WORK SCHEDULE & EXCEPTION REPORTING POLICY

Transcription

1 A guideline recommended for use For use in: For use by: For use for: Document owner: Status: Trust Wide All staff WORK SCHEDULE & EXCEPTION REPORTING POLICY HR & Communications Approved Approved by and Ratified by: TNC (Medical & Dental) Date Approved: 21 st March 2018 To be reviewed before: To be reviewed by: Guideline supersedes: Location of archived copy: TNC (Medical & Dental) Committee Deputy Director of Workforce and OD and Staffside New policy New policy Guideline Registration No. Version No. 1 Policy Number: PP Table of Contents 1. INTRODUCTION PURPOSE SCOPE TRUST VALUES STATEMENT AND PRINCIPLES DEFINITIONS... 3

2 7. ROLES & RESPONSIBILITIES WORK SCHEDULE WORK SCHEDULE REVIEW CHANGES TO THE WORK SCHEDULE ROTA PATTERN REVIEW CHANGES TO THE WORK SCHEDULE AFFECTING PAY EXCEPTION REPORTING IMMEDIATE SAFETY CONCERNS ADDITIONAL TIME WORKED IN UNPLANNED EXCEPTIONAL CIRCUMSTANCES TO SECURE PATIENT SAFETY FINANCIAL PAYMENTS... Error! Bookmark not defined. 17. BREACHES OF SAFE WORKING RULES NOT INCURRING A FINANCIAL PENALTY BREAKS VARIATION FROM WORK SCHEDULE ROTA / WORKING PATTERN VARIATION FROM WORK SCHEDULE EDUCATION OPPORTUNITY AND SUPPORT HONORARY CONTRACT HOLDERS ASSURANCE APPENDIX 1 SAFE WORKING RULES APPENDIX 2 EXCEPTION ADDITIONAL HOURS/PATTERN APPENDIX 3 - EXCEPTION EDUCATIONAL OPPORTUNITIES AND/OR SUPPORT.. 18 APPENDIX 4 - IMMEDIATE SAFETY CONCERNS Version Date Comment 1 21/3/18 First Finalised Version of Policy Equality Impact Assessment This document has been reviewed in line with the Trust's Equality Impact Assessment guidance and no detriment was identified. This policy applies to all regardless of protected characteristic - age, sex, disability, gender-re-assignment, race, religion/belief, sexual orientation, marriage/civil partnership and pregnancy and maternity. Dissemination and Access This document can only be considered valid when viewed via the West Suffolk NHS Foundation Trust Intranet. If this document is printed in hard copy, or saved at another location, you must check that it matches the version on the Trust s intranet. Associated Documentation Grievance Policy & Procedure PP035 Incident Reporting & Management Procedure PP105 Allocate Guidance & Flow Charts Review This document will be reviewed within three years of issue, or sooner in light of new evidence. 1. INTRODUCTION 1. This policy has been specifically developed to manage exception reporting and work schedule reviews within the West Suffolk NHS Trust (the Trust). 2. The Trust actively manages its services to provide the most effective healthcare for patients and clients within its resources. It recognises the need to deliver safe clinical services and to ensure adherence to safe working hours protections Authors: HR & Communications Version: 1 Page 2 of 19

3 together with access to appropriate training opportunities for all Doctors in Training (Junior Doctors). 3. This policy is in accordance with current legislation and the Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 (TCS). 4. The Trust s electronic system for Exception Reporting and Work Schedule Reviews is Allocate. This is accessible by personal mobile devices, and computers located in Timeout, Education Centre Library or Doctors Mess. 2. PURPOSE 1. The principles underpinning this policy support the aim of managing safe working and training for junior doctors in a way that is both supportive to staff, and enhances the provision of the highest quality patient care. 3. SCOPE 1. This policy will apply to all doctors in training (referred to as doctor) holding employment contracts with West Suffolk NHS Trust under the Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016 (TCS) and in a General Medical Council (GMC) / General Dental Council (GDC) approved training programme. 2. This policy will not apply to doctors issued with an honorary contract for the purposes of attendance on the Trust s premises on behalf of another organisation except for those doctors under a host employer arrangement as part of a Health Education England lead employer contract. 3. This policy will also not apply for doctors where the Trust acts as the lead employer for payroll purposes for whom the host employer will be accountable. 4. Other policies that should be taken into account when applying this policy are: - Grievance Policy & Procedure PP035 - Incident Reporting & Management Procedure PP105 - WhistleBlowing PP056 - Fraud & Financial Irregularities PP173 - Organisational Change Management Policy PP TRUST VALUES The Trust Patient First Values can be found on the intranet at 5. STATEMENT AND PRINCIPLES This policy is for guidance only and does not form part of the employee s contract of employment. 6. DEFINITIONS The definitions used in this policy are those outlined in the definitions section of the TCS. Authors: HR & Communications Version: 1 Page 3 of 19

