Introduction
Trusts often find that their emergency department (ED) doctors have low levels of satisfaction, high rates of burnout and high turnover. Brighton and Sussex found that while ED could be a highly pressurised environment that could contribute to these issues, another key challenge was the way shifts were organised and the lack of flexibility that had become a standard part of being an ED doctor.
In 2013, the trust had seven consultants and seven registrars for two sites and understood this was not acceptable for staff or patients.
About University Hospitals Sussex NHS Trust
University Hospitals Sussex NHS Foundation Trust (UHSussex) is an NHS foundation trust which provides clinical services to people in Brighton and Hove, parts of East Sussex and West Sussex.
We run seven hospitals across Brighton & Hove and West Sussex. The mission of University Hospitals Sussex – what we are striving to achieve – is to provide ‘excellent care every time’.
As one of the UK’s largest acute trusts, we’re proud to be part of the excellence, ambition and values that define the NHS.
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Solution
Traditional rotas are based on a nine-to-five model, working five days a week, which is not appropriate for specialty staff at the forefront of delivering care during unsocial hours.
The lack of flexibility in the traditional rota model had become a significant factor in convincing staff to leave the trust. The solution was a new annualised hours and self-preferencing rota system.
The trust implemented an annualised system for consultants, middle grades and junior rotas, alongside self-rostering or self-selecting preferences, with staff choosing the amount of clinical work they wish to do.
For example, junior doctors can ‘block out’ dates they do not wish to work up to a year in advance, and the rota automatically maps the appropriate number of staff with the requisite skill mix onto the shifts that need to be covered.
This means ED doctors know their shift patterns up to a year in advance and can plan accordingly. Staff have their rotas emailed directly to their online calendars and can easily swap shifts with each other via an app, without needing to do this through rota co-ordinators.
I get a whole rota a year in advance, and I cannot tell you the massive impact that has on you being able to do things that on a usual rota you just wouldn’t be able to do…Now I can know, and I can participate and have a life outside this as well.
Philip Rankin, Clinical Fellow
Results
The trust went from seven consultants and seven registrars (for two sites) to 23.8 full-time equivalent consultants and 25 registrars within five years. Consultant cover is now 24/7 at Brighton and 8am to 10.30pm seven days a week at Princess Royal.
F1 numbers have increased from 20 to over 40 while junior doctor locum costs have been eliminated. In a survey, 73% of doctors questioned are ‘very satisfied’ with the rostering aspects of their clinical work, while 67% said the new system had been ‘very beneficial’ to their professional life and career.
The fellows project has been rolled out to numerