AIBU - Junior Doctor Rotas

[Allofme1]

Just wondering about how a Doctor's rota works in the NHS ?

I've heard of people asking for annual leave 9 weeks in advance and been given on-calls. How does that work?

Anybody work in the HR department care to shed some light on why rotas are late(supposed to be 6 weeks in advance)?
Why they don't give time for teaching in training posts ?
Does the person doing the rota acknowledge and understand the job descriptions of those he or she is putting on the rota?

It's probably some under trained, low paid administrator doing it. I expect when that admin person is off on leave or sick no one covers the role. Just a hunch.

I doubt it would be the HR department doing the rotas. Surely it is not the admins fault that there are just not enough doctors to go around. Or nurses, paramedics, or any other HCP.

Usually one of the consultants secretaries.

HR don't generally do junior doctor rotas. In big teams there is a separate rota co-ordinator, in smaller teams it might be a consultant secretary. There is usually a consultant who has oversight of the rota as part of their job planned admin time.
Usual rule is 6 weeks' notice is required for annual leave, but a lot of doctors don't stick to that so last minute changes and swaps are very common. Also almost every single medical rota in this country will have gaps - so staff will be asked to cover extras.
"time for teaching in training posts" means lots of different things - some teaching sessions will be fixed rota duties, but if ward cover is needed during that time and there's a gap, then someone will be asked to cover it.
The facts are - from my fairly wide experience as an NHS manager - there are not enough doctors. There are some amazing rota co-ordinators and some terrible ones. Some awful practice and some amazing practive.

It is done by different people in different departments. Could be an administrator, consultants secretary, a registrar or I've even seen the consultant do it. Generally I found the rota was done late - for some of these people they had more pressing priorities, some were a bit useless and just did it late. In a large department with multiple shift patterns it can be complicated.

I even saw one job where the rota wasn't done until a month after the junior doctors started. For the first four weeks, each week the consultant would assign people for nights, weekend and other shifts for that week only and say the rota would definitely be done by the next week.... but it wasn't, and each week it got more complicated to try and make it fair with all the random shifts done already. It was a nightmare as by the time the rota was finally done they couldn't make it fair between the different doctors eg some ended up doing more hours than others and they couldn't equalize it.

Junior doctors often rotate every 3-6 months, so they are frequently moving into a new department where nobody knows them. So it's even hard to figure out who to submit leave requests to in advance, and you can just get a response that the rota isn't done yet so you can't submit any leave requests, hard for something booked far in advance like your own wedding!

And if the department won't give you the leave you need there is little the junior doctor can do really. If they refuse to work they will be told they are letting down their colleagues and risking patient safety. Some Consultants will be understanding, others won't, or can't if the department is really overstretched.

Why are you so interested?

Why they don't give time for teaching in training posts ?

Generally because there is too much 'service delivery' work for the number of doctors available.

Adam Kay's book goes into a lot of detail. Seems to vary a lot locally, and seniors get better days time off.

Depends on where you are. A hospital?

I do the rota for the GP registrars where I work. They are only allowed to work 40 hours per week which is 7 sessions and 3 teaching sessions (one is by the lead employer for all registrars on the same day). We are bound by the lead employer to evidence that this is their work schedule and there is an entire HR department for the registrar.

When I worked in psychiatry there was a separate arm of an HR department who coordinated all of the registrar shifts and teaching sessions etc. On each rotation this is probably different but there is usually someone dedicated to doing this job

Rotas are the worst job, trust me. You have to coordinate so many different elements and people are often very unhappy about their shifts, sickness, leave, supervision needs to be incorporated and trying to meet safe staffing numbers

If you are a reg then talk to the lead employer and the hosting department if you are annoyed about your rota

IME ‘teaching session’ (not where I work but elsewhere) is often fobbed off either just shadowing another doctor and watching what they do
Also just giving extra self study time to meet the quota

As per pps.

But also - on calls are part of the job. Study leave will be given in line with the contract. Service cover will be the priority - once allocated I have always taken the view (as a manager) that it’s your responsibility to arrange cover if you want leave that falls during a period where you’re on call etc. There’s usually a set shift pattern.