4 7. ROLES & RESPONSIBILITIES Guardian of Safe Working Hours (GSWH) The GSWH will provide assurance to the employer, and host organisation if appropriate, on compliance with safe working hours by the employer and the doctor. Educational Supervisor (ES) The ES will be the doctor s named educational supervisor except for GP & Foundation trainees for whom the title ES in this policy will refer to their named clinical supervisor in the acute setting for the purposes of Exception reporting for Hours/Pattern of working and breaks. Director of Medical Education (DME) The DME will oversee the quality of the educational experience. Doctor A Doctor will ensure that both their pattern of work and their total hours of work, including any and all work undertaken for any employer, whether directly or indirectly (for example through an agency or limited company), comply with the limits set out in Schedule 3 of the TCS, and that they remain safe to carry out clinical duties. Responsible Clinician The responsible clinician will be the clinician identified as responsible for the service in the circumstances where there is thought to be an immediate and substantive risk to patients and/or doctor. 8. WORK SCHEDULE There is a work schedule for each training post listed in the Trust s Learning and Delivery Agreement/s with Health Education England. These work schedules will be subject to annual review at a minimum. Generic Work Schedule Where the post holder has been identified to the Trust, a generic work schedule will be provided to the doctor at least 8 weeks prior to commencement in the placement which will include: Intended learning outcomes Scheduled duties of the doctor Indicative time for quality improvement and patient safety activities Opportunities for periods of formal study (other than study leave) Number and distribution of hours for which a doctor is contracted and associated pay Personalised Work Schedule The generic work schedule will be the basis for a personalised work schedule. The doctor should discuss with the ES how they can achieve their training objectives either ahead of commencement or, as soon as possible, after the commencement of the placement Junior Doctors should arrange to meet with their Educational Supervisor within the first two weeks of the placement and/or rotation to discuss and agree their individual educational requirements during that placement/rotation. Authors: HR & Communications Version: 1 Page 4 of 19

5 General Rules for Work Schedules - A doctor s work schedule will normally apply for the duration of each training placement - The work schedule will be discussed as part of educational review and at a minimum an educational review should take place at the start and finish of the placement for which the work schedule applies - The doctor must disclose the nature and timing of private professional clinical work at the initial work schedule meeting with the ES and inform the ES in advance of any change to their disclosure. A record of the private commitments should accompany the work schedule - Full-time will be a minimum of 40 hours and a max of 48 hours per week averaged over the reference period (rota cycle or length of the placement or 26 weeks whichever is shorter) inclusive of annual leave calculation - Less than full time (LTFT) will be a maximum of 40 hours per week averaged over the reference period (rota cycle or length of the placement or 26 weeks whichever is shorter) inclusive of annual leave calculation 9. WORK SCHEDULE REVIEW A work schedule review can be triggered by one or more exception reports, or by a request from a doctor, an ES, a manager or the GSWH. A work schedule review should consider safe working, working hours, educational concerns and/or issues relating to service delivery. The work schedule review structure comprises Initial Review, Level 1, Level 2 and Final Stage process. Where the exception report highlights a work schedule review for reason of an immediate safety concern (immediate and substantive risk to the safety of patients or of the doctor making the report) then an Initial Review should occur at the earliest reasonable opportunity and within 7 working days. Such an exception report will be further to the doctor s immediate verbal conversation with the responsible clinician to agree the most appropriate real-time solution. An Initial Review takes place ideally no later than 7 working days after receipt of an exception report. It is anticipated that in the first instance, that concerns raised in exception reports with regards to additional hours, pattern of work and/or breaks be addressed by the Service Manager. On the majority of occasions this will be via the electronic system. Where issues or patterns are identified, the Service Manager may choose to meet with the doctor to discuss further. This may or may not include the ES, Clinical Supervisor and/or on-call consultant depending on the circumstances. If the initial review is agreed by the doctor, the result will be sent to the ES for information. Concerns regarding support and/or training opportunities will be addressed by the ES by meeting the doctor within 7 working days of the exception report. The ES may choose to invite the Service Manager, Clinical Supervisor and/or on-call Consultant if the issues require this additional input. The details of the exception report will have automatically been shared electronically with the ES, GSWH or DME and Administrator upon submission of the report, so that an appropriate oversight can be maintained of patterns emerging which merit further exploration. If a doctor Authors: HR & Communications Version: 1 Page 5 of 19

