Dev Lall

Armageddon for out-of-hours rotas finally arrives

It has finally arrived – the staffing crisis that has long been threatening to hit out-of-hours rotas.

The crisis has been coming such a long time that you would have thought a plan for managing it would have been put in place. We thought it would arrive in 2007 when MMC restricted training numbers. We then thought it would arrive in 2009 when the 48-hour week finally became law. But only this year, has push really come to shove.

When will those at the top of the decision-making tree actually listen and take heed of the day-to-day difficulties currently facing clinicians?

Money has been found here and there and diverted from many pots to fund a couple of extra consultant jobs (which to date don’t solve the first on rota problem).

As trainee numbers have dwindled the unused salaries have been identified and made available to be used for specialty doctor posts. But that solution doesn’t work in practice. There are fewer and fewer applications for our almost continually run specialty doctor advert. This is largely because there are no such doctors out there anymore. They are either in Specialty Training or in Australia.

Nor are there any locums. Since the ‘lost tribe’ found other sources of employment and other doctors were refused entry to the country, there is no pool of locums. Trainees are limited to a 48 hour working week. They cannot readily do the locums shifts even when extra money is available.

But, crunch time is here. Forty per cent of our trainee cohort are about to leave the programme due to a variety of bona fida reasons: a year abroad, a specialist fellow post, an inter deanery transfer, a maternity leave. These leave unfilled and unfillable posts.

Unfortunately, it feels like no-one is really listening. Perhaps we are our own worst enemy by continually coping with such staff reductions. But the slack in our system has run out. We will no longer be able to run our rotas.

What’s the solution? The number of man hours available within the system is finite.

We could waive the working time regulations, and revert to an on call system with more hours in hospital, but recognising that all of them are not spent working.

The other option is to merge sites and reduce the number of rotas to maintain current out-of-hours staffing and services. This would undoubtedly be unpopular. Smaller hospitals would close, MSPs would lose their seats, the public would lose their local hospital services and have to travel further afield for treatment.

But, is this a bad thing? Maintaining medical staffing on a wing and a prayer is not a success at any level.

The hope is that we will struggle on managing in the short term. In 2012, a bulge of trainees will finish their training culminating in the CCT and entry to the specialist register. They will be consultants in all but name or pay (status went a long time ago). There will be plenty of them, desperate for any jobs with which to pay the mortgage. The old rules of supply and demand will force them to take the jobs on offer and, lo and behold, we will have specialists to deliver the service.

But we can’t wait for them. Our out-of-hours Armageddon happens before then. Our workforce is annihilated now and trainee numbers continue to be reduced.

There will be a gap, and this sort of gap will threaten patient care. The radical and unpopular decisions that are needed will be postponed until after 5 May, the date of the next Scottish parliamentary election. And there’s a danger that they’ll be postponed until after the next one, and the next one…

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7 Responses to “Armageddon for out-of-hours rotas finally arrives”

  1. Tom Goodfellow says:

    We are our own worst enemies.

    The more we “rescue” the system the less attention will be paid to sorting it.

  2. chrissa says:

    exactly right tom! the managers are using the “guilt induction technique”: despite management being responsible for a hospital to function, they try to make doctors feel guilty if it does not. for as long as doctors do not toughen up and stand their ground, saying “this is not my problem” when a rota collapses, nothing will improve.

  3. wmcc says:

    Depends on there being goodwill on the part of the doctors – wonder where that went?
    If the managers wanted to fill rotas they would pay the market rate which is by definition the amount of money needed to entice people to do the additional work. Pay enough and the work will be done

  4. joshek says:

    wmcc – you are 100% right!
    Carolyne can not be seriously thinking that the new gerenation of CCT holders coming trough will simply continue to bend over and and fill the currently unfillable staff grade jobs. The majority of trainees “in the pipeline” are females, many of them have put off having families until the completion of their training with the plan to go part time the moment they have their CCT. Expect a baby boom in that cohort! The only reason for a new CCT holder to accept one of the currently unfillable staff grade jobs is to start a family and get the max maternity leave. The system is still to find out how costly it is to have squanderd doctors’ good will.

  5. caroline says:

    No, I don’t think they will fill the “staff grade jobs” as you refer to the new Specialty doctors. My point is that they will be a new cohort of specialists to do the work currently being done by specialty doctors and in doing so will mark the beginning of post CCT doctors working not as Consultants as we currently know them but as a new type of specialist providing services around the clock hitherto provided by Consultants during the day and trainee service providers at night. I do not think the similarity in new names of specialty doctors and specialty trainees is coincidental.

  6. chrissa says:

    caroline – yes you do expect them to do the traditional staff grade jobs that nobody wants. this “new type of specialist” you talk about is the demotion of new cct holders, down a big step from consultant status and precisely onto classic staff grade level! it means trainees now are going through all the effort the british cct requires – for a de-facto staff grade job at the end! that is pure lunacy. the british cc(s)t was only worth the effort because the classic consultant job beckoned in the end. australia, new zealand, canada will not need to invest a penny in their medical schools for years – british graduates will supply them with all the doctors they need.

  7. drsupport says:

    Completely agree. This situation has been staring everyone in the face for the past 5 – 10 years now; and anyone who is surprised has had their head in the sand, or perhaps they’ve been studying too hard for PG exams. The harsh laws of supply and demand will be used to squeeze the expanded cohort of CCT-holders, who don’t move to Australia, into ‘specialist’ posts with inferior Ts&Cs; and that’s before you factor in the need to reduce the burden of the public sector on taxpayers.
    We’re already seeing the fallout of the consultant body kowtowing to managerialism: many SUIs are occurring due to inappropriate deployment of medics and overstuffing of clinics and theatre lists to keep the service running, lest anyone, heaven forbid, have their appointment or operation postponed. It’s productivity over safety and quality all the way down from here.

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