COVID-19 presents the NHS with unprecedented challenges. In the coming weeks and months it is likely to bring significant disruption to your normal working patterns, your working conditions and even to your teams, your roles and the settings in which you work.
BMA Cymru Wales has agreed a joint statement with NHS Wales Employers and Welsh Government on the application of the 2002 terms and conditions of service for junior doctors during COVID-19.
With one or two exceptions, the BMA has not allowed any changes to your terms and conditions of service. Instead, we have worked with stakeholders to come up with solutions that protect your safety, wellbeing and pay whilst ensuring the effective running of the NHS in Wales.
This guidance relates solely to working during the response to COVID-19. Rotation freezes and temporary rotas must remain under constant review to ensure that they remain both proportionate to demand and sustainable for doctors.
Your health and wellbeing
Health boards are looking at every option to maximise their clinical capacity, so your rota is likely to be temporarily reconfigured and you may be redeployed to a different department or team.
All emergency rotas should:
- adhere to contractual and WTR (Working Time Regulations) limits as detailed below
- include sufficient rest to ensure both patient safety and your own health and wellbeing, not just over the next few weeks but potentially for the next few months
- incorporate a degree of flexibility to ensure that unexpected absences can be covered
- be compliant with any reasonable adjustments that you have already agreed with occupational health.
If you have difficulty working your new temporary rota due to caring responsibilities, disability, or another reason, you need to raise this with your employer. If you are unable to agree an acceptable resolution, please contact the BMA as we may be able to help.
We have a range of services to support you.
- Peer support
- UK wellbeing support directory
Call our free and confidential helpline on 0330 123 1245
Hours limits and rest
Whilst you may feel compelled to work more hours during this time, it is important that any temporary rotas adhere to current contractual provisions and WTR (Working Time Regulations) to ensure your own safety as well as the safety of patients.
The WTR set a maximum 48 hour week, averaged over an agreed reference period. This means that some weeks you can work more than 48 hours, so long as the average remains no more than 48 hours.
Opting out of the WTR
You can choose to opt out of the WTR weekly hours limit, enabling you to work up to an average of 56 hours, but you are under no obligation to do this.
If you do sign an opt-out, you can rescind it at any time. The WTR also require a minimum 11 hours rest between each shift and other restrictions on working time. There is no opt-out from these restrictions.
It is important that you have time to rest during your shifts. Your terms and conditions of service stipulate you must be allowed a 30 minute break after approximately four hours of continuous duty. Full details of hours limits and compensatory rest can be found in the junior doctor handbook.
Under normal circumstances, rota monitoring would ensure that your actual working hours are accurately reflected in your rota, contractual provisions regarding shift length and frequency are being fulfilled and you are being paid appropriately.
NHS Wales Employers has taken the decision to temporarily suspend rota monitoring in the current climate.
What you need to do
In the absence of monitoring, we advise you to check that your employer has run any redesigned rota through the compliance software Allocate. This will highlight any breaches of the hours and rest rules in the new rota and will calculate the appropriate banding supplement that you should receive.
All new rotas should be correctly banded and paid accordingly. Other arrangements where compensatory time off in lieu in the future is promised or other informal solutions are not acceptable.
When your rota is changed, this may or may not result in a change to your banding and an increase in pay.
In the unlikely event that your temporary rota is banded lower than your current rota you should continue to receive the banding supplement that previously applied (ie pay protection).
Welsh Government have confirmed that:
- all NHS staff should be paid at the appropriate rate for any hours worked during the emergency
- all emergency rotas should be correctly banded and paid accordingly
- any extra hours worked over the rota should be paid at an appropriate additional rate as detailed below.
If you have any reason to believe that your new temporary rota is not compliant with the banding stipulated, please contact the BMA and our employment advisers will take this up on your behalf.
If your actual working hours do not reflect your temporary rota then you should claim for any additional hours through the system set up by your health board.
These hours should be paid at locum rates.
You should only agree to work additional hours that allow you to get enough rest to ensure both patient safety and your own health and wellbeing and are compliant with the WTR.
What you need to do
If you are asked to alter your rota duties at short notice, it can be difficult to calculate what you should claim. We strongly recommend that you agree in advance the rates for any additional work beyond your regular working pattern.
If you have any difficulty in being paid appropriately for additional work please contact us for advice.
Some health boards are seeking to develop and implement ‘shadow’, ‘float’ or ‘ghost’ rotas, where doctors must be available for periods with the potential to be called upon at short notice to perform a full shift.
These shifts must be clearly outlined in your rota and you should receive at least 24 hours notice that you will be required to work the shift.
It should be paid at a locum rate if you work the shift. It is not acceptable to be expected to be ‘on call’ at home to come in at short notice.
If 24 hours’ notice is not given, you are under no obligation to take up the shift and instead it should be offered out to others according to local arrangements for short notice sickness cover.
Such shifts should be shared across the rota and should be counted in calculations for WTR limits.
Taking annual leave is important for your wellbeing, especially at a time like this.
Your employer should not cancel annual leave bookings that you made before the introduction of an emergency rota.
If you wish to, you may cancel existing bookings for annual leave - however, you should be under no pressure to do so.
You should still be able to book annual leave during the pandemic.
Where it is not possible to take annual leave (including public holidays) before the end of a rotation due to service demands, this may be carried over in line with the NHS Wales COVID-19 FAQs for NHS managers and employers.
Welsh Government and NHS Wales Employers have committed to further discussions with the BMA on annual leave issues.
Less than full-time
When an emergency rota is introduced, if you are working LTFT (less than full-time), your LTFT status must be protected.
You may voluntarily agree to increase your usual LTFT percentage temporarily or pick up additional shifts on an ad-hoc basis, paid according to the same additional hours system as those working full time.
Consideration will need to be given as to how working hours can be distributed depending on personal circumstances or requirements.
If you are able to offer additional hours by increasing your proportion of full-time equivalent, this should be reflected in a new rota with revised pay. For advice on impacts on your pay, please contact us.
Any decision by a LTFT trainee to offer to work additional hours must not prejudice your current situation or any application you make to work LTFT in the future.
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