Hospital Dr News

Consultants needed during ‘killing season’

More consultants should be on duty and elective work should be reduced when trainees change jobs in August, the four UK chief medical officers have recommended.

Rotas should also be more flexibly and intelligently designed and high quality clinical inductions should be provided for all trainees, according to the proposals drawn up by the Academy of Medical Royal Colleges.

But employers question whether the proposals, designed to improve patient safety and reduce stress on juniors, are affordable and practical.

The first week in August – or the ‘killing season’ as it’s colloquially called – has been the changeover time for most grades of junior doctors since 2007.  But UK and international studies have shown that this is associated with up to a 12% increase in mortality for patients and an increased length of stay of up to 7%.

A survey last year by the Royal College of Physicians of Edinburgh and the Society of Acute Medicine revealed that 58% of juniors believed the August changeover damaged their training, and 90% said it compromised patient safety.

In addition the changeover arrangements place considerable stress on junior staff managing unfamiliar patients in an unfamiliar setting. This is often compounded by having equally new, more senior, trainee colleagues as the first port of call for advice and support.

“Such an unhappy and stressed start to a post is particularly undesirable for doctors embarking on their career and may set the tone for the whole attachment even for those already on a formal career path,” says the AMRC.

The Academy’s recommendations have been endorsed by the Medical Education UK Strategy Group which comprises the chief medical officers and UK medical education representatives. Hospitals, deaneries and college members are being asked to act on the proposals at local level.

But Bill McMillan, head of medical pay and workforce, at NHS Employers, said: “This Academy report is helpful in addressing what constitutes well managed handovers at changeover time. We aim to meet with the Academy soon to explore whether there are issues around terms and conditions, as well as how future developments will support patient care while being affordable and practical for employers.”

Marion Matheson, co-chair of the BMA’s medical student committee, said: “The recommendations offer a logical and practical approach to improving the transition of medical graduates into their first jobs in the foundation programme. It’s a bit disappointing they aren’t already in place and this isn’t already happening and it has had to be explicitly pointed out that this is the best way to get around these problems.

“If the recommendations came in it would be fantastic but it is questionable whether they are attainable.”

The AMRC and the Conference of Postgraduate Medical Deans also plan to further explore moving to a staggered transition date for changeovers. They propose that higher specialty trainees (ST3 and above) should change jobs between two and four weeks after foundation, core and specialty years one and two doctors start.   Some specialities in a number of deaneries have already adopted this approach with positive results.

The recommendations are:

1. Consultants should be available to deliver patient care and support their trainees at transition dates and should ensure their teams value their trainees and welcome trainees seeking assistance.

2. Rotas should be designed to ensure incoming juniors receive rota protection and additional support when on call for the first few weeks of each attachment.  Doctors continuing in posts should cover the initial on call slots of incoming doctors to give them time to increase their confidence and familiarity with the system before being on call. At the end of attachments departing doctors should not, wherever possible, be on call the night before moving.

3. High quality induction should be provided on all units. Inductions should cover: how the unit works, assessing information, investigations, prescribing, unit protocols and introductions to staff. Every effort should be made to make the incomer feel a valued member of the team.

4. Elective work, clinics and meetings should be reduced at changeover in order to free clinical staff to deliver effective induction.

Bookmark and Share

5 Responses to “Consultants needed during ‘killing season’”

  1. Supersub says:

    Wouldn’t it just make sense to move the start date to September?
    I’ve always thought it’s daft to have new doctors starting in a month when most seniors take annual leave.
    Give the newly qualified house officers an extra month on the beach and sort out this out once and for all.

  2. Dazzledoc says:

    Totally agree with Supersub. In anaesthetics our novice trainees do no solo on call for 3 months (until they have passed their initial competencies) and this puts a strain on our resources. There is a much higher demand for senior leave in August so moving the changeover date to September would make a lot of sense.

  3. Consultant Surgeon says:

    Absolutely agree. Move the changeover date to September. Makes sense all round.

  4. Jim says:

    Totally agree. Change over in September, and new FY1’s should have 4 weeks’ paid shadowing before they start work.

    An alternative suggestion: 54-week training years for all trainees, giving a stagger time of 2 weeks between changeovers, in which the new trainee in each post works alongside their predecessor for 2 (or 4) weeks. Would cost slightly more, but loads of potential advantages. Also would mean that personnel only have to cope with one year’s worth of trainees every 2 weeks rather than a whole year on one day.

  5. js says:

    Stop Consultant leave in August.

Post a Comment

Enter this security code

Submit Comment for Moderation