Junior Doctors Committee, British Medical Association

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Junior Doctors CommitteeRota Monitoring – the essentialsA doctor’s guide to rota monitoringRota Monitoring  – the essentials 1IntroductionAccurate, fair and robust hours monitoring is an important part of our practice todayand is the best way we have to demonstrate the true duration and intensity of workthat we do. Its role will continue to be vital in the future as we begin to monitorcompliance with the European Working Time Directive (EWTD). For most of us,monitoring has become a part of our day-to-day working lives. However, there is stillsometimes confusion about how hours monitoring is carried out, what ourresponsibilities are and what to do if we feel something has gone wrong. This guideaims to give you the knowledge to understand more about monitoring and how togain the maximum benefit from it. New Deal & European Working Time DirectiveThere are two different regulations but both the EWTD (European Law and Health &Safety Legislation) and the New Deal have profound influences on our workingpatterns and training. New Deal compliance became a contractual requirement fromAugust 2003 and the first stage of the EWTD became UK law in August 2004.Summaries of the requirements of both the New Deal and the EWTD can be foundin the back cover of this booklet. The New Deal already requires regular monitoringand the new provisions of the EWTD will also require to be integrated into thisprocess. This will need to take account of the different definitions of ‘work’ (theEuropean Court of Justice has ruled that all hours spent compulsorily resident at theplace of work will count as work for the EWTD, whereas under the New Deal, timespent resting at the place of work is not included). Monitoring of Working Time – the process explainedMonitoring of hours and rest is pivotal to ensure that in practice we are working ina safe and sensible manner. Many questions about monitoring are asked by doctors(both trainees and seniors) as well as trust officials. Many of these stem from a lackof understanding of the process or reasons for monitoring. The following section willhopefully answer some of these and help you understand the importance of themonitoring process. Why do we have to monitor?Monitoring is the key method we have to demonstrate the true number of hoursthat we are being required to work by our trusts. It may be assumed on paper thata normal working day is eight hours long, whereas in reality doctors may be workingfor up to 10 hours on a normal day, thus increasing the hours worked quitesubstantially. Monitoring also provides documentary evidence of how much rest you Rota Monitoring  – the essentials2are able to achieve during your working time. This may have an effect on bandingor indeed whether the rota is compliant. The diagram below demonstrates howhours monitoring fits into the overall process.* new working patterns must be approved by the majority of trainees, post graduate deanand the New Deal Regional Action Team (Strategic Health Authority) prior to rota beingimplemented.† further information on rebanding can be found in our publications, ‘Time is Running Out’and ‘Time’s up’ (see BMA website) as well as in the rebanding protocol see page 12.Every junior doctor has a contractual obligation to comply with monitoring exercisesand to provide truthful, timely and thorough information. It is also your employer’sresponsibility to provide a robust framework to allow for accurate recording ofhours, rest and breaks.CURRENT ROTAOUTCOMEJunior doctors should be involved at every stageIMPLEMENTREBANDING†DESIGN NEW ROTAAppealsMechanismApproval*COMPLIANT?REASONNON-COMPLIANTYES NOMONITORINGRota Monitoring  – the essentials 3What is good monitoring practice?There will probably never be a perfect way to conduct hours monitoring, ashospitals, departments and rotas vary so widely. The following, based on a survey oftrusts and training grade doctors, gives suggestions of how we feel the process maybest be carried out. Not all trusts will follow best practice, and you may be able tosuggest some of the following advice in your own area. We believe that thesemeasures will help provide a framework to deliver a high return rate of forms andaccurate data. The monitoring process, like any audit cycle, can be broken down intoseveral components and the power of the audit is dependant on all the steps beingcompleted thoroughly.Pre-Monitoring• Face-to-face forum• Good monitoring packs• Ensure packs for all• Covering letterMonitoring• Junior to facilitateprocess• Suitable simple system• Accurate & timelycompletion & collectionPost-Monitoring• Rapid, accurate &transparent feedback• Work as a team to tackleconcerns