6 disagrees with the outcome of the Initial Review then a Level 1 review may be requested within 7 working days of the notification of the decision. A Level 1 review takes place with the doctor, ES and Service Manager ideally no later than 7 working days after the outcome of the Initial Review. This may be triggered for instance by a pattern of concerns as identified by the GSWH or DME as well as at the specific request of an individual doctor(s) or following an Initial Review being disagreed on the system by the doctor. Depending on the nature of the concern(s), the ES is likely to require support and guidance from the operational clinical teams, Medical Staffing, the GSWH and / or the DME. If a doctor(s) is dissatisfied with the outcome of the Level 1 review then a request for a Level 2 review may be made within 14 working days of notification of the Level 1 decision. A Level 2 review takes place with the ES, the doctor, a service representative and a nominee either of the DME (where the request pertains to training concerns) or GSWH (where the request pertains to safe working concerns) ideally no more than 21 working days after receipt of the Level 2 request. If dissatisfied with the outcome of the Level 2 review, the doctor may request a Final Stage work review within 14 working days of notification of the decision. The Final Stage process is a formal hearing under the final stage of the Trust s Grievance Policy & Procedure with the addition of the DME or nominated deputy as a panel member. In the circumstances of an appeal of a decision by the GSWH, the hearing panel will include a representative from the BMA nominated from outside of the employer/host organisation. The latter will be provided by the union within one calendar month. The timescale of the hearing will be in accordance with the Trust s Grievance Policy & Procedure. The panel s decision will be final with the outcome communicated in writing and copied to the GSWH. If, at any stage in the work schedule review process, changes to individual or collective rotas / working patterns are identified as the appropriate solution to the concerns this will be undertaken in accordance with Section 11 below; including discussion and agreement with doctors working on the rota in question, service representatives, educational representatives and Medical Staffing. 10. CHANGES TO THE WORK SCHEDULE Work schedule changes agreed between the doctor and the ES are able to be made prospectively at any time during the doctor s placement where they do not impact upon pay or, the contracted work pattern or, have a wider impact within the service/ Trust which require other parties to be involved. A written record of the change should be made and the revised work schedule returned to Medical Staffing. Changes which impact upon pay or, the contracted work pattern or, have a wider impact within the service / Trust should only be made as a result of a submitted exception report. Major organisational changes, such as service reconfiguration, will continue to be managed via the Trust s Organisational Change Management Policy. This will include any changes which may lead to redundancy and / or redeployment. Wherever possible local departmental changes will be agreed through discussion and collaborative team working, the need for which may be triggered by Exception Reporting and Work Schedule Reviews. 11. ROTA PATTERN REVIEW Rotas will be reviewed as follows: Authors: HR & Communications Version: 1 Page 6 of 19

7 1. Request raised e.g. by Doctor/s, Supervisor/ES, Department, Medical HR, GSWH, DME (the origin of the request to be noted for determination of pay protection) 2. Medical HR, Department representative/s and doctor(s) working on the rota in question review the current rota/working pattern, model alternative options, agree preferred template and proposed implementation date 3. Template approval sought from Junior Doctor BMA Rep, DME, GSWH, CD and GM, template and costing summary submitted to GM, CD and Finance Manager. 4. Once template approved implementation proceeds in accordance with proposed timeline and the terms of amendments to pay from work schedule changes This process will constitute a joint work schedule review but not preclude access to the work schedule review process. 12. CHANGES TO THE WORK SCHEDULE AFFECTING PAY When rota changes have been finalised under the Trust s work pattern review process the following will apply for pay: - Where pay of individual doctor(s) is increased by a change to the work schedule, pay will be altered prospectively from the date that the change is implemented except in exceptional circumstances - Where total pay of individual doctor(s) is decreased as a result of a change to the work schedule required by the Trust, then pay will be protected until the end of the particular placement covered by that work schedule. Protection will not extend to any subsequent placement, including a placement where the doctor returns at a later date to the same post - Where total pay of individual doctor(s) is decreased as a result of a change requested by the doctor, the doctors total pay will be reduced in line with the change in the work schedule, from the date that the change is implemented This will apply to all involved parties whether it is a standalone rota / work pattern or a shared rota / work pattern. The origin of the request to change the rota / work pattern will be determined and clearly documented at the outset. 13. EXCEPTION REPORTING Exception Reporting is the mechanism to facilitate prompt resolution and / or remedial action to ensure that safe working hours are maintained. Quick reference guides are available on the Medical Staffing intranet page, along with reporting flow charts, and should be read in conjunction with this policy. An exception report may be submitted when day-to-day work varies significantly and/or regularly from the agreed work schedule. Primarily these variations will be: a) Differences in the total hours of work (including opportunities for rest breaks) b) Differences in the pattern of hours worked c) Differences in the educational opportunities and support available to the doctor, and/or d) Differences in the support available to the doctor during service commitments All exception reports should be logged to the WSH Administrator who will process and allocate the Exception Reports. The variation in day-to-day work could be for reason of individual, rota management, local department or Trust issues and the variation could involve either an increase or a decrease from the usual day-to-day work. Authors: HR & Communications Version: 1 Page 7 of 19

