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