dorset County Council Social Services, NHS South West Ambulance Trust, practice based commissioning GPs and NHS South West.
The main driver was the need to support the NHS to deliver the requirements of the European Working Time Directive (EWTD) 2009. The business case was supported by a number of strategies around workforce redesign, planning and service. This was an ambitious project to reduce the pressure on junior doctors, enhance the training and skills of a wide range of staff and to ensure compliance with the EWTD through a range of measures transferable across the NHS.
The medical HR committees (chaired by the medial director) set up a working group to implement modernising medical careers (MMC) and EWTD. The remit of the group was to make all rotas 2009 compliant as early as possible. This course of action was taken 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.
Key Learning
Know New Deal and EWTD rules inside out. A rota that makes logical sense and fits the service well might not fall in line with a particular rule
Aim to keep all shifts at eight 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 avoid shifts longer than 10 hours.
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.
Each of the participating agencies performed their own stream of work to contribute to the project and full details of this can be found in the full project closure report here.
The main outcomes of the programme included an expansion of nurse practitioner hours and roles within the A&E department extending patient pathways, a new system by ambulance staff to reduce the number of patients brought to hospital unnecessarily, the extension of nurse skills in community hospitals and reduction in emergency admissions across the project (however this was unsustained). Hospital at Night (HaN) was also introduced in July 2007 and was positively received by staff.
Whilst the project group has stopped meeting, work continues to progress with regular meetings of the directors and partner organisations. They aim for two rotas to be EWTD compliant by the August 2009 deadline with work underway through the hospital’s medical HR committee, as well as rolling HaN out across the entire hospital. The multi agency directors meeting agreed to consider a series of remaining actions, whilst it is also recommended that better methods for data collection are implemented.
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Working Time Directive 2009 