8 Apart from where there is no case to answer, exception reporting outcomes are anticipated to usually be one, or more, of the following: - Work schedule review - Financial payment in certain circumstances - Reduced payment in certain circumstances - Individual performance management - Work pattern review - Time off in lieu - Individual or collective training - Incident Investigation - Disciplinary proceedings - Organisational changes Exception Reporting Eligibility To be eligible an exception report must be: - An electronic submission to the WSH Administrator - Sent within 14 days of the exception or, - Sent within 7 days if it includes a claim for additional pay, or - Sent within 24 hours where there is an immediate safety concern. Additionally, this concern must have been raised immediately (orally) by the doctor with the clinician responsible for the service in which the risk is thought to be present (typically, this would be the head of service or the consultant on-call). In certain circumstances, the responsible clinician shall ask the doctor to raise the exception within 48 hours. - Further to efforts already undertaken locally to resolve the issue - Not the result of a doctor to doctor negotiated swap - Not related to locum work (locum work is excluded from all assessments and calculations as it is renumerated work that is agreed outwith the main contract of employment) Exception Reporting Process All exception reports must be submitted and managed through to outcome electronically via the designated software to safeguard that there is transparency and visibility of all exceptions and outcomes. Individual wards/areas may have specific arrangements in place regarding permission to work additional hours, and these will be outlined during Departmental Induction. Authors: HR & Communications Version: 1 Page 8 of 19

9 Upon receipt of the exception report Service Manger or ES will make a first assessment of the exception using the following indicators: - Immediate safety concern - Rule breach incurring a financial payment - Unplanned additional time worked to secure patient safety - Rule breach not incurring a financial payment - Variation to work schedule pattern without rule breach - Variation to work schedule education without rule breach See Appendix 2 & 3 for the exception reporting process flow charts 14. IMMEDIATE SAFETY CONCERNS (ISC) Where there is an immediate and substantive risk to the safety or patients or of the doctor making the report, this should be raised immediately (orally) by the doctor with the clinician responsible for the service in which the risk is thought to be present (typically, this would be the SM or the consultant on-call). See Appendix 4 for ISC process. The SM or clinician responsible for the service will assess and act on the risk according to its classification and respond (orally) as follows: a) Serious Concerns / Immediate Risk Where appropriate grant the doctor immediate time off and/or (depending on the nature of the variation) ensure the immediate provision of support to the doctor. This is likely to be necessary when the individual doctor has worked excessive hours without proper rest / breaks and their continued presence at work constitutes a real risk to the individual doctor(s) and / or patients. Request that the doctor submit an ER within 24 hours and mark it as an immediate safety concern. Notify the SM/ES and the GSWH of the issue/s within 24 hours b) Serious But Not Immediate Concerns This is likely to be necessary where there are frequent significant breaches of the working hours safeguards and / or a sustained inability for doctor(s) to attend training opportunities. Request the doctor to submit an ER within 24 hours. Notify the SM/ES and the GSWH of the issue/s within 24 hours. c) Significant But Not Serious Concern or Similar Persistent or Regular Concerns Being Raised Request the doctor to submit an exception report to the ES within 48 hours Notify the SM/ES and the GSWH of the issue/s within 48 hours. 15. ADDITIONAL TIME WORKED IN UNPLANNED EXCEPTIONAL CIRCUMSTANCES TO SECURE PATIENT SAFETY Authors: HR & Communications Version: 1 Page 9 of 19

10 In unplanned circumstances a doctor may consider that there is a professional duty to work beyond the hours described in the work schedule, in order to secure patient safety. In such circumstances compensation will usually be by payment, time off in lieu or a combination of these. Voluntarily offering time on a goodwill unpaid basis can continue by personal choice. General Rules for Compensation to a Doctor in Exceptional Circumstances - When a doctor finds they have to work additional hours, and it is not possible to discuss the current situation with a consultant, this discussion should take place at the earliest opportunity. This may or may not be prior to the submission of the exception but it is important that a Doctor feels able to discuss issues. - Upon receipt of the exception report the Doctor will be asked if they have discussed this with a consultant or if a consultant is aware of the issue (if the doctor has not stated this already). - an exception report should be submitted whether discussion has taken place or not. - Time in lieu should be the default option where the additional time worked constitutes a safe working issue. If the additional time worked causes a breach in rest requirements, then time off in lieu must be taken within 24 hours unless the doctor self declares fit for work and the manager agrees with this selfassessment in which case the time owed can be accrued to be taken at a later date. Time off in lieu arising from breaches of hours but not rest can be accrued - Accrued time off in lieu should normally be taken within three calendar months of accrual or by the end of the rotation (whichever is soonest) - Where time off in lieu cannot be taken, payment will be made - Where payment for additional time is while acting down, payment will be made at the doctors nodal point not that of grade into which they are acting down - It must be made clear by the doctor within the exception report if the consequence of agreeing to the additional time will be to trigger a financial penalty scenario for the department - Agreed payments for additional hours will be submitted to payroll on 4 th of each month. - Where a manager does not authorise payment the reason for the decision will be provided to the doctor and copied to the GSWH for review Calculation of Exceptional Circumstance Pay and Time in Lieu to the Doctor Payments will be made in accordance with Schedule 2, paragraph 4 of the TCS and the Pay and Conditions Circular (M&D) in force at the time the hours occurred. The calculation is that: - The additional hours will be paid at the basic rate 1/40 th of the weekly whole-time equivalent for each additional hour worked rounded up to the nearest quarter hour (applicable contractual hourly basic or enhanced rates) except where additional work takes place on a Saturday or Sunday where payment will be made at the applicable locum rate (basic or enhanced) Time in lieu will be compensated as a direct calculation of the additional hours worked. 16. FINANCIAL PAYMENTS Breaches Incurring a Financial Penalty There are four breach scenarios whereby a fine can be levied on the department employing the doctor when breaches have been validated. Authors: HR & Communications Version: 1 Page 10 of 19

