Aims The project was conducted across all medical inpatient specialties within a UK teaching acute trust comprising a large hospital with secondary/tertiary services and a district general hospital (DGH). The trust faces the these challenges:

• General medical council (GMC) trainees’ survey highlighted red flags in training: workload, access to teaching and senior supervision.

• Discrepancy in ability to work within contracted hours between inpatient teams.

• Low morale amongst junior doctor (JD) workforce.

• Deanery training posts allocations not keeping pace with the change in medical inpatient demographics.

• This project aimed to:

• Benchmark workforce and workload against standards from the Royal College of Physicians (RCP).

• Identify root causes for variation.

• Suggest actions to future proof the medical workforce.

Methods

• Two–week audit of activity of 20 medical teams across the trust applying the RCP tool to estimate workload against recommended workforce.

• Total JD ward work–hours per week within each tier of seniority calculated.

• Variation of workload to workforce ratio determined.

• Questionnaires sent to all JDs regarding their perceptions of challenges.

Results

• Wide variation of workload to workforce ratio.

• Tier 1 staffing is above minimum RCP recommendations in all teams.

• Tier 2 presence on medical wards is on average ¼ RCP recommendation.

• The reasons for non–compliance with contracted hours and dissatisfaction with training cannot be explained by shortage of tier 1 doctors.

Conclusions The finding of adequate overall levels of staffing and outdated allocation is important. Addressing historical workload imbalances will impact significantly upon safety, quality of care, training and morale. JD staffing is often cited as inadequate. While this may be true, it is also likely that JD workload is similarly inefficient across the country. We hope this work will encourage others to identify and improve inefficiencies in JD workload.