Bruno Rushforth’s first blog

It’s that time of the year again: stroppy diktats from medical staffing about not working one minute past 5pm; developing RSI from scribbling in tiny boxes; and testing the very limits of memory (and probity) in recalling exactly when you had that ‘natural break’ the Friday before last…yes, ’tis the season of monitoring junior doctors’ hours.

Of course this is important – to find out if our rotas are compliant and to make sure that banding supplements match the intensity and antisocial hours worked. But juniors are so busy dealing with a whole host of competing demands: work, job applications, exams, families, and perhaps even finding room for a social life, that this additional duty can seem like a tiresome chore. Not least due to the sneaking suspicion that, like the Kenyan election, the final outcome might not fully represent the reality on the ground. Sadly, creative accounting appears to be the name of the game these days in the NHS, from A&E 4 hour waiting targets to MTAS competencies answers.

In a recent job we were told that all monitoring cards which showed us working even 5 minutes over our set hours could not be submitted without a consultant signature on the back, confirming that this excess had been warranted. So much for encouraging a full and frank disclosure of actual hours worked – the very point of monitoring. Words like ‘coercion’ and ‘undue pressure’ seem apt here.

And has anyone ever got any feedback on the results of their monitoring process? Closing the feedback loop is a notion lost on the medical staffing mandarins, reinforcing a sense that plus ca change, plus c’est le meme chose. But I actually feel rather sorry for these faceless Trust employees (despite not having any replies to my letters almost four months ago about our contract). They are no doubt underpaid, overworked and also under pressure to deliver evidence of compliant rotas.

Looking back, the shift from payment by additional duty hours (ADHs) to banding supplements has not only helped redress the previous underpayment for out-of-hours work, but has acted as a real incentive (together with the European Working Time Directive) to drive down juniors’ hours. So when you get that pile of monitoring cards in your pigeon-hole, don’t despair but rejoice in the physical manifestation of our collective victory against the Trust taskmasters, and try not to be too creative in your responses.

Bruno Rushforth, age 37 – GP trainee (Yorkshire Deanery) currently doing psychiatry junior doctor hospital job

  • Milly Mandarin

    Ouch! Bruno Rushforth’s first blog hits hard at people who may not really be in a position to hit back. The stroppy faceless servants of the dreaded Taskmasters.

    Its true that the diary cards are the physical manifestation of a moral victory scored in what now seems to be a lifetime ago but from where I sit, it seems to me to be a rather hollow victory (and yet they pay my mortgage).

    We have a situation now where a tit-for-tat point scoring (and sometimes pay-yielding) squabble dogs almost every monitoring exercise that takes place. Closing the feedback loop involves the pro-active involvement of managers and senior clinicians who are jumping through every hoop known to man in order to secure the PBR that will keep their service alive and pay for all the salaries, including 50% of the junior docs and the OOH Payband supplements, so that we can still have 24/7 care for our sickest patients. And we are asking them to be responsive and to evaluate and amend their working practices, with the full engagement of an itinerant trainee workforce that may be in post for 26 weeks if we’re lucky, but more likely a mere 17 weeks!

    I have no wish to return to the draconian days of treating a young professional workforce as if we are living 100 years ago, where the overtime rate meant earning 50% of salary instead of the time +50% out of hours and double time at weekends, that once was freely available to even unskilled workers. I do think that we should be concentrating on what really matters – how can we deliver sensible working conditions, at the correct rate of pay AND train junior doctors to become competent senior clinicians. We need to look seriously at how much time is spent on the shop floor and what training is being delivered when you are there. We need to examine the effect of mis-managed study leave, the total impact of sick leave on a short placement and the effect of stripping out day-time work to deliver 48 hours. We need to have dialogue about what can make this situation work and be able to discuss the effect of an apparent excess of 1 hour per person per week and resolve how we can fix it, without having to face a claim of £9000 pa.per person in the aftermath of monitoring, because we know that the money isn’t there. Oh yes, and we need to consider all this in terms of the well-being and positive outcomes for the patients, let’s not forget who we are here to serve.

    Next time a mandarin comes your way, waving a form and asking you to be realistic in your response, or heaven forbid, suggesting that you really need to make sure this comes out well, why not take the time to sit down with them and ask “What’s really the problem here and what can we / could we do to make it better?” After all, that’s what doctors are supposed to be good at!