11 The following three circumstances will result in a penalty rate payment to the doctor of the additional hours and the levy of a fine on the department employing the doctor for the additional hours worked: a breach of the 48-hour average working week (across the reference period agreed for that placement in the work schedule);or a breach of the maximum 72-hour limit in any seven days; or that the minimum 11 hours rest requirement between shifts has been reduced to fewer than eight hours (excluding on-call) The following circumstance will result in the levy of a fine on the department for the time in which the break was not taken. Breaks have been missed on at least 25% of occasions across a 4 week reference period See Appendix 1 for List of all Safe Working Rules General Rules for Financial Penalty Payments For transparency and audit in allocating public money the following will apply: - Exception reports which outline a breach with a potential financial payment will be submitted electronically within the agreed timescales with clear evidence supplied by the doctor to their Supervisor. The department subject to the potential fine will be given 7 working days opportunity to respond to the content of the exception report. After the Supervisor has made a decision, the GSWH will review the exception report, with its identified potential financial payment, and either corroborate or question the decision that a financial payment is or is not required. The GSWH will be the authoriser of financial penalty payments - Payments relating to a breach of the 48-hour average working week can only proceed after retrospective assessment to calculate the variance in average hours at the end of the reference period identified for that placement - The 48-hour average week reference period for any placement will be the length of the rota cycle or length of the placement whichever is the shorter. - Payments relating to a breach of the maximum 72-hour limit in any seven days will be assessed on the basis of a rolling 7 day period and the retrospective assessment to calculate the variance in hours - Payments relating to breaks missed on at least 25% of occasions will be assessed retrospectively on the basis of the submitted 4 week reference period and assessed in accordance with the classification of breaks in this policy - All submissions for financial payments will be expected to be accompanied by day by day evidence from the doctor (e.g. log book, e-roster, s) for the full period in question - Further evidence may be required from alternative sources available within the service e.g. admission data, logs of phone calls, to corroborate the evidence provided by the doctor. - Breaches of the 48-hour and 72-hour limits will constitute one single penalty payment breach in their respective placement period or 7 day period - Breaches of the 48-hour limit will be calculated inclusive of annual leave allowance (summing total hours of actual work excluding leave divided over the rota cycle minus leave weeks) - Breaches of the 72-hour limit will be calculated on actual work excluding leave allowance - The circumstances of breaches incurring a financial penalty may be deemed by the GSWH to warrant the trigger of a Trust serious incident investigation Authors: HR & Communications Version: 1 Page 11 of 19

12 - Claims that are found to be false or vexatious may result in disciplinary action - The GSWH will distribute the monies received from fines to improve training and service experience of doctors - A junior doctor forum will take part in the scrutiny of the distribution of income drawn from fines - The GSWH will report on both fines and penalty rate payments made to doctors as well as the distribution of the income from fines, to the Board no less than quarterly - The fines to the department will be invoiced by GSWH - The fine payments to the doctor will be raised for payroll payment by Medical Staffing - Breaches in the category which incur a financial penalty will satisfy the definition of significant and regular as individual single submissions - Locum work is excluded from calculations for financial penalty payments Calculation of Penalty Pay to the Doctor and Fines to the Department Excluding break breach fines, payments will be made in accordance with Schedule 2, paragraph 68 of the TCS and the Pay and Conditions Circular (M&D) in force at the time the breach occurred. The calculations are that: - the department will be fined at a rate of x4 of the hourly rate (applicable contractual hourly basic or enhanced rates) for the time in question - the doctor will receive x1.5 of the applicable locum rates (basic or enhanced) for the time in question - the balance of the x4 fine will be under GSWH jurisdiction to disburse Fines for missed breaks will be paid in accordance with Schedule 5, paragraph 12 of the TCS and the Pay and Conditions Circular (M&D) in force at the time the breach occurred. The calculation is that: - the department will be fined at the rate of twice the relevant hourly rate (applicable contractual hourly basic or enhanced rates) for the time in which the break was not taken Hours for payments will be rounded up to the nearest quarter hour. Authors: HR & Communications Version: 1 Page 12 of 19

