Solutions

The introduction of the Working Time Directive (WTD) in gradual stages over the last few years has been a key driver for the RCPCH and other Medical Colleges to look closely at the issues around service delivery.

Our key aims are to develop safe and sustainable solutions for patients and to ensure that high standards of training are maintained.

This section considers the impact of the European Working Time Regulations (EWTR) through the surveys the College and others have undertaken, and summarises the solutions being developed. 

Rota compliance and vacancies survey Winter 2011

Findings are now available

The College has recently completed a survey of clinical directors responsible for all units in the UK providing general paediatric and neonatal services. The purpose of this survey, the third in consecutive years, was to collect evidence on the current state of compliance with the EWTR, the extent of rota vacancies and gaps, and the concerns of those responsible for managing these services.  

An excellent response of 87% - 194 out of 223 units - was received and the survey findings show that:

• 4% of rotas were reported as being non-compliant in practice in December 2011, a fall from 16% a year earlier.
• For tier 2 (middle grade), rota non-compliance is more common, but has fallen from 23.9% of units in December 2010 to 16.1% in December 2011.
• The overall number of gaps and vacancies recorded in our survey has fallen from 490 in 2010 to 402.4 in 2011, representing a reduction in the rate from 12.6% to 10.2%.
• On tier 2 rotas there was a small reduction in the rate, with vacancies and gaps representing 16.3% of the total WTE posts compared to 20.4% in December 2010. 
• Clinical directors and leads reported 283 consultants now permanently working on tier 2, a 60% increase on December 2010.
• These consultants spend on average 2.65 PAs undertaking tier 2 duties.
• 75.6% of clinical directors and leads stated that they were either very or moderately concerned that their service would not be able to cope with demands upon it during the next 6 months – down from 86% in December 2010.
• There are however considerable national differences with 93.8% of clinical directors and leads in Scotland and 92.3% in Wales very or moderately concerned.

The full report can be found here: Rota compliance and vacancies survey 2011-2012 (PDF, 252KB, 5 pages)

Regional/deanery breakdowns will be available shortly and the College will repeat the survey in winter 2012/13.

Rota compliance and vacancies survey December 2010- February 2011

A total of 188 responses were received representing 84% of all UK units. The survey found that:

• 16% of rotas were reported as being non-compliant in practice, but only 2.2% non-compliant on paper.
• Non-compliance was more common on Tier 2 (middle grade) rotas where 32.4% of shared general and neonatal rotas and 24.2% of all 2 Tier rotas were non-compliant in practice.
• For Tier 2 (MG rotas) there were 238.1 vacancies due to failure to recruit and 122.7 gaps due to OOP. These vacancies and gaps totalled 360.8 representing 20.4% of reported Whole Time Equivalent (WTE) Tier 2 posts.
• On Tier 1 (Junior) rotas, there were 129.2 vacancies and gaps reported by the 188 units – a rate of 6.4% of the WTE positions on these rotas.
• Clinical Directors and Leads reported 176.5 consultants permanently working on Tier 2 rotas.
• 86% of Clinical Directors and Leads said they were either very or moderately concerned that their service will not be able to cope with demands placed on it during the next six months.

EWTR Survey Findings(PDF, 245KB, 4 pages)

Rota compliance and vacancies survey November 2009

A survey of all Clinical Directors of acute paediatrics in England was conducted in November 2009 with a 72% response rate. With data from two previous email surveys and the workforce census, the College has comprehensive data about the impact of WTD.

• New consultant posts as a solution to WTD. We estimate 123 consultant posts were created as a WTD solution in 2009. Only 82 of these include resident shift working and only 45.8 are estimated to be fully funded from the £50m DH funding.
• Units that say they are concerned that they will not be able to cope within six months. Almost 73% of respondents reported that they were concerned that their service will not be able to cope with the demands placed on it in the next six months.
• Non-compliant rotas. 44% of responding trusts reported that at least one of their middle grade rotas (general or neonatal) was non-compliant and 9% (10/111) reported that at least one junior rota was non-compliant.
• Paper compliance. Over 55% (60/109) stated that although all rotas were compliant on paper; this was not the case in practice.
• Impact on Patient Care and Training. 18.5% of those responding stated that the excess work undertaken by consultants has had an effect on planned patient care and over 42% said it had an impact on training of junior staff.
•  Vacancies. The College's November survey and the 2009 census indicate that there are at least 180 training and 120 service vacancies in paediatrics in England.

Useful Working Time Directive references

• In 2007-2008 RCPCH undertook a joint project with the Royal College of Obstetricians and Gynaecologists to assess the impact of the 2009 implementation. This project was completed in 2008. Children's and maternity services in 2009: working time solutions (PDF, 449KB, 80 pages)

• A Guide to the implications of the WTD for trainees (PDF, 320KB, 41 pages) was published by the DH in December 2009.

• RCPCH Advice on WTD and Consultant Working Patterns (PDF, 234KB, 2 pages) published in July 2009, provides advice to consultants to reflect the expected pressures on general and neonatal rotas when the directive comes into force in August 2009.

• The European Working Time Directive - what does it mean for paediatrics?(PDF, 21KB, 5 pages). This RCPCH document, published in May 2009, provides information on EWTD rules, derogation and opt-out, and how to bid for new consultant paediatricians to support EWTD compliance.

• RCPCH guidance on the role of the consultant paediatrician in providing acute care in the hospital (PDF, 135KB, 18 pages), published in May 2009 was approved by the RCPCH Executive Committee March 2009 with input from the BMA. The guidance includes background to the changing role of the paediatrician, recent trends in the supply of trained paediatricians, guidance on developing a business plan for new consultants, job plan recommendations and examples of innovative staffing models.

• A Workforce Solutions workshop was held on the 13 May 2010 to consider EWTR solutions and to look to the future design for paediatric services. 63 clinicians attended the workshop; the majority were Clinical Leads/Directors. There was also representation from the DH, Skills for Health and from Collinson Grant (Consultants developing a workforce demand model). The President, Professor Stephenson, attended and provided the introduction to the day.