Leicestershire, Northamptonshire & Rutland Healthcare Workforce Deanery

A multi-disciplinary approach to WTD 2009 compliance

Overview

In 2004/05, the three acute trusts within Leicestershire, Northamptonshire and Rutland (LNR) implemented a local version of the Hospital at Night project. Capitalising on identified successes of this project, the current pilot, based at Northampton General Hospital, will extend the Hospital at Night approach to daytime teams. The pilot will draw on the integration of new practitioner roles into out-of-hours cover, allowing duties previously undertaken by junior doctors to now be undertaken by other healthcare workers. This will help to enable WTD 2009 compliance.

Organisational background

The LNR Healthcare Workforce Deanery has been formed from the integration of the Postgraduate Deanery and the Workforce Development Confederation (WDC). Its aim is to radically review the strategies for workforce development and education and fully integrate the service provided. For this pilot project, it will be working in partnership with Northampton General Hospital NHS Trust where the pilot will be based. Northampton General Hospital is a large district hospital with more than 700 beds, including ITU, HDU, and coronary care wards along with a 24-hour Accident & Emergency department. It has a wide range of in-patient, day case and out-patient treatment for acute medical and surgical conditions.

Challenges

One of the key issues raised from the implementation of the Hospital at Night model was the importance of smooth implementation of the handover process. By introducing a weekend team, the frequency of the whole hospital handover will be reduced by 50% at weekends (previously the night team would hand over to the whole hospital on both Saturday and Sunday mornings). The makeup of the weekend and night teams will promote multidisciplinary team handover. Drawing on the success of the integration of the new practitioner roles into out-of-hours cover and on work done elsewhere on the development of wireless technology, LNR Healthcare Workforce Deanery will help Northampton General Hospital NHS Trust to move toward WTD 2009 compliance.

Specific objectives of the pilot

The LNR Healthcare Workforce Deanery project objectives are to:

• Create a multidisciplinary team to cover the daytime out of hours at weekends
• Implement the changes in line with the introduction of the national roll-out of the Foundation Programmes resulting from the Modernising Medical Careers (MMC) initiative
• Provide a WTD solution to smaller specialities
• Provide continuity of care to patients
• Improve the patient pathway
• Provide safe and accountable handovers
• Reduce the complexity of handovers.

Benefits of the pilot

This pilot is based around a multidisciplinary team approach, which has demonstrable benefits:

• A sustainable solution for reducing the out-of-hours work of junior doctors in training
• Establishment of an efficient and effective weekend team
• Continuity of care for patients
• Improvement of the patient pathway
• Provision of safe and accountable handovers
• Reduction in the complexity of handovers
• Improvement of junior doctors’ skills
• Provision of generic training opportunities
• Exposure for junior doctors to a variety of specialities
• Provision of a WTD solution for smaller specialities
• Improvement in junior doctors’ experience of out-of-hours care
• Increased ability for junior doctors to capitalise on learning opportunities in normal daytime hours.

Resources

Audit of weekend daytime work activity initial results for the whole hospital

Can less be more? Reducing doctors working hours while enhancing education and training

Rotas

This section contains the rotas this pilot site has developed to achieve EWTD 2009 compliance. They are presented as the analysis of the template rota in a Word or PDF format. Where the rota is from a DRS database we have tried to also source the xml format of the rota for downloading straight into DRS. These rotas can be used as a starting point for working towards compliance but Trusts must make sure they adapt rotas to fit their local requirements and EWTD policies.

• MF SHO 2008 Specialty registrar 2 Oral and maxillo-facial surgery.
• ITU SHO 08 (4) Specialty registrar 2 Anaesthetics
• ENT SHOs 2008 Specialty registrer 2 Orolaryngology
• Anaes SHO (8). Senior house officer Anaesthetics.
• A&E 9 middle grade rota
• A&E 9 SHO rota
• Anaes 8 SpR rota
• GM 12 SpR rota
• GM 20 SHO rota
• GS 9 SpR rota
• GS 11 PRHO rota
• HORDR 10 SHO rota
• O&G 8 SHO rota
• Paeds 10 SHO rota