Problem Surgical FY1s routinely exceeded their contracted hours. Some doctors were also rostered to work more hours than others, which was affecting teamwork and morale.
We reviewed the work schedules of surgical FY1s and found:
Significant variation between contracted hours (range from 42 hours/wk to 46 hours/wk).
Large discrepancies between contracted and rostered hours (2¼ hrs/wk on average amounting to an underpayment of £1,499.25 per annum).
A fifth of work schedules contained a week of zero days timetabled to occur after the placement had finished.
As a result hours-safeguards were not being adhered to.
Intervention We presented our data to Human Resources and a corrective payment was issued. However we needed to address the unsafe working hours and unfair hours distribution between trainees. We consulted stakeholders and it was agreed to increase certain shift lengths. We then created generic work schedules, which were consistent in the average number of hours worked, the proportion of antisocial hours allocated and the salaries paid.
Variability in working hours between FY1s: no variation within each subspeciality, 30 mins/week variation between subspecialities. Previously: 4 hours/week variation between FY1s.
Rota and work schedule concordance: 100% concordance. Previously: 0%.
FY1s satisfaction: 100% of FY1s felt the new rotas more accurately reflected their working hours.
ResultsThe changes resulted in: rota and work schedule concordance; an even distribution of shifts between trainees; and rostered hours that were reflective of the hours actually worked. Hours-safeguards were met and trainees were paid fairly. Trainees reported feeling more valued by the organisation, which improved morale and teamwork.
Lessons learnt There is generally a poor understanding of the 2016 Junior Doctor Contract, so there can be errors in its implementation. The most important lesson we learnt was that we can engineer significant change- even as an FY1.
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