So I manage the medicine dept in a small DGH. And have managed several other specialties in my time. Junior doctor Rotas are complex for a number of reasons like a few previous posters have said. The reasons include but aren't limited to: last minute changes of individuals rotating into that hospital/specialty and their needs (ie expecting someone full time, then finding out when you've done the rota that they are part time and have to have a Wednesday off), getting people assigned to your hospital that then go on maternity leave (and no the receiving hospital isn't always made aware by the deanery - the school which sends the junior doctors), ditto for sickness, paternity leave, special leave granted but not shared. Occupational health reasons: ie some pregnant doctors are taken off the on-calls to help them.
And yes a great many gaps, so you do what you can with what you get whilst ensuring their rotas are European working time directive compliant as well as "junior doctor rota" compliant.
Not on call requests are usually sent out 8 weeks before they start that rotation, with a 2 week deadline to get the rotas written and sent out with 6 weeks notice. Some people just don't respond. Honestly it's worrying sometimes that these adults are doctors and have to have their hands held.

In my experience (4 trusts) there's always been a consultant or a dedicated skilled rota coordinator who write the rotas. Some times a senior trainee writes them. They absolutely know the job descriptions, what an absurd thing to presume that they don't, or that they dont get what they're responsible for.

It's very hard to give everyone their requested annual leave and study leave and fit in their allocation of long days/nights which the adequate rest periods. Sometimes the RCs get an easy group. Sometimes not. They work very hard and have a lot of stress put on them due to the amount of changes and having to go out to agency staff constantly due to gaps.

I know I couldn't do my job if it weren't for the rota coordinators. Unsung heroes of the NHS.

Why do you ask?

Also they do get allocated teaching time, usually once a week for a formal class or lecture. The rest of the time they are working, they are learning.

Yeah, where I work the issue is that the registrar has to follow the supervisor and work along side their sessions, but that teaching doctor only works part time so I have to cobble someone else to supervise on the other days. I also lose a lot of clinical time out of the day as I have to lose time to the supervision, admin time etc

Not a doctor but work in a hospital. The dept I work in one of the junior doctors (SHO) does the rota. I’ve certainly known of people struggle to get time off for honeymoon, their own wedding, siblings weddings, etc. Often relying on colleagues to cover for them.

As a junior doctor myself I can confirm it’s pretty shit. Rotas are often done by an administrator and often for the most junior doctors this is someone in medical staffing which is essentially the HR dept for doctors. As you move up it tends to be department specific, a business manager or even fellow doctor. Our latest contract deal states rotas should be published with minimum six weeks notice and that leave should be granted for life changing events-usually interpreted as your own wedding or similar. Often the problem arises in the fact that the rota isn’t made until six weeks before-most of us planning holidays or weddings etc would like to make firm arrangements well before then. You do your best to request the leave months or even a year in advance...however it almost seems inevitable that this is ignored or forgotten and you are on call when the rota is published. Their are countless stories of doctors being rota’d on call for their own wedding and once a rota is published we tend to be told it’s our responsibility to arrange swaps as you may only take annual leave on a day where you aren’t on call. It is one of many reasons why my colleagues are leaving the nhs at an alarming rate which only compounds the problem as multiple rota gaps inevitably mean fewer people allowed off at any one time. We are treated appallingly - teaching is supposed to be protected as we are in training contacts where part of our salary is supplied by educational bodies however in reality doctors often end up holding bleeps during teaching if indeed they are released at all. Something needs to change but the system may have already tipped too far.

To add as lots posted whilst i was writing-I do feel for rota coordinators where they get crappy notice of who is actually going to be working there. My main issue is where a doctor goes above and beyond to secure leave well in advance and still can’t make firm plans in case it doesn’t translate to actual time off. And in response to a post above-I’ve only been contacted once prior to a rotation to get requests in to allow the rota to be written, this is not a common approach at all.

@Ginfilledcats sorry but i find your answer laughable. When i was a junior dr (admittedly a few years before the recent contract change), the main reasons for rota issues were incompetence from the 'management' staff, and them just not giving a shit. No other company or service would get away with treating its front line staff as badly as the NHS does! Your post suggests that most of the reasons behind the rota issues lie with the junior drs themselves, and from my experience they are given substantially less input/control when it comes to annual leave/requests as your post implies.