identifiedRota Monitoring  – the essentials4Pre-MonitoringThis is a crucial and often ignored aspect of the whole monitoring process. It is notgood enough to assume that doctors will instinctively know when the monitoringperiod is to start, what forms to use and how to return the forms. The following aresuggestions to try to improve understanding of the process before it takes place. Itis helpful to view the monitoring cycle as something to be achieved collectivelybetween the trust, senior medical staff and the doctors on the rota. 1. Documentation packThis will include the monitoring form/booklet but should also contain otherinformation relevant to the monitoring period: • dates of monitoring period• copy of the template rota• details of the rest and break requirements• sample completed monitoring form to demonstrate the information required,including details of what to do if on leave• contact details in case you require further information• ideally this pack should be supplied with a covering letter signed by a leadconsultant as well as a junior doctor representative. It is important to show seniorleadership as well as teamwork in the process.2. Face-to-face forumBest practice would be a meeting between the trust officer responsible, the leadconsultant with responsibility for the rota and the trainees, held at a suitable time sothat as many trainees as possible can attend, eg before a teaching session or at ahandover period. This is better than receiving documents through internal mail orbeing expected to pick them up from elsewhere. It provides an opportunity to:• ensure that all trainees have received a pack• look at the monitoring forms and document pack• ensure that everyone is monitoring the same rota!• outline the importance of accurate monitoring• ask questions about the process.Despite best efforts, it is likely that some doctors will not attend the meeting. It isvital to ensure that these doctors receive all the relevant information. Spare copiesof the packs should be readily available to ensure that each doctor involved is in aposition to accurately monitor their working pattern. Systems should be in place toensure everyone has all of the documents and information for the monitoringprocess. Rota Monitoring  – the essentials 5During the Monitoring1. Simple suitable systemMany different systems are used to collect data on working hours. The system shouldideally be as simple to complete as possible, while capturing all the data required. Adiary booklet has proven popular rather than multiple sheets that are easily lost.Whatever the system, make sure you understand it.2. Junior doctor rota representativeAvailable to help with facilitating the process, answering questions and encouraginga good return rate.3. Timely completionComplete the forms as you go, not retrospectively. This will provide the mostaccurate information. It is hard to remember accurately the rest or breaks you haddays ago.4. Accurate CompletionAccurate data is required for you to be properly paid for the work you do now, butalso to enable the service to plan for the future. If you under-report your hours thenthis may lead to changes that expose patients and juniors to inadequate levels ofcover. The GMC also takes probity very seriously and this includes completion ofmonitoring data. Recording rest and breaks is just as important as the total hoursworked. As our hours have gradually decreased over the last few years, workintensity has increased. It is vital to ensure that we get the appropriate amount ofrest to ensure safe practice. Rota Monitoring  – the essentials6Post–Monitoring1. Robust returns systemThis is one area of monitoring that trusts frequently complain that we do badly.Several methods of ensuring returns have been employed but the following haveproved the most successful:• regular collection of sheets from the work area by the monitoring officer• nominated junior doctor representative collects forms • addressed envelope enclosed in pack to enable easy return• collection by monitoring officer at an appropriate time following monitoring eghandover, teaching.It is, unfortunately, the case that many monitoring attempts fail due to aninadequate return (a minimum of 75 per cent fully completed returns are requiredto properly analyse the monitoring episode). Whatever the system, it is your duty toensure you get your completed forms returned.2. Rapid, accurate and transparent feedbackOnce all of the forms are collected, the trust is required to analyse the data andfeedback within 15 working days. This is best done in a face-to-face manner likethe pre-monitoring forum, although if that is not possible then at least, a lettershould be sent to all trainees informing them of the summary of the data, and theoutcome of the