13 Disbursement of Fines Money raised through fines is to be used to benefit the education, training and working environment of trainees. The GSWH is accountable to the junior doctor forum and the Board for the distribution of the income from fines. Funds must not be used to supplement the facilities, study leave, IT provision and other resources that are defined by HEE as fundamental requirements for doctors in training and which should be provided by the employer/host organisation as standard 17. BREACHES OF SAFE WORKING RULES NOT INCURRING A FINANCIAL PENALTY The following breaches of the contractual rules, when satisfactorily evidenced, will satisfy the definition of significant and regular as individual single submissions. Rule Max 13 hour shift length Max 5 consecutive long shifts, at least 48 hours rest following the fifth shift Max 4 consecutive long daytime/evening shifts, at least 48 hours rest following the fourth shift Max 4 consecutive night shifts. At least 46 hours rest following the third or fourth such shift Max 8 consecutive shifts (except on low intensity on-call rotas), at least 48 hours rest following the final shift Max frequency of 1 in 2 weekends can be worked Max frequency of 1 in 2 weekends can be worked (special extension for nodal point 2) OC - no consecutive on-call periods apart from Saturday and Sunday. No more than 3 on-call periods in 7 consecutive days OC - Day after an on-call period must not be rostered to exceed 10 hours OC - Expected rest while on-call is 8 hours per 24 hour period, of which at least 5 hours should be continuous between 22:00 and 07:00 OC - No doctor should be rostered oncall to cover the same shift as a doctor on the same rota is covering by working a shift Notes On-call periods can be up to 24 hours Long shift a shift rostered to last longer than 10 hours Long evening shift a long shift starting before 16:00 rostered to finish after 23:00 (a long shift starting after 16:00 will fall into the definition of a night shift) Night shift at least 3 hours of work in the period 23:00 to 06:00. Rest must be given at the conclusion of the final shift, which could be the third or fourth Low intensity on-call duty on a Saturday and Sunday where 3 hours, or less, work takes place on each day, and no more than 3 episodes of work each day. Up to 12 consecutive shifts can be worked in this scenario provided that no other rule is breached Weekend work any shifts/on-call duty periods where any work falls between Saturday and 23:59 Sunday For one placement at F2 (typically emergency medicine) the definition of weekend work is any shift rostered to start between 00:01 Saturday and 23:59 on a Sunday A maximum of 7 consecutive on-call periods can be agreed locally where safe to do so and no other safety rules would be breached; likely to be low intensity rotas only Where more than one on-call period is rostered consecutively (e.g. Sat/Sun), this rule applies to the day after the last on-call period If it is expected this will not be met, the day after must not exceed five hours. Doctor must inform employer where rest requirements not met, TOIL must be taken within 24 hours or the time will be paid Unless there is a clearly defined clinical reason agreed by the clinical director and the working pattern is agreed by both the GSWH and the director of medical education Authors: HR & Communications Version: 1 Page 13 of 19

14 Breaches of 11 hours rest between 11 hours and 8 hours will be classified as a breach of safe working rules not incurring a financial penalty. See Appendix 1 for List of all Safe Working Rules 18. BREAKS A doctor will receive at least one 30-minute paid break for a shift rostered to last more than five hours and a second 30-minute paid break for a shift rostered to last more than nine hours. Breaks can be taken flexibly during the shift, and should be evenly spaced where possible. These would normally be taken separately but may if necessary be combined into one longer break. Where the breaks are combined in to one break this must be taken as near as possible to the middle of the shift. No break should be taken within an hour of the shift commencing or held over to be taken at the end of the shift. Breaks will not be precluded by holding a bleep, attendance at teaching or being situated in theatre areas. Break Breaches on less than 25% of occasions in a 4 week period will be addressed as a variation from the work schedule rota / working pattern. 19. VARIATION FROM WORK SCHEDULE ROTA / WORKING PATTERN Where there are variations in day-to-day rota / working pattern that do not classify as immediate safety concerns, breaches incurring financial penalty, unplanned additional time to secure patient safety or breaches of the safe working rules but there is a variation from the rota / working pattern considered by the doctor to be a variation to the extent of occurring significantly and/or regularly, then an exception report may be submitted. Variations include both increases and decreases to the day-to-day rota / working pattern. Such exception reports will be considered on a case by case basis by the Service Manager however, they will be handled in the first instance with consideration of the regularity and significance of exception reporting from the doctors within the same work area. 20. VARIATION FROM WORK SCHEDULE EDUCATION OPPORTUNITY AND SUPPORT Where there are variations to the education and support in the work schedule which are considered by the doctor to be a variation to the extent of occurring significantly and/or regularly, then an exception report may be submitted. Such exception reports will be considered on a case by case basis by the ES however, they will be handled in the first instance with consideration of the regularity and significance of exception reporting from the doctors within the same work area. 21. HONORARY CONTRACT HOLDERS Doctors holding honorary contracts with the Trust will follow this policy where the duties are carried out for this Trust. The GSWH, as the host GSWH, will ensure that information is available to the GSWH at the lead employer as well as to the host board. 22. ASSURANCE The GSWH is responsible for providing assurance of the compliance to safe working hours by the employer and the doctor. General Rules on GSWH assurance Authors: HR & Communications Version: 1 Page 14 of 19

