Supporting our Educators in Personalised Work Scheduling & Exception Reporting Dr Andrew Frankel, Postgraduate Dean HEE SL Dr Claudie Sellers, Medical Education Fellow HEE SL Dr Jeeves Wijesuriya, Co-chair BMA JDC Mr Sam Wakeford, Senior Policy Advisor BMA Mr Gareth Jones, Associate Director Medical Workforce, NHS Employers

We will not be discussing Workshop Objectives A clear understanding of the new processes, with which to support your local educators and trainees A knowledge of resources available to support you A recognition of potential difficulties in successfully embedding these new processes We will not be discussing We would like you to leave with… It is important that we all strive to look forward now… How we got here Personal views on the contract dispute

Whilst there are certain amended responsibilities for existing roles (ES & CS) under the new contract which we will speak about in more detail, and the creation of a new role in the Guardian of Safe Working, it is important to understand that you are not alone. The successful protection of training opportunities and safe working patterns for our doctors relies on collaboration between GoSW, ES, CS, doctor, HR staff, PGME staff, DME, rota planners etc etc. So whilst we explain the new responsibilities particular to Educational Supervisors in this talk, it is important for you to be clear about sharing the message that your administrative & managerial colleagues have responsibilities for the success of these processes.

Educational Supervisor (ES) “overall supervision and management of a doctor’s trajectory of learning and educational progress during a placement and/or series of placements.” You are aware of the GMC definition of the ES. Every doctor must have a named ES, who helps the doctor to plan their training & achieve agreed learning outcomes. He/she is responsible for the educational agreement and for bringing together all relevant evidence to form a summative judgement at the end of the placement and/or series of placements. This has not changed. General Medical Council. SAS Doctors, Educational Supervisors and Clinical Supervisors. View document http://www.gmc-uk.org/SAS_Doctors__Educational_Supervisors_and_Clinical_Supervisors___Feb_12.pdf_47584374.pdf NHS Employers. Information for educational supervisors. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/information-for-educational-supervisors

Educational Supervisor (ES) “overall supervision and management of a doctor’s trajectory of learning and educational progress during a placement and/or series of placements.” As part of the Terms & Conditions of Service the ES will: Have joint responsibility with the doctor for personalising their work schedule Action any exception reports Conduct work schedule reviews The existing role remains the same, with the stipulated new responsibilities being a formalisation of what should be happening as ‘best practice’ already. The aim is to empower educational supervisors to champion their trainees rights as professionals, by accommodating reasonable training and personal requests at a departmental level, and who can proactively escalate deficiencies or difficulties to more senior decision makers who will challenge system problems at board level. General Medical Council. SAS Doctors, Educational Supervisors and Clinical Supervisors. View document http://www.gmc-uk.org/SAS_Doctors__Educational_Supervisors_and_Clinical_Supervisors___Feb_12.pdf_47584374.pdf NHS Employers. Information for educational supervisors. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/information-for-educational-supervisors

Reassigning Tasks While accountability remains with the Educational Supervisor, completing certain tasks can be formally reassigned to the Clinical Supervisor. Where this is appropriate, a local policy should be agreed to reflect this.  Understanding the realities of the ES and CS roles in the real world, for example it may not be appropriate for a Foundation Yr 2 doctor’s Geriatric Medicine ES to personalise a GP placement work schedule. There are two points here: 1 is that all CSs as well as ESs need to be aware of the processes and responsibilities should certain tasks be delegated to them. The second is that reassignment of tasks doesn’t mean reassignment of responsibility. For example if said F2 in a GP practice feels their reasonable request for work scheduling has not been met by their CS, it will still be the responsibility of the educational supervisor to champion the trainee before escalating upwards. NHS Employers. Information for educational supervisors. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/information-for-educational-supervisors

Generic Work Schedule The duties expected to be undertaken during a placement The number and distribution of hours for which the doctor is contracted Intended learning outcomes, mapped to the educational curriculum and educational events Time for quality improvement and patient safety activities Periods of formal study (other than study leave) Contact details of supervisors and GoSW To be developed by HR for the hours, pay, shift patterns, generic rota information, in collaboration with Med Ed staff who will identify generic learning opportunities mapped to trainees’ stage of the curriculum. Sent out to trainees a minimum of 8 weeks in advance of commencing their training post. This should allow for specific leave requests to be sent in, to remove fixed annual leave and maximise accessibility to study leave.

Personalised Work Schedule The personalised work schedule reflects the doctor’s personal objectives stated in the e-portfolio.  It may also accommodate : Individual training needs Caring responsibilities Reasonable requests for variations to work patterns Personalisation, again a formalisation of a process which was hopefully being undertaken routinely, is about seeing the trainee as an individual, each with particular learning needs and personal circumstances. Reasonable requests may seem a grey term, but the message being that where alterations to a schedule can allow a doctor to meet their training needs, the departmental service needs and their own individual needs eg MSc, Personal health appointments whilst remaining full time, this should be accommodated.

Personalisation Sarah is an FY1 starting her third placement in rheumatology. She feels that she has insufficient expertise in assessing acutely unwell patients. This is borne out by previous reports in her e-portfolio and discussion with her ES and foundation TPD.

Personalisation At her first meeting with her CS, it is agreed that a change from the generic work schedule for that placement is required. They decide that she should substitute a rheumatology ward day for a day on the Acute Medical Unit. The CS liaises with colleagues to make arrangements for her to develop her skills under supervision there. This is recorded as a personalised work schedule on the e-portfolio, and communicated to Sarah’s ES, clinical lead and rota manager.

