Challenges & objectives

Challenges

Junior doctors are employed in both the acute hospital at Scarborough and the community hospital at Bridlington. At the start of the pilot there is 100% compliance with the 2004 58 hour WTD target but only 16% compliance with 2009 target of 48 hours. Analysis demonstrates that only 37% of junior doctors are working less than 54 hours and 24% less than 52 hours. In order to reach 2009 compliance, 455 hours per week of junior doctor time will need to be lost - the equivalent of almost 10 new posts. The only likely expansion in medical workforce will be at the most junior level with little impact on the 2009 target.

Specific objectives of the pilot

The Scarborough health community aims to ensure WTD 2009 compliance through system redesign and partnership working to provide care and services in new ways. This includes:

• Greater provision of care in primary and community settings as close to patients homes as possible leading to fewer presentations to hospital
• Co-ordinated working of front line services especially outside normal working hours
• Front line assessment by a senior clinician for acutely ill patients in primary and secondary care.

For patients who are admitted to hospital this way of working will mean:

• Clear pathways and intended outcomes
• Management of planned ‘step up’ care by appropriately qualified health or social care professionals
• Improved learning for junior doctors and an improved culture of joint working between primary, secondary and social care - and between clinicians and managers.

Delivering compliance

This pilot is based around a multi-agency approach to redesigning healthcare in the Scarborough healthcare community. The approach will see:

• Benefit workshops to map out way forward with all stakeholders
• Clear data collection of evidence around care patterns and areas where change is required
• Planning of new services, care pathways and structures to deliver care and WTD compliance
• Formation of new teams and structures to deliver the services.