15 The GSWH will: - be a senior appointment not holding any other role within the management structure - receive copies of all exception reports in respect of safe working hours - escalate issues relating to working hours, raised in exception reports, to the relevant executive director, or equivalent, for decision and action, where these have not been addressed at departmental level and if it remains unresolved, submit an exceptional report to the next meeting of the Board - require intervention to mitigate any identified risk to doctor or patient safety in a timescale commensurate with the severity of the risk - require a work schedule review to be undertaken, where there are regular or persistent breaches in safe working hours, which have not been addressed - have the authority to intervene in any instance where the GSWH considers the safety of patients and/or doctors is compromised, or that issues are not being resolved satisfactorily - report to the Board no less than quarterly inclusive of data on rota gaps and provide the report to the Local Negotiating Committee (LNC) - inform the Board of post / placement issues that cannot be remedied locally for the Board to raise with partner organisations - with the DME, establish a Junior Doctors Forum Concerns regarding the GSWH The BMA or other recognised trade union, or the Junior Doctors Forum will raise and concerns regarding the GSWH with the Medical Director. If not properly addressed or resolved, concerns can be escalated to the senior independent director on the Board of Directors. Authors: HR & Communications Version: 1 Page 15 of 19

16 APPENDIX 1 SAFE WORKING RULES Source: NHS Employers Factsheet rota rules at a glance Rule Max 48 hour average working week Max 72 hours work in any 7 consecutive days Max 13 hour shift length Max 5 consecutive long shifts, at least 48 hours rest following the fifth shift Max 4 consecutive long daytime/evening shifts, at least 48 hours rest following the fourth shift Max 4 consecutive night shifts. At least 46 hours rest following the third or fourth such shift Max 8 consecutive shifts (except on low intensity on-call rotas), at least 48 hours rest following the final shift Max frequency of 1 in 2 weekends can be worked Max frequency of 1 in 2 weekends can be worked (special extension for nodal point 2) Normally at least 11 hours continuous rest between rostered shifts (separate on-call provisions below) 30 minute break for 5 hours work, a second 30 minute break for more than 9 hours OC - no consecutive on-call periods apart from Saturday and Sunday. No more than 3 on-call periods in 7 consecutive days OC - Day after an on-call period must not be rostered to exceed 10 hours OC - Expected rest while on-call is 8 hours per 24 hour period, of which at least 5 hours should be continuous between 22:00 and 07:00 OC - No doctor should be rostered oncall to cover the same shift as a doctor on the same rota is covering by working a shift Notes A GSWH fine will apply if this rule is breached A GSWH fine will apply if this rule is breached On-call periods can be up to 24 hours Long shift a shift rostered to last longer than 10 hours Long evening shift a long shift starting before 16:00 rostered to finish after 23:00 (a long shift starting after 16:00 will fall into the definition of a night shift) Night shift at least 3 hours of work in the period 23:00 to 06:00. Rest must be given at the conclusion of the final shift, which could be the third or fourth Low intensity on-call duty on a Saturday and Sunday where 3 hours, or less, work takes place on each day, and no more than 3 episodes of work each day. Up to 12 consecutive shifts can be worked in this scenario provided that no other rule is breached Weekend work any shifts/on-call duty periods where any work falls between Saturday and 23:59 Sunday For one placement at F2 (typically emergency medicine) the definition of weekend work is any shift rostered to start between 00:01 Saturday and 23:59 on a Sunday Breaches of rest subject to time off in lieu (TOIL) which must be given within 24 hours. In exceptional circumstances where rest reduced to fewer than 8 hours, time will be paid at a penalty rate & doctor not expected to work more than five hours the following day. A GSWH fine will apply in this circumstance. A GSWH fine will apply if breaks are missed on at least 25 per cent of occasions across a four week reference period. Breaks should be taken separately but if combined must be taken as near as possible to the middle of the shift. A maximum of 7 consecutive on-call periods can be agreed locally where safe to do so and no other safety rules would be breached; likely to be low intensity rotas only Where more than one on-call period is rostered consecutively (e.g. Sat/Sun), this rule applies to the day after the last on-call period If it is expected this will not be met, the day after must not exceed five hours. Doctor must inform employer where rest requirements not met, TOIL must be taken within 24 hours or the time will be paid Unless there is a clearly defined clinical reason agreed by the clinical director and the working pattern is agreed by both the GSWH and the director of medical education Authors: HR & Communications Version: 1 Page 16 of 19

