1. GCWRP Glasgow Clinical Workforce Redesign Hospital At Night

2. 2 Glasgow Clinical Workforce Redesign Group Group set up July 2003 Multidisciplinary Group including clinicians (surg, med, anaesth, radiol) Background: Widespread failure to achieve New Deal & EWT targets across Glasgow Task: Imaginatively consider and deliver new ways of working to provide a safe, efficient and high quality service.

3. 3 Glasgow Clinical Workforce Redesign Pressures New Deal & EWT: reducing juniors hours and increasing costs. Out-of-hours duties affect day-time training time. Modernising Medical Careers: shortening training time, reducing trainee numbers and decreasing trainee involvement in service delivery. Population Demographics

4. 4 Clinical Workforce Redesign The status quo is not an option Change is unavoidable: by design or default

5. 5 Hospital at Night: what is it? HAN aims to redefine how medical cover is provided in hospitals during the out-of-hours period. The project requires a move from cover defined by professional demarcation and grade, to cover defined by competency. The HAN model consists of a multi disciplinary night team with the competencies to cover a wide range of interventions and the capacity to call in specialist expertise when necessary. This contrasts with the traditional model of junior doctors working in relative isolation, and in specialty-based silos.

6. 6 Glasgow Clinical Workforce Redesign Important Principles Medical Manpower is not cheap option: it must be used efficiently and appropriately Must provide appropriately trained staff to carry out non-medical tasks Avoid duplication of activity Patients must see a doctor who possesses the relevant skills Team working is critical

7. 7 Hospital At Night NHS Modernisation Agency British Medical Association Academy of Royal Colleges Royal College of Nursing

8. Source: NHS Modernisation Agency8 Workload Falls After Midnight

9. 9 Hospital At Night Activity after Midnight Non-medical skills Most medical problems require generic medical skills irrespective of specialty Specialty skills usually require senior input Non-urgent work spills over from daytime Duplication of work: seen by multiple individuals

10. 10 Hospital At Night Principles Adequate cover during the evening to avoid backlog New workers with general skills Team approach Fewer doctors after midnight All necessary skills appropriately available

11. 11 Hospital At Night Steps To Establishment Recruit and train non-medical workers Identify Workload Identify essential set of skills: frequency and urgency of requirement Identify who can provide each of the essential skills Identify skill providers needed on-site Streamline processes eg clerk-ins/bleep policies

12. 12 Hospital At Night Team Enhanced evening cover & reduced overnight numbers On-site Team: generic medical skills, non-medical skills, senior acute assessment & management skills including airway support Patient seen by person with the most appropriate skills Off-site support: skills required less frequently and less urgently (>30mins)

13. 13 Hospital At Night: Benefits Care becomes pro-active rather than re-active Better patient care (decreased arrest rate in some pilot sites) Efficient cost-effective working: resources targeted at service improvement Less nights for trainees and more time spent on daytime training and education Addresses EWT issues without compromising quality of care and training