Cambridge University Hospitals NACT / COPMED conference January 2018 Exception reporting – a new tool for improving working hours & training opportunities for doctors in training? Jane MacDougall (GOSW), Katharine Sharrocks, Stephen Smith (JDF chairs) Cambridge University Hospitals NACT / COPMED conference January 2018

Introduction Background Data from CUHFT from Dec 2016-Dec 2017 Guardian of safe working (GOSW) Exception reporting A hypothesis? Data from CUHFT from Dec 2016-Dec 2017 Driving change – local & regional examples Conclusions & next steps

GOSW New role introduced to support implementation & maintenance of new (2016) national contract for doctors in training Independent oversight of working hours Identifies missed training opportunities Provides mechanism whereby safety concerns related to working hours and rota gaps can be identified, responded to and addressed Reports quarterly directly to Trust Board of Directors

JD GOSW appointed in every hospital Accountable to Trust Board Work with DMEs / Medical Staffing / LNC Establish Junior Doctors Forum (JDF) Line managed (usually) by medical director No management roles – conflict of interest Encouraged to develop regional & national networks

Board reports National template for reports – includes rota gaps, locum use Quarterly report by GOSW to Trust Board Attend in person Report on Trust website; sent to LNC & JDF Annual report to GMC, CQC, NHSE

Junior Doctors Forum (JDF) Apolitical Meets monthly Chair, committee, TOR Forum to raise issues / concerns and discuss these plus solutions with Med Staffing / Senior medical management / DME / GOSW

Improving training Current / historical drivers College visits School visits HEE / deanery / GMC visits to Trusts GMC/ PMETB trainee survey GMC trainer survey RCOG TEF survey Feedback at ARCPs

Hypothesis? “Quality of training decreases and bullying increases with high workloads”

New driver - exception reporting (ER) Process for junior doctors to report when their day to day work varies significantly and / or regularly from agreed work schedule Variations include differences in: Total hours worked Pattern of hours worked Educational opportunities / support provided

Experience at CUHFT 642 doctors in training 435 exception reports in first year (01/12/16-31/11/17) 460 exception reports to end Dec 2017 Variable numbers, type, speciality & grade Few educational exception reports

Exception reports CUHFT Dec 2016-Dec 2017

Exception reports CUHFT By grade trainee

Exception reports CUHFT By speciality

Exception reports CUHFT Dec 2016-Dec 2017 Immediate safety concerns

Educational template Introduced to guide departments and provide numbers (eg number of clinics trainees should attend/mth) against which trainees can exception report Contains information on: Training opportunities (clinic, ward, theatre, MDT, handover) Local teaching (dept, trust based) QI / Audit Regional teaching Dept / local induction Other – eg research, student teaching, leadership Need to have something to report against

Exception reporting Advantages Disadvantages Faster more responsive mechanism to identify and address unsafe hours and thus improve patient safety Fines useful in getting attention of managers to drive change Exception reporting immediate safety concerns provides additional mechanism to improve patient safety Disadvantages Very few educational exception reports Engagement educational supervisors challenging

Good news stories Haematology 21 exception reports first ¼ New post appointed to 4 exception reports 2nd ¼ Colorectal Many exception reports & fine of £3-4000 Action plan incl short & long term solutions Paediatrics Increasing ERs New post agreed and being appointed to Trust has budgeted £3-4m for extra posts to plug gaps – problem is finding people to do this

Others from regional network.…. Extra posts to make rotas work Improved rota design Improved communication between trainees & management via JDF New equipment acquired to help juniors do their jobs Board engagement Number of exception reports decreasing with time ? Disengagement ? Getting better

Challenges Engaging educational & clinical supervisors in process Rota redesign – 95 rotas in CUHFT Rota gaps IT – accuracy of data Encouraging trainees to exception report Sustainability JDF Changing the culture….

Conclusions New process aimed to improve trainee welfare – and patient care / safety Potential to be real driver for change in short & long term GOSW provides independent oversight of working hours and education/training Need data – ie need individuals to exception report – to effect change Can use data to improve training by reducing service burden Thus additional resource to work with PGMEC team to improve training

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