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?

I care about my doctors too and I am in a role where I am on call, I worked Christmas Day last year and new year this year - I will put my money where my mouth is and do shift work

@Allofme1 it can be really hard (I’m a post grad medic too). There are however decent rota coordinators out there and to some extent when we stand together it forces culture change- where you have requested leave well in advance sometimes you have to be unpopular and kick
Up a fuss in order to remind people that we are humans and allowed to take time off rather than service delivery monkeys who can be used up.

Depends on the location / specialty. I work in paeds and all rotas I've ever worked have had a junior doctor or advanced nurse practitioner (ie a nurse who works as a doctor to all intents and purposes) writing them and being in charge of swaps and trying to cover gaps. HR check the written rota on some software to check it's compliant. The poor sod who got assigned to write the rota never gets admin time for it so it's probably 10 hours a week extra work they're unpaid for. And noone is happy with their rota generally!

I know departments who never get external locums to fill gaps as they don't trust the quality available. So one of the usual junior doctors is persuaded to fill gaps and work extra. It's fairly brutal when you're 25 per cent short of doctors to cover the rota.

Thanks for all those who have given some insight though!

I just wonder even for childcare, - if a rota is late and I can't find anyone to look after my chid. I have no choice but to refuse! Yes I know it impacts patient safety, but what about the impact of my child being left unattended and social services knocking on my door!

We are in a situation where locum costs are just absolutely insane - and they don’t do most of the paperwork, they often create more work than they complete. They cover physical gaps but then cause all kinds of other issues

In the hospital I work in there is a rota coordinator. That is her actual job.

And to get my wedding and honeymoon off I worked 28 long days or night shifts in a row (ie each of these was 13 hrs) with the only break being when I went from a long day onto a night shift the next day with a couple hours downtime. Shifts never finish on time either.

BUT it's the best job in the world

You need cast iron childcare. The patient in ED who needs you or the woman giving birth or the suicidal man coming to clinic can't wait for you to park your previous first born with somebody. Get it sorted or don't bother taking the job.

Childcare is your responsibility. If your child is sick and can't be in childcare then you generally can take the day off (your colleagues will cover for you) but it should officially come out your annual leave I believe. Most doctors though try and find another solution other than missing work.

@menora - I can understand that the lack of continuity really impacts patient care. I also understand that there are shortages, but the thing is who wants to work in an environment where they can't even have their wedding day off or a weeks vacation. It almost feels like it's them or me! I can see a lot of people on those forums opting for the locum life and saying how much happier they feel and how they can now have some control in their own lives. Interestingly I got an email the other day saying Junior Docs have been added to the shortage of labour list of occupations - I guess making it easier to get a visa. Yet the foundation programme for 2020 is still likely to be oversubscribed? I can't really understand why they don't just open up more places of there are more doctors willing to work ? Would make things easier for all of us!

@Veganmedic it's great to hear that everyone is supporting each other. I also feel in some specialties (at least abroad where I am) it's almost competitive regarding how many hours they can average! They are all unhappy, yet they also want to be martyrs which mean's everyone has to keep up with each other. One question for you if wouldn't mind, what happens if you don't opt out of the EU working directive ? Do they have to make the rota adhere to that ?

Yes they can’t make you opt out of EWTD however I think most rotas comply with it anyway-it would limit your ability to do extra shifts rather than your core rota. Although on the newer contract doing extra shifts is harder anyway as the rules are now very strict regarding number of long shifts in a row -in my experience this has also made swapping shifts really hard and in some cases impossible.

(Remember they average house over many weeks to check compliance with EWTD so while an individual week might look like it breaches, it doesn’t when you average it all out)

@jellyjellyinmybelly and @Afrigginggoat - one of the situations I read about was a very late rota with with the first week being all night duties and the woman was a single parent. My point is, if you are organised, but someone can't be bothered to do the rota on time - there have to be allowances. Otherwise how can you have a family and be a Doctor ?

and @jellyjellyinmybelly how is it possible that you were allowed to do that? That isn't safe surely?

