Resident on call
The 2004 Scottish consultant terms and conditions of service (para 4.9.1) clearly state that consultants will not, save in exceptional circumstances, undertake resident on call. There is however no definition of ’exceptional circumstances’ . Resident on-call by consultants is a wasteful way of providing cover and questions should be raised as to whether this is an acceptable way of covering the service.
There is no contractual obligation for consultants to undertake resident on call work and no national agreement on the rate payable. Instead, the terms and conditions of service stipulate that employers will negotiate resident on call arrangements with the BMA’s Local Negotiating Committees. LNCs will have reached a local agreement with the Board on the arrangements that will apply to consultant resident on call, including remuneration, accommodation and catering. The BMA Scottish consultants committee believes that pay for resident on call should be substantially higher than standard or premium time rates.
Consultant out of hours working
At the time of the introduction of the 2004 contract, for most consultants being ‘on call’ tended to mean just that. They would do their routine day’s work, followed by an on call period when they might provide some telephone advice and support, or in some circumstances be recalled to the hospital. Although there were exceptions, most consultants would have expected to achieve enough rest when on call to be perfectly safe to work the next day.
For some consultants in some specialties, ‘on call’ remains an appropriate way to describe a safe and sustainable working pattern. For many consultants some elements of out of hours working have changed over the years to a situation perhaps better described as ‘on site out of hours emergency working’ (understanding that emergency encompasses both emergency and urgent care).
This has been driven by a number of factors: fewer trainees; increasing patient numbers and complexity; higher patient expectations. Where this has occurred, there are some areas and some rotas where there has been a necessary change to working patterns to accommodate this. However many consultants are still working an ‘on call’ pattern, with an ‘on site’ workload.
Ensuring safe out of hours working
There are a range of consultant working patterns across different healthcare settings in Scotland. Consultants locally are best placed to determine what constitutes safe working in their particular context. However the practicalities of providing safe consultant working patterns may mean some consultants spending an increased proportion of their time working on-site out of hours.
It should also be remembered when considering resident on-call or any out of hours work that consultants are covered by the Working Time Regulations (WTR), which came into force in 1998 and are aimed at protecting employees from working excessive hours. However, the WTR came in at a time when for most consultants, ‘on call’ still meant just that, and the BMA reached an agreement with the UK Government that most of the WTR provisions around minimum rest periods would not apply to consultants via a derogation to the regulations, with provision instead for ‘compensatory rest’.
At the time, this was a reasonable approach to avoid patient care being disrupted unnecessarily; however changing consultant working patterns mean that compensatory rest may now be required to a much greater extent than previously, and also has to be factored into job planning. This makes it important to ensure that safe out of hours working is built into consultant rotas and job plans.
Ensuring safe consultant working patterns in Scotland
Guidance for consultants in Scotland under pressure