University Hospitals Birmingham GUARDIANS OF SAFE WORKING

Guardian of Safe Working (GSW) role: Provides assurance that doctors are safely rostered and work in compliance with the contract. Has authority to intervene where safety is compromised or issues have not been satisfactorily resolved. Is accountable to the Trust Board.

Safe Working rules: Rule Max 48 hour average working week Max 72 hours work in any 7 consecutive days Max 13 hour shift length Max 5 consecutive long shifts, at least 48 hours rest following the fifth shift Max 4 consecutive long daytime/evening shifts, at least 48 hours rest following the fourth shift Max 4 consecutive night shifts. At least 46 hours rest following the third or fourth such shift Max 8 consecutive shifts (except on low intensity on-call rotas), at least 48 hours rest following the final shift Max frequency of 1 in 2 weekends Normally at least 11 hours continuous rest between rostered shifts 30 minute break for 5 hours work, a second 30 minute break for more than 9 hours Specific to on-call working patterns No consecutive on-call periods apart from Saturday & Sunday. No more than 3 on-call periods in 7 consecutive days Day after an on-call period must not be rostered to exceed 10 hours Expected rest while on-call is 8 hours per 24 hour period, of which at least 5 hours should be continuous between 22:00 and 07:00 No Doctor should be rostered on-call to cover the same shift as a doctor on the same rota is covering by working a shift For them to get the idea …. Don’t go through them all, the purpose is to demonstrate that its complicated hence we use software to manage this…

Purpose of Exception Reports: Highlight areas where there are major and/or regular difficulties with hours, work patterns, support or educational opportunities. Identify trends and empower GSW to take action. Encouraged but, not contractually obligatory. All ERS are monitored by GSW office. Exception reporting has replaced the old “monitoring”. There is a myth that Exception Reporting is CONTRACTUALLY OBLIGATORY – its not.

Reporting Timeframes: Routine Exception Reports should be lodged within 7-14 days. IMMEDIATE SAFETY CONCERNS (ISCs) i.e., where there is an immediate and substantive risk to patient or doctor. Reported verbally to own or on call Consultant IMMEDIATELY and raised as an ER within 24 hours.

Getting set up on Exception Reporting: All JDiTs issued with login details and guides of how to use the software - CHECK YOUR TRUST E-MAIL:- noreply@healthmedics.allocatehealthsuite.com Set up your account asap (it may expire). Internet based, so can be accessed from home, smartphone etc. Password resets can be requested: ExceptionReportsJDLoginSupport@uhb.nhs.uk

Making an Exception Report - Need to know: Your ‘Rota’ code: (from your Work Schedule) eg:- Who to submit it to?: All ERs, send to Clinical Service Lead … except Education ERs - send to Supervisor

Detail is important Give as much detail as you can in the free text box. If you are seeking HOURS compensation, state clearly: how much extra time you are claiming the circumstances that led to you working over who you discussed this with If you are raising an education er, provide all the facts. “Worked late” is not enough detail. ERs with inadequate detail will be sent back requesting more information.

Workovers require Consultant approval: You must state the name of the Consultant you contacted (or tried to contact) to approve any ‘workovers’.   This should be at the time OR retrospectively i.e. within 24 hours of the event (verbal or e-mail). Note this in your Exception Report. Contentious - We are aware that contacting a Consultant at the time can be difficult hence the 24 hours grace. This is non-negotiable, all other staff groups must gain approval for overtime.

How is my ER doing? Log-into ALLOCATE regularly and respond to requests for information. Review the outcome of your Exception report – ‘accept’ or ‘escalate’ it. Many ERs get stuck in the system because the JDs raise them, but don’t respond to queries or outcomes on the software.

Further training/information: The Guardians office will: Provide regular updates for Junior Doctors (e-mail/briefing sessions) Monitor and chase progress of Exception Reports Set up a Guardians Review Group Brief Clinical Service Leads and Consultants Visits to speciality forums or an individual meeting with the GSW can be requested.

The Team: Mr Alok Tiwari – Deputy Guardian of Safe Working (HGS lead) GuardianofSafeWorkingDeputyHGS@uhb.nhs.uk: Dr Jason Goh – UHB Guardian of Safe Working (QEHB Lead) GuardianOfSafeWorking@uhb.nhs.uk: Wendy Baldwin – Manager Junior Docs Monitoring Office (JDMO) Lesley Williams – Deputy Manager JDMO Abid Ali & Natalie Ford – Medical Workforce Leads Hitendra Patel – Exception Reporting Officer Jag Shergill – JDMO Co-ordinator