monitoring. This part of the process will help to build mutual trustand understanding of the process. Juniors should be encouraged to comment bothon the rota itself and on how the monitoring process may be improved.3. Compliant? …moving onwardsIn most cases monitoring confirms the banding and compliance of the workingpattern. It may, however, generate other comments or show a trend towards non-compliance that can be addressed. In some cases monitoring will prove a rota to benon-compliant or require a banding change. In these circumstances it is important(indeed the trust and juniors are contractually obliged) to work together to developsolutions. Use of post-monitoring meetings will help to facilitate this process. Thereare specific steps that are required in order to reband a rota following changes inworking patterns and these are detailed in the table below. Rota Monitoring  – the essentials 7Monitoring FormsAlthough forms are many and varied in their design they must all be able to catchat least the minimum data required. If a form is too simple it may not capture all thedata, too complex and compliance with monitoring becomes more of an issue. Process for changing a rota bandingStage 1Suggest change in working practice• consult post holders• majority approval of post holders• approval of post graduate dean• approval of Regional Action TeamStage 2Monitoring of new working pattern• >75% of monitoring forms completed• minimum of 14 consecutive days• validation by Action Team / junior doctor representativesStage 3Notification of monitoring outcome• to all parties as specified in HSCStage 4Approval mechanism to change band• Action Team receives proof of aboveStage 5Appeals mechanism• trust or trainees can appeal the monitoring outcome / banding decisionThis must be documented on the approval to change banding form and a copy forwarded to the Action Team for signature BEFORE the change is made to the banding.Rota Monitoring  – the essentials8Frequently Asked QuestionsI am not sure what the difference is between ‘rest’ and a ‘natural break’?A natural break is a ’30 minute continuous break after approximately four hours ofduty’. The time is counted as actual work. Natural breaks are required during thenormal day and at all times on full shifts. Rest, under the New Deal, does not count asworking time and this is what gives the difference between ‘duty / available hours’ and‘actual hours’.Following recent monitoring my payslip shows my band has changed, can thishappen?Banding can change after monitoring, but you should be made aware of this in post-monitoring feedback, not in a pay-slip.If my banding changes will I lose out financially?Pay protection protects you from significant changes in pay and exists both for six month contracts and within rotational posts. The Band 3 multiplier is not protectedhowever to encourage trusts to achieve compliance. It is not an option to stay non-compliant and we must co-operate with trusts in moving towards compliance. Furtherdetails of pay protection can be found in paragraph 21 of the Terms and conditions ofservice and the junior doctors contracts section of the Department of Health’s website. How often do I have to monitor?The minimum that you are required to monitor is once every 6 months. Monitoringexercises may need to be carried out more frequently in some circumstances such asimplementing new working patterns or after a period of invalid monitoring.What if I don’t fill my monitoring forms in?This is not an option for anyone. Both doctors and Trusts are contractually obliged to monitor: ‘there will be a contractual obligation on employers to monitor New Dealcompliance…and on individual junior doctors to co-operate with those monitoringarrangements’... ‘should a junior doctor fail to supply monitoring data, they shallreceive written notice of their contractual responsibility to cooperate, and be requiredto participate in a further round of monitoring. Persistent failure to comply willrepresent a breach of contract and may result in disciplinary procedures.’It also avoids the unnecessary hassle for yourself and your colleagues of having to re-monitor if everyone fills in the form fully the first time round. Rota Monitoring  – the essentials 9What if monitoring takes place during a particularly busy / quiet time?Sometimes, it is difficult to predict this sort of thing, although rotas should be robustenough to withstand periods of increased activity, as long as they are not exceptional.It is your right to appeal a monitoring outcome if you feel the monitoring period doesnot reflect the true nature of the post.What if the trust put extra people in place or changed the rota for themonitoring period?This may sound unlikely but unfortunately it does happen. If it does, you