I do make the rota adhere yes.

I think it’s very different doing the GP rotation compared to acute

I honestly do get where you are coming from and we are in a situation where we rely on extortionate costs of locums who do not do any of the core work such as coding letters, signing scripts, checking results, completing referrals properly (and they over refer and over prescribe as over cautious and don’t know the patients) we would all prefer to have non locum staff. Just wanted to reassure you that not all rota coordinators are horrible

You couldn’t legally do that run of shifts on the new rota OP

Do people put the rotas into software to get something sensible and help with swaps? There is software available as I worked in one place that had some - which was ok to use so people could easily look up who they can swap with.

The worst is when they say you can have the weekend off and then months later when you get the rota, you realise they ignored your request and put you on call. Had to miss a wedding where my husband was best man.

I think in some cases rota co-ordinators do get caught in the cross fire of bad senior management decisions, poor software and large numbers of doctors with differing life events/contracts.

All the foundation doctors I’ve known have had appalling Roma’s with little flexibility. Long stretches without days off and frequent rotation to nights. Changes had to be negotiated between peers, if you could find someone to swap with.
Frequently they finish late and go without breaks but are seriously discouraged from reporting breaches to guardian of safe working hours.

Most Docs I know with children have live in care - nanny or au pair.
It is a bloody hard training period and bloody hard job - but rewarding. It has to be your vocation/passion or it won't work.

Well I’m not a doctor (not bright enough 🤣) so I can’t offer anything to this thread other than to say, I hope all you doctors realise how much we (the public) appreciate all your hard work. Have some emoji flowers 💐

Just started reading through the posts, the working hours, expectations sound really difficult. It’s so sad that we have so many wonderful doctors but they are constantly being ‘put on’ and are under severe pressure.

To think the person had to work 28 days straight just so they could secure their wedding day?! 😧 deary me!!

It's become harder and harder to work it. There are a lot of rules (some of them recently imposed) that impact on the rota. Some of these are related to EWTD, some to imposition from government. So, for instance, there are rules about proportion of time spent out of hours, number of shifts worked in a row, proportion of weekends worked, how long off after nights etc. Most of these rules are good ideas in principle, to avoid junior doctors having to work patterns like we used to, which were inhumane and unsafe. However, following all the rules, with a limited number of staff, tends to mean a complex rota template, from which the department cannot significantly deviate without breaking the rules, and getting in trouble.

So it tends to mean that there are places on the rota where it is easy to take leave (no swaps required), places where it is tricky to take leave (swaps to cover evenings, with several people who might be able to swap with you), and places where it is very, very tricky to take leave (mostly where it involves swapping nights).

It isn't just junior doctors. In nearly 10 years as a consultant, I have only once taken leave that involved swapping ward cover weeks. And that caused mayhem. I am currently looking at the next 12 months of rota to see where I can take leave without having to ask for any swaps, because I just can't face the stress of trying to make swaps work. It's not great.

Ps..... you hear it in the news etc but to hear it from you guys is quite the eye opener

Oh, and my brother chose his wedding date based partly on my rota, and my grandma's funeral was delayed until after my nights were over. It's a nightmare when there's no slack in the system.

It’s tough. Rotas can be only 6 weeks in advance. You have to swap oncalls to get leave. If you can’t swap... then...no leave.
I now run our dept trainee (by trainee I mean up to the most senior onsite anaesthetist in the hospital, trainee is a misleading term) Rota and try very hard to help and switch. Our dept will pay for locums for some personal (all paternity, wedding, honey moon or other ‘different’ things) but that’s not always the norm.
I’ve had years of not being able to book a summer holiday until the end of May because the Rota doesn’t come out until April.... but you need to get the leave approved.... but to do that you need a swap... then the Rota person is on holiday.... etc etc

Yes and I’ve known a senior 5 yrs ago have to work the morning of their wedding

And the new contract makes swapping even more difficult.... and therefore leave is harder to take 😭