1. 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

2. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. Exception reports CUHFT Dec 2016-Dec 2017

13. Exception reports CUHFT By grade trainee

14. Exception reports CUHFT By speciality

15. Exception reports CUHFT Dec 2016-Dec 2017 Immediate safety concerns

16. 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

17. 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

18. 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

19. 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

20. 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….

21. 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

22. ?