Exception Reporting Formal process where a doctor can raise a concern when their work varies significantly +/- regularly from their agreed work schedule. May relate to educational opportunities and support, working patterns +/- total hours, rest breaks and breaches of safe working limits. This may appear a bureaucratic process for trainees and supervisors, but this is in fact extremely empowering , aimed at protecting and enhancing the educational opportunities and safe working practices of doctors in training via rigid accountability and escalation structures. It must be made clear that the act of submitting a report is not a value judgement, and for the system to work it is important that trainees feel able to do so where they have a concern’ NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Exception Reporting Formal process where a doctor can raise a concern when their work varies significantly +/- regularly from their agreed work schedule. Exception reports are sent to the ES (CS if responsibility formally assigned). Safe working practices Training issues This is a bureaucratic but ultimately empowering process for trainees and supervisors, aimed at protecting and enhancing the educational opportunities and safe working practices of doctors in training. NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Exception Reporting Sent by doctor within 14 days (7 if payment requested) Response required within further 7 days Detailing: Name, specialty and grade of doctor Name of Educational Supervisor Dates, times and duration of exceptions Nature of variance from work schedule NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Exception Reporting Sent by doctor within 14 days (7 if payment requested) Response required within further 7 days Detailing: Name, specialty and grade of doctor Name of Educational Supervisor Dates, times and duration of exceptions Nature of variance from work schedule Copy to: DME for training issues GoSW for safe working issues NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Response Review report & meet doctor within 7 days Agree an outcome Time off in lieu Additional pay for work done Trust fine NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Response Review report & meet doctor within 7 days Agree an outcome Time off in lieu Additional pay for work done Trust fine Is this a one-off? Is this a pattern? NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Response Is this a one-off? Is this a pattern? Work Schedule Review Hours Schedule Compensation Organisational change The outcome may require the input of any or all of the CS, ES, service manager, rota co-ordinator, HR, DME, GoSW. The outcome may not necessarily be any of these things, but the very act of addressing a concern head-on is helpful. NHS Employers. Guardian of safe working and exception reporting FAQs. View website http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract/faqs/guardian-of-safe-working-and-exception-reporting-faqs

Trust Fines Levied by GoSW when working hours breach: > 48-hour avg working week > 72-hour limit in any 7 days < 8 hours rest between shifts Breaks missed on >25% of occasions across a 4-week reference period These fines are automatic – it is the responsibility of the guardian to review all exception reports copied to them in order to identify if any of the above breaches have occurred. In such circumstances, TOIL cannot be negotiated as a replacement for the fine. NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016. View website http://www.nhsemployers.org/case-studies-and-resources/2016/07/junior-doctors-terms-and-conditions-of-service-july-2016

Trust Fines Levied by GoSW when working hours breach: Working hours > 48-hour avg working week > 72-hour limit in any 7 days < 8 hours rest between shifts Breaks missed on >25% of occasions across a 4-week reference period Working hours 4 x hourly rate applicable when the additional time was worked  x 1.5 paid to the doctor x 2.5 retained by the guardian Breaks missed 2 x hourly rate for the time in which the break was not taken Entire sum retained by Guardian These fines are automatic – it is the responsibility of the guardian to review all exception reports copied to them in order to identify if any of the above breaches have occurred. In such circumstances, TOIL cannot be negotiated as a replacement for the fine. NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016. View website http://www.nhsemployers.org/case-studies-and-resources/2016/07/junior-doctors-terms-and-conditions-of-service-july-2016

Junior Doctors’ Forum A group chaired by the Guardian, where Doctors LNC reps DME IRO Discuss working issues, collaborate on improvements to training and advise the Guardian on the disbursement of fines NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016. View website http://www.nhsemployers.org/case-studies-and-resources/2016/07/junior-doctors-terms-and-conditions-of-service-july-2016

Case Studies NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016. View website http://www.nhsemployers.org/case-studies-and-resources/2016/07/junior-doctors-terms-and-conditions-of-service-july-2016

Additional Resources HEE e-learning module http://www.e-lfh.org.uk/programmes/educational-and-clinical-supervisors/ Rota Rules Factsheet http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Factsheet%20on%20rota%20rules%20August%202016%20v2.pdf Roles and Responsibilities of all staff involved in Training http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Roles%20and%20responsibilities.pdf Factsheet for Educational (and Clinical) Supervisors http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/1617%20PO153_04%20Factsheet%20for%20Educational%20Supervisors%20(2).pdf Key Contract Guidance https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract-2016 Multi-professional Faculty Development: Support for Educational Supervisors http://faculty.londondeanery.ac.uk/educational-supervision NHS Employers. Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016. View website http://www.nhsemployers.org/case-studies-and-resources/2016/07/junior-doctors-terms-and-conditions-of-service-july-2016

Workshop Objectives A clear understanding of the new processes, with which to support your local educators and trainees A knowledge of resources available to support you A recognition of potential difficulties in successfully embedding these new processes Key messages: Educational and Clinical Supervisors have new, formalised responsibilities, within their existing roles. Exception reporting and personalised work scheduling are intended to empower trainees and supervisors to escalate unsafe working or insufficient training, in real-time. You will need to work in collaboration with trainees, educators, clinical, managerial and administrative staff to ensure your systems support safe working conditions and high quality training.

Thank you