Ahead of winter and the very real pressures we know that will bring to the NHS, the Junior Doctors' Committee has shared with Health Education England our concerns about the movement of junior doctors between hospitals in a Trust and across departments within a hospital.
Whilst we would always respond to exceptional crises, we must ensure protections are in place for trainees and to safeguard patient care. We have agreed a statement (below) with the Academy Trainee Doctors' Group, setting out our concerns and the criteria that must be in place before any movement takes place. The HEE has responded positively and adapted their guidance.
As representatives of junior doctors across a range of organisations, we, the BMA Junior Doctors Committee and the Academy Trainee Doctors' Group, are deeply concerned about the effect of increasing pressures on our health service, and the inevitable impact this is having on doctors training in the UK and the patients we care for.
The pressures in the NHS have been growing year on year. The crisis is no longer confined to winter, with figures from the BMA showing that the summer of 2018 was as bad as previous winters, leaving little capacity to deal with the inevitable surge in the coming months.
Throughout the year patients miss out on the high-quality care they deserve, and trainees routinely bear the brunt of staffing shortages, made worse by poor workforce planning and employment practices.
Junior doctors missing specialty training
When long-term planning fails, attempts at short-term fixes appear, however these fixes must not exacerbate the problems they are trying to solve.
Increasingly, junior doctors are being moved from their approved speciality training jobs into service delivery roles to ease winter pressures. Yet moving trainees from a known training environment to deliver service elsewhere risks crucial training being missed or delayed, and widening gaps in the future senior workforce.
Without suitable safeguards in place, patients may be at risk – both those being treated by doctors working in unfamiliar settings and specialities, and those denied continuity of care because the junior doctor has been moved away. Additionally, junior doctors frequently tell us that an increasing lack of control over their working and training life is demoralising, and is driving them to leave the profession in the UK. Trainees must not be treated as a faceless resource to be moved on a whim when longer term planning fails.
Processes to prevent doctors being moved
The protection of quality training for junior doctors must remain a priority if we are to ensure a safe, high quality health service that meets the needs of patients.
All alternative options must be fully considered and implemented before junior doctors are moved. If they are moved, it must be:
- Only when a Trust is working at Operational Pressures Escalation Level 4 (OPEL4) – when it would otherwise be unable to deliver comprehensive care
- Where there is increased potential for patient care and safety to be compromised
- Where decisive action to recover capacity and ensure patient safety is needed
- For the shortest time possible
Trust responsibilities when moving doctors
Movement of trainees to meet service pressures must be recorded and data must be shared with training, representative, and regulatory bodies including HEE, the GMC, ATDG, the CQC, and the BMA.
Any decision to move junior doctors must be fully transparent and open to scrutiny. While we will always assist in emergencies and unpredictable crises, such moves should not be seen as an easy fix to plug gaps caused by long-term underfunding and poor planning.
Junior doctor training environments can be extremely demanding. As such, trusts must recognise that moving doctors out of their expected area of training will exacerbate existing workplace stress and anxiety levels, which have consistently been highlighted as reasons for poor wellbeing and staff retention.
Process to move a doctor
If junior doctors are asked to move or cover different areas:
- It must be only with the agreement of the junior doctor, their educational supervisor, the Guardian of Safe Working, DME (Director of Medical Education), FSD (Foundation School Director) or College Tutor, and PGD (Postgraduate Dean)
- They must not be asked to provide care they feel is outside their competence
- A thorough induction to any new working environment and systems must take place, and doctors must have the same access to clinical systems and information as staff based in the area
- The identity and location of their supervisor must be clear at all times. If junior doctors do not feel this is clear or appropriate, this must be raised as a patient safety issue immediately, the PGD must be informed and they should file an exception report or equivalent to this effect
- The DME and TPD/FPD must be made aware of any missed training, either through exception reports or similar systems, and there must be a clear plan to deliver this training at an alternative time
- Any training environment operating on this basis must be subject to review to ensure facilities, education provision and employment practices are suitable for the continued training of junior doctors, and safe treatment of patients
As the NHS braces itself for another winter for which it is underprepared, it is vital that we start to see long-term sustainable workforce and funding solutions.
Dr Jeeves Wijesuriya
Chair, BMA UK Junior Doctors Committee
Dr Alice Wort
Chair, Academy Trainee Doctors' Group