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I get home frustrated and fed up; another day of discharge paperwork, high-speed admission clerking, and knowing I haven’t learned anything.
I’m shattered, and I’ve got 11 hours until I’m back in. In that time, I need to eat, sleep, shower, drive to work, and finish that quality-improvement project ... sound familiar?
All too often our training posts are actually all-service provision; it’s demoralising, it knocks our confidence, reduces motivation and affects patient care. The pressures on the NHS are only making it worse, but there is hope. Most of us are on the new 2016 contract, which states: ‘Work schedules should be designed to meet the service-delivery needs of the organisation and the education and training needs of the doctor.’
There is more: ’The generic work schedule will list and identify the intended learning outcomes (mapped to the educational curriculum), the scheduled duties of the doctor, time for quality improvement and patient safety activities, periods of formal study (other than study leave), and the number and distribution of hours for which the doctor is contracted.’ This means that your work schedules should outline allocated time for training aspects of your role before you even start in post.
I know what you’re thinking, ‘that’s great but it’s not happening’. But did you know that trainees are already successfully exception reporting their time spent doing mandatory e-learning, and either getting that time back, or being paid for it? What’s more, GP work schedules already include four hours per week of ‘independent study and revision’, as described on the NHS Employers’ website. The Royal College of GPs was integral in producing the example work schedules that outline this time for training. We’re working with the other medical royal colleges to produce similar examples and encourage you to contact your college reps to tell them what you want to see included. This will vary for everyone; surgical trainees may need dedicated time in theatre, whereas foundation trainees may want an emphasis on portfolio and quality-improvement projects.
This clear guidance is great for GPs but should be there for all trainees. That’s why the BMA has worked with NHS Employers to produce joint rostering guidance to ensure that trainees have access to time for education and training planned into their rosters. It’s simple. Doctors in training are expected to train and develop; they are not there as pure service provision. This is explicitly clear in the contract and further guidance is provided via the curriculum and ARCP (Annual Review of Competence Progression) requirements. Meeting these criteria is an expectation of every doctor in training. The new joint rostering guidance makes it clear that training equals work, and when designing rosters:
Professional development is afforded real significance under this guidance. We are no longer expected to press on and be grateful for our protected teaching time. The guidance stipulates that provision should be made for: time with your supervisors; time for quality improvement and patient safety activities; periods of formal study (other than study leave); and audit and e-portfolio activities. Where rosters don’t meet these requirements, they would need to be redesigned. This process is triggered by requesting a work-schedule review or exception reporting.
Training is work, and this guidance recognises that principle; training needs are to be incorporated from the outset, not squeezed in as an afterthought. These rosters will become ‘live’, meaning it’s not fixed in stone; problems can be identified early on and where training needs are not met, intervention can be taken to ensure doctors are facilitated to meet their training requirements.
Here’s where you have power:
Change takes time and there’s always resistance at first. Experiences vary dramatically between trusts and departments. If you speak with your colleagues and all agree to exception report, it’s much more difficult to ignore.
So yes, there’s hope, but we need to use it. We need to be brave and use the mechanisms afforded to us rather than shy away because ‘it’s not the done thing’ or ‘I don’t want to be a troublemaker’. Together we’re strong; if we all do this, it will work.
Jennifer Barclay is an F2 doctor in the north-west of England and is a member of JDC
Find out more about our new joint rostering guidance here.
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