The COVID-19 pandemic placed an unprecedented demand on the NHS. In response, high-intensity rotas were implemented with short notice. This project aimed to fairly and safely step down the COVID response rota as normal working patters resumed.

Assessment A cross-sectional survey was distributed to doctors on the medical COVID rota. It explored their views on the step-down process. The majority of respondents (68%) had concerns including discrepancy between on calls and lack of opportunity to plan leave. A document of key themes in the feedback was prepared and presented to senior clinical managers.

Intervention and Improvement The new rota produced ensured an even distribution of shifts and honoured pre-existing leave. The new rota was compliant and ran to completion for every trainee. Comparison of stepping down to the trust rota vs our new rota reduced inter-trainee shift variation. Night shift discrepancy SD reduced from 2.89 to 0.97, long day (ward cover) on-calls reduced from SD 3.57 to 1.12 and long day (take) shifts SD 0.98 to 0.56.

Following implementation a second cross-sectional survey was distributed. 85% agreed or strongly agreed that there was sufficient staffing levels ‘on call’ and 80% agreed or strongly agreed that there was sufficient staffing levels on the wards. 95% found they were able to take their annual leave and 80% agreed or strongly agreed that there was an even distribution of on-call and night shifts.

Conclusion The success of our project relied on good engagement with colleagues to collect a representative view for leverage in discussions with seniors, and produced a result that was fairer for trainees, sustainable, and preferable for rota coordinators and senior clinical management. Active collaboration in the rota design process will improve junior doctor engagement, well-being and job satisfaction.