17 APPENDIX 2: EXECPTION REPORTING PROCESS ADDITIONAL HRS/BREAKS/PATTERN Doctor raises an exception report if their work hours vary significantly or regularly from the agreed work schedule or does not receive appropriate rest or breaks in accordance with Schedule 3 of TCS or works beyond the hours described in the work schedule in order to secure patient safety or well being. See General Notes for further guidance. Doctor submits exception report electronically via Allocate as soon as possible after the exception takes place and within 7 days if making a claim for additional pay & TOIL and 14 days in all cases. Exception Reports must be logged to WSH Administrator Exception reports should include: a. the name, specialty and grade of the doctor concerned b. the dates, times and durations of exceptions c. the nature of the variance from the work schedule (ie usual duty times v- actual times) d. an outline of the steps the doctor has taken to resolve matters before escalation (if any) e. name of the consultant discussion took place with (where applicable see General Notes) f. if the doctor would prefer TOIL or payment as compensation g. if the doctor believes additional hours works constitutes a breach under 48/72hrs work Administrator logs report to CS/ES once completed If Doctor disagrees to initial review, CS/ES: Level 1 Review meeting is held with Dr/SM & Supervisor SM & ES/CS will consider if issue is a one off or pattern. If pattern: Work Schedule Review Meeting to be held Administrator (Med Staffing) will liaise with relevant Ward Manager & Doctor to confirm additional hours worked Administrator (Med Staffing) will liaise with relevant Service Manager for final authorisation for payment or TOIL Outcome reported to GSW & ES General Notes: Junior doctors should discuss the situation with their consultant at the earliest opportunity. This discussion or planned discussion should be noted within the exception report. Doctors should ensure the exception report clearly shows the additional hours worked (not the whole shift worked) Doctors must say if they prefer payment or TOIL as compensation. TOIL should be the default option where the additional time worked constitutes a safe working issue. If the additional time worked causes a breach in rest requirements, TOIL must be taken within 24 hours. Authors: HR & Communications Version: 1 Page 17 of 19

18 APPENDIX 3: EXECPTION REPORTING PROCESS EDUCATION OPPORTUNITIES AND/OR SUPPORT AVAILABLE Doctor raises an exception report if their education/training opportunities and/or support available is being raised as an issue. Doctor submits exception report electronically via Allocate as soon as possible after the exception takes place and within 14 days in all cases. Exception Reports must be logged to WSH Administrator Exception reports should include: a. the name, specialty and grade of the doctor concerned b. the dates, times and durations of exceptions c. the nature of the variance from the work schedule d. an outline of the steps the doctor has taken to resolve matters before escalation (if any) WSH Administrator Copied to DME Educational Supervisor will liaise with relevant Service Manager & trainee if required Doctor notified of outcome Outcome reported to GSW/DME/Admin Authors: HR & Communications Version: 1 Page 18 of 19

19 APPENDIX 4: IMMEDIATE SAFETY CONCERNS PROCESS Where there is an immediate and substantive risk to the safety or patients, or of the doctor making the report, this should be raised immediately as follows: (orally) by the doctor with the clinician responsible for the service in which the risk is thought to be present (typically, this would be the SM or the consultant on-call) immediately. Log an Exception Report (within 24 hours) Complete a datix SM/Clinician should respond as follow: a) Serious Concern/Immediate risk Where appropriate grant the doctor immediate time off and/or (depending on the nature of the variation) ensure the immediate provision of support to the doctor. This is likely to be necessary when the individual doctor has worked excessive hours without proper rest / breaks and their continued presence at work constitutes a real risk to the individual doctor(s) and / or patients. Request that the doctor submit an ER within 24 hours and mark it as an immediate safety concern. Notify the SM/ES and the GSWH of the issue/s within 24 hours b) Serious But Not Immediate Concerns This is likely to be necessary where there are frequent significant breaches of the working hours safeguards and / or a sustained inability for doctor(s) to attend training opportunities. Request that the doctor submit an ER within 24 hours Notify the SM/ES and the GSWH of the issue/s within 24 hours c) Significant but not Serious Concern or Similar Persistent or Regular Concerns being Raised Request the doctor to submit an exception report to the ES within 48 hours Notify the SM/ES and the GSWH of the issue/s within 48 hours. SM/Educational Supervisor will liaise with relevant clinicians & trainee if required Doctor notified of outcome Outcome reported to GSW/DME/Admin Authors: HR & Communications Version: 1 Page 19 of 19