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So, a year has gone by since my appointment as flexible working champion at Barts Health. I wasn’t completely sure what I was taking on at the time and NHS Employers’ guidance regarding the role was helpful but not particularly specific.
I was asked to write a report for the trust education board in May reflecting on my achievements after a year. When I was first asked I honestly thought – what on earth have I managed to do here? However, when I started to think about it, I began to reflect on all I have done, and what I hope to do.
I have made progress in a number of key areas. Firstly, obtaining the names of LTFT (less-than-full-time) trainees. Not that easy. The data provided by HEE (Health Education England) is often incomplete and inaccurate. And in fact, I have now ditched using HEE as a source and reverted to that old favourite – a tick-box column in the sign-in sheet at Induction.
Next: visibility for me and my role. I attend monthly medical staff inductions. I think this is probably the most important thing I do - people seem to have found my story genuinely inspiring, illustrating how fundamental it is to have a LTFT consultant in this role. I then subsequently email all LTFT trainees to introduce myself.
I have also developed an online survey which I send out to LTFT trainees to collect information on their experience within a few months in post. I ask for names of their educational and clinical supervisors. I then email the supervisors with the link to HEE online training on supervision of LTFT trainees . I have finally managed to get a presence on the trust intranet and a repository of information there on ‘flexible working for medical staff’. I am developing a trust-wide presence – I attend medical education committee meetings and junior doctors’ forums and it feels like people are getting to know I am.
Next: Actually providing support; I answer email enquiries, in as timely a fashion as possible. Tricky as often the question I am asked I don’t know the answer to, requiring me to go and find out. Such as ‘as I am doing 60per cent of on-calls, do I therefore get 60per cent of zero days?’ Interestingly, at the beginning, I had very few emails. This is gradually changing. I find that I seem to be most useful as a signpost – directing trainees on the right person to sort out their work schedule or where to find the policy on paternity leave.
Finally, I have also been given the opportunity to develop a national voice – I have recently been appointed as a joint deputy director of the Royal College of Physicians Medical Workforce Unit (on a voluntary basis of course). In this capacity I have been able to write the questions for the next survey of new consultants (due out this month). Expect lots on LTFT working.
Big problems/challenges? It’s not all been a smooth ride. Getting details of LTFT trainees from HEE has been difficult. We urgently need HEE to address the delay in informing hospitals about trainees. This is particularly important for those who work LTFT as their work schedules need to be individually agreed with departments and checked by HR – something that should have been done BEFORE the trainee arrives for work.
So what are my plans for the next year? I want to visit departments with lots of LTFT trainees to see examples of good practice and also to discuss the problems they face and how they resolve them. This can then be used to help departments less used to LTFT trainees.
I want to develop a trust-wide mentoring network for LTFT trainees. But crucially, I plan to engage with senior management at the Trust – we need to see consultants changing practice in their departments to ensure LTFT working at a consultant level is equitable for our current LTFT trainees. For example, why shouldn’t LTFT consultants participate in the care of inpatients? LTFT working at a consultant level has always been there – it is called private practice. Let’s have some honest discussions regarding how best we can serve our patients. Being LTFT does not preclude excellent clinical practice.
My final thought is this. I have been able to attack this role in the way I have because Barts Health have recognised its importance and provided me with 1 PA of funding to do the job. In fact, they have now also increased this to 2 PAs for 6 months to cover the national reach that my role is taking. If we as a medical profession are going to do more than just pay lip service to the ideal of ‘creating a culture change in the NHS and championing flexible working more broadly, including beyond doctors in training’ (HEE ‘Enhancing junior doctors’ working lives’ A Progress Report 2017), adequate resource has got to be provided.
Rifca Le Dieu is a clinical senior lecturer and honorary consultant in haemato-oncology at Barts Health NHS Trust
Read the good practice guidance for flexible training champions, developed by NHS Employers in consultation with the BMA.