Case Study - Northampton General Hospital Pilot

A multidisciplinary approach to EWTD compliance

Northampton General Hospital (NGH) is a district general hospital serving a local population of 360,000 and employing just under 200 junior doctors.

It was originally proposed that the success of the existing Hospital at Night (HaN) team could be extended to provide a single, multidisciplinary team to cover the whole hospital during the daytime and out of hours (OOH) periods at weekends. It was felt that this approach would achieve a cost effective solution for EWTD 2009 compliance, while maintaining patient safety and high standards in the education and training of junior doctors. However it was determined that a single, multidisciplinary team would be inadequate to cover the hospital during busy weekend periods. As a result, the project focus shifted towards providing multiple, multidisciplinary teams across specialties to provide 24/7 hospital cover.

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A baseline measure of workforce and working practices was performed in November 2006. The exercise identified 184 junior doctors working on 30 different rotas (providing an OOH service) across NGH. 128 of these doctors were identified as working an average 56 hour week, with 106 receiving an 80% supplement banding (2A). Only nine rotas were identified as 2009 New Deal and EWTD compliant.

A project steering group met regularly with each directorate to identify how they could reduce junior doctors’ hours while maintaining service, OOH cover, education and training opportunities. Input from other staff was sought as appropriate. This approach resulted in multiple, specialty specific solutions across the hospital. Three ‘types’ of approach have been established (with some solutions involving a mix of the three):

1. The development of multidisciplinary teams
2. The introduction of cross specialty cover
3. Rota redesign.

Changes to working patterns have been carefully designed to ensure less time at work is not to the detriment of training. Strategies include more focused clinical exposure, better access to formal teaching sessions and exploitation of opportunities for multidisciplinary team working.

The solutions have proved to be cost neutral. That is, by reducing the average working week for doctors, the OOH banding supplement is reduced to a maximum of 50% (1A). By reducing 128 junior doctors’ working hours, 106 of which are paid 80% (2A) supplements, a saving of 30% can be made per doctor, which equates to the equivalent saving of 31.8 whole time equivalent (WTE) posts. It was agreed that these savings would be ring fenced and reinvested in additional resources.

As solutions are implemented on a rolling basis, the project team is closely monitoring their impact on patient care and on education and training.

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