Managing rotas and duty rosters for junior doctors in England

Work schedule review process

Location: England
Audience: Junior doctors
Updated: Tuesday 8 February 2022
Topics: Working hours

Doctors should be encouraged to activate the work schedule review process if there are any concerns with a new roster, as per Schedule 5 of the 2016 Terms and Conditions of Service (TCS) but should be aware of the following from the good rostering guide.

Indicators that redesign might be required:

  • if the average number of hours per week required of doctors is close to, or above, the 48-hour average limit
  • if doctors are unable to access the necessary training and educational opportunities to meet their curriculum requirements
    a high number of exception reports being submitted by doctors, especially if these reports are not attributable to a singular, non-recurrent, event (ie an unforeseen emergency)
  • if numerous exception reports are being submitted, resulting in fines for the employer requests for work schedule reviews are being submitted by doctors working under the rota with outcomes that affect the roster
  • if the guardian has directly raised concerns regarding the viability of a rota and/or roster
    the shift pattern is close to breaching the hours and rest requirements of doctors
    when there are breaches of the minimum rest requirements for non- resident on-call shifts
  • if there is insufficient flexibility within a roster around when doctors can take their leave
  • if there is insufficient capacity required to accommodate full leave entitlement, training needs and likely rates of short-term sickness absence for the rota to operate effectively
  • if doctors on the roster are due to go on maternity/ paternity/ adoption leave this may not be required, dependent on: the length of the roster, where in the roster the absence is occurring, and the overall gap that the absence leaves
  • if there are significant changes in demand on the service, which require a different level of staffing
  • if there are changes to the service, which significantly affect how the service can be rostered (ie closed theatres).

Individual changes

  • Roster managers should ensure rosters are continuously updated to provide the most accurate and up-to-date picture of the staffing arrangement. Therefore, rosters should be updated continually to reflect any changes such as approved leave, shift swaps, sickness, end and start time changes, and gaps requiring temporary staffing.
  • Doctors should aim to provide as much notice as possible to the roster manager when arranging swaps, and the roster manager should be flexible, where possible, in regard to shift swaps.
  • Doctors and roster managers must ensure that shift swaps are between two doctors of commensurate grade.
  • The roster manager must ensure that a doctor’s requested swap does not result in them breaching any of the contractual hours or safety limits. (Rosters that do not provide enough flexibility for swaps without breaches of safety limits should be reviewed to ensure adequate numbers of doctors present on the rota.)
  • When changes need to be made to a live roster, which will have an impact on other doctors on the roster, the optimal approach will be to openly consult those doctors to see if anyone will volunteer themselves for their personal roster to be amended. If changes are made, every effort should be taken to avoid affecting any previously arranged leave or training.
  • A doctor will be prepared to perform duties in occasional emergencies and unforeseen circumstances, if they are able and safe to do so, such as short-term sickness cover, where the employer has had less than 48 hours’ notice, and for less than 48 hours’ duration of cover.
  • There is no requirement to payback shifts missed due to sick leave.

Wholesale changes

  • There should be a minimum of six weeks’ notice, in accordance with the code of practice, for any implementation of a new roster or changes affecting existing doctors on the rota.
  • When wholesale changes are required to a roster, doctors’ training requirements and individual circumstances should be given due consideration in the design of the new roster.
  • All training requirements should be incorporated and prioritised when designing the new roster, to ensure doctors are given the opportunity to progress at the Annual Review of Competence Progression (ARCP).
    Doctors should be encouraged to activate the work schedule review process if there are any concerns with a new roster, as per Schedule 5 of the 2016 Terms and Conditions of Service (TCS).