should raisethe matter immediately with your local BMA office / junior doctor representative whowill advise you further. Some specialties do this sort of thing to a less obvious degree,such as seniors being more available or changes being made to the nursing staff rotas.Again you have a right to ask that the monitoring be declared unrepresentative andask for a further period of monitoring.What if while monitoring there is sick leave?Again, if you or the trust feels that this has unfairly biased the monitoring outcomethen there is an option to re-monitor.What if I don’t fill my form in accurately?Ask yourself, would you falsify patient notes? Monitoring forms are legaldocumentation and wilfully falsifying them is fraud and may land you in serioustrouble.What if my consultant tries to persuade me to alter my monitoring to ensurecompliance?This sort of inappropriate action must not be tolerated and you should bring it to the attention of the BMA. In many circumstances this constitutes harassment andbullying, and seniors should be reminded of the clear policy the GMC has regardingthis.What happens if there are non-training grade doctors on my rota?Custom and practice is that all participants on a rota will be asked to monitor, includingnon-training grades. The return rate will be based on the percentage of training gradedoctor shifts monitored. If you find it difficult to get monitoring data from non-trainingdoctors, then the expected hours will be substituted into the monitoring calculationwith an assumption that the required rest is achieved. It is in the interest of all doctors on a rota to monitor their working patterns to ensureit is a true reflection of practice. Rota Monitoring  – the essentials10And FinallyMonitoring is the key to successful implementation and ongoing assessment ofworking patterns that comply both with the New Deal and in future the EWTD.Monitoring is our opportunity to demonstrate the true nature of the posts we work.As the number of hours starts to fall, intensity has risen and it is not acceptable tobe required to work solidly for 13 hours without any breaks. Monitoring provides aninvaluable tool both to assess current compliance and also to work pro-actively toavoid non-compliance pitfalls.Monitoring is the key to unlocking the door to compliance with the New Deal andEWTD regulations. Rota Monitoring  – the essentials 11Table 1a - New Deal hours requirementsRota Type Maximum duty hours / weekMaximum actualhours / weekMaximum continuousduty hours24-hour Partial shift 64 56 24Partial shift 64 56 16On call 72 56 32 (56 at w/e)Full shift 56 56 14Table 1b - New Deal rest requirements Rota Type Minimum timebetween duties (h)Minimum timeOff Duty (h)RestOn call 12 48 + 62every 28 days1/2 OOH incl. 5 hourscontinuous at night24-hour Partial shift 8 48 + 62every 21 days6 hours incl. 4 hourscontinuous at nightPartial shift 8 48 + 62every 21 days1/4 of OOH periodFull shift 8 48 + 62every 21 daysNatural breaks only• OOH (Out-of-hours) – all time outside normal working day Mon - Fri.• All working patterns are entitled to Natural breaks – 30 minutes continuous breakafter approx four hours of duty Websites and Contacts – you are not aloneRota Monitoring  – the essentials12Max duty / actual hoursTable 2: EWTD implementation timetable August2004August2007August200958 / 56 56 48Min periods offduty24 hours in 7 daysOr48 hours in 14 daysRest11 hourscontinuous inevery 24 hours & New DealrequirementsResident workpatterns72 / 56 72 / 56 72 / 48Non-residentOn callJunior Doctors CommitteeBritish Medical AssociationBMA House, Tavistock Square, London WC1H 9JPTel: 020 7387 4499Email: info.jdc@bma.org.ukwww.bma.org.ukwww.dh.gov.uk/Home/fs/enMonitoring junior doctors hours:http://www.bma.org.uk/ap.nsf/Content/monitoring‘Time’s Up’ – a guide on the EWTD forjunior doctorshttp://www.bma.org.uk/ewtdRebanding protocol England and Waleshttp://www.dh.gov.uk/assetRoot/04/05/38/78/04053878.pdfScotlandhttp://www.show.scot.nhs.uk/sehd/mels/HDL2002_33.pdfNorthern Irelandhttp://www.dhsspsni.gov.uk/hss/HRD/documents/guidance_on_working_patterns.pdfTerms and conditions of service:www.publications.doh.gov.uk/hrinthenhs/doctorstermsandconditions/doctorstermsandconditions.pdfHours of work and rest requirements:www.dh.gov.uk/assetRoot/04/07/55/53/04075553.pdfFor further information please see the Junior Doctors handbook 2003/04British Medical AssociationJunior Doctors CommitteeBMA HouseTavistock SquareLondonWC1H 9JPwww.bma.org.ukYour junior doctor representative is: 

Rota Monitoring - the essentials : a doctor's guide to rota monitoring

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Rota Monitoring - the essentials : a doctor's guide to rota monitoring

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