I have vivid memories of being the on call SHO on a friday afternoon, where the rota coordinator swanned down to the ward and informed us with a little laugh that unfortunately the 2 night SHOs over the weekend had called in sick and she couldn't find a locum, "and we'd just have to manage". At 2pm on a friday, and she was going home now so couldn't possibly keep trying to find another locum.

i find it ridiculous that usually the rota coordinators have never worked a night or weekend shift in their life but expect you to put your life on hold to fill gaps as they couldn't be bothered to do their jobs and find cover! Sorry small rant but overall i think their is an expectation of junior drs to put up and shut up and its not acceptable. Thank god I'm fully qualified now so don't have to put up with that nonsense!

@veganmedic you're right juniors do get treated appallingly as usually they aren't aware they deserve better, honestly - my best advice is learn early on that its just a black hole - don't pour any excess energy or effort into it, as it will take a limitless amount from you and give nothing back.

@Veganmedic have you not been contacted for not on call requests? That's interesting. My last 2 locations did it but my current one does not and I'm looking to implement it for all the reasons you said.

With a lot of the NHS problems, communication is a big problem (not necessarily from the docs) as you've said I've had doctors write to my team as soon as they know they're coming and explaining weddings etc and we've always done what we can to accommodate. It's when the docs tell the deanery and they don't tell us info that winds me up! Especially with the less than full time doctors.

I love my junior doctors, and consultants too, I do think you get a tough deal now with posts and what is expected of you within these jobs!

@bobbypinseverywhere - agree, I’m
Lucky that I’ve found a specialty I love that is relatively good compared to others (anaesthetics). I would not have stayed in the nhs in other specialties-juniors are often frankly bullied to cover chronic understaffing and any pushback from us is often met with remarks that we don’t care about our patients enough. No wonder burnout is rife!

Bad as it is, I still think it’s an improvement on how things were when I was a junior doctor back in the 1980’s. I remember the consultant cocked up the rota and allowed my two colleagues to go on holiday at the same time. That left me on continuous duty for 17 days and nights. I was hallucinating by the end of it. And when I wanted leave to attend a family wedding, nobody would cover it, so I ended up working 120 continuous hours before driving 200 miles to the venue. My normal rota averaged 100 hours a week.

@Ginfilledcats - once I’ve been contacted with a full blank rota and asked which lines would suit me and also encouraged to put leave requests in. That was amazingly helpful. In another job a rota coordinator emailed about 6 Weeks prior to job start to mention that rota was late but also to request we submit leave requests. The rest of the time, nothing. Once I tracked down the rota coordinator for a new job myself to ask for leave some 4 months into the job (so about 8 months notice). I was told I was extremely unreasonable to ask and no such request would be accommodated that far in advance! I’ve also arranged leave 10 months in advance with email confirmation meaning I felt safe booking flights-only to be rota’d on nights and told it’s my responsibility to find a swap or not go.

@bobbypinseverywhere I'm sorry you find my post laughable and against the doctors. That was not my intention! My biggest gripe is with the lack of communications from deanery or change of departments. The docs usually get the fall out of it.

I'm sorry it sounds like you have had some awful coordinators manning the rotas in your time and that's just wholly unacceptable behaviour from the individual in your example. I hope that was complained about!

You're right it does happen that the night shift doctor will ring in half an hour before their shift starts (this happened to me in December night). The bed manager (no idea why it was their decision) told the day time on call doctor they had to stay and work 24 hrs. Luckily I was checking my emails from home and found out so could put a stop to it. I couldn't believe the doctor was asked/pressured into staying.

I certainly care about my doctors welfare and hope that my managerial colleagues do too and I hope times have changed since your terrible experience, as I would not want to be part of something that treated people as such.

For those who are asking why I am asking. I'll be starting F1 in August and i'm on some forums where junior doctors discuss issues about work/life.

It's a constant stream of people really upset about rotas amongst other things.
In all honestly i'm really anxious about starting. My friend told me on his first rotation he was doing 90 hour weeks leading into a 55 hour week with no days off between.
I'm a post-grad so I just don't know if I have the energy for that and battling those in charge of the rota.
Really don't understand why I should be in charge of swapping on calls if I request AL months or weeks in advance - it's nonsense.
I'm already thinking about becoming a locum post foundation years and I haven't even started working!