New Junior Doctor Contract
The new contract for junior doctors in England came into effect for doctors in Paediatrics in February 2017.
Principles of the Contract
The Secretary of State for Heath, announcing in Parliament that the contract would be imposed, recognised that “junior doctors are some of the hardest working staff in the NHS, working some of the longest and most antisocial hours.” He acknowledged that the new contract does not address many serious concerns, notably “rota gaps and rostering practices.”
The new contract puts patient safety at its heart. It explicitly links safety to working hours an
d conditions of junior doctors. It acknowledges that working long, often antisocial, hours can put the safety of doctors themselves at risk. It puts in place specific safeguards to reduce risks to patient and staff safety, linked to working hours and conditions.
Night working
The contract acknowledges the additional risks to patient and staff safety from working at night.
The London School of Paediatrics has previously emphasised the importance of thinking about how we work at night.
This, as well as pragmatic strategies and tips for both healthcare workers and employers, is covered in the Archives of Disease in Childhood Education and Practice article: “Managing the effects of shift work on your health.”
Rest and Breaks
An essential principle is that breaks and rest are not a luxury, especially when doing busy or intense work, particularly at night. Regular rest is essential to ensure safe, effective patient care; without breaks, healthcare workers are not able to work at their best. Failure to consistently achieve rest and breaks has consequences for both patient and staff safety.
The new contract makes it clear
that the minimum acceptable standard for breaks, for shifts lasting
It is clearly not possible to guarantee that every shift worked will allow every doctor to achieve this.
The contract makes it clear that the minimum acceptable standard for frequency of breaks is that 75% of the time, junior doctors should expect to receive the required minimum breaks per shift.
Rest Facilities
Employers have a mandated responsibility to provide access to appropriate facilities during a night shift
Driving Tired
After an individual has been awake for ~16-18 hours, or the functional equivalent, on average reaction times are the same as if they are at the legal drink-driving limit. This level of sleep deprivation and fatigue is frequently reached by healthcare workers working night shifts.
Driving home after a night shift when tired puts healthcare workers at significantly increased risk of road traffic accidents.
Over 40% of doctors report “near misses” when driving home after night shifts.
The new contract recognises
this, and puts in place specific safeguards.
Employers have a responsibility to think about the safety of their staff when driving home after a night shift, to reduce these risks as much as possible. It is important that any member of staff who is too tired to safely drive home does not.
Senior staff on the dayshift should make it their responsibility to check whether nightshift staff are safe to drive home if they plan to. The new contract makes clear that employers should have mechanisms in place to support staff where they are too tired to safely drive home
.
The Guardian of Safe Working Hours
The new contract puts in place a new senior consultant post in each Trust working to it to specifically ensure that these provisions are being met.
The role of the Guardian is to ensure that issues of compliance with safe working hours are addressed by the doctor and/or the Trust, as appropriate. They are required to provide assurance to Trust Boards that their doctors’ working hours are safe. They are required to act as the champion of safe working hours for doctors in approved training programmes.
Exception Reporting
Where junior doctors are working in circumstances where the above provisions for breaks, rest and facilities are not met, the new contract makes it clear that this poses a risk to both patient and staff safety. As per the GMC Duties of a Doctor, it is the responsibility of any individual doctor both to make the care of their patients their first concern and to take prompt action if patient safety is being compromised.
It is therefore essential that junior doctors working rotas where minimum standards for rest, breaks and facilities are not being met use the exception reporting process to notify the Guardian of Safe Working. It is then the responsibility of the Guardian to take steps to address these issues.
Pressures
The NHS is under extreme pressure. The effect on staff who provide the care the NHS delivers is increasingly evident.
Healthcare staff will often try to fill in resource gaps from their own personal reserve. The ‘hero attitude’, that patient care is always more important than self-care is widely prevalent. It is well-intentioned but misguided - as in an aircraft emergency, the principle to put on your own oxygen mask before attending to the needs of others is absolutely fundamental.
The ultimate responsibility for addressing those pressures lies not with junior doctors, but those who employ them, at Trust level and, eventually, higher.
The new contract explicitly links breaks, rest and working patterns to patient and staff safety.
It explicitly tells those working it that non-compliant rotas are an unacceptable risk to patient and staff safety.
The GMC Duties of a Doctor emphasise the responsibility of individual doctors to make patient safety their first concern, and take prompt action if that is compromised.
Exception reporting will highlight risks caused by working pressured rotas to those with the responsibility to deal with it. It will emphasise where demand does not meet supply. It provides an essential tool to try to make things better, for all working within the NHS, and for all those whose care depends on it.
Dr Michael Farquhar
Consultant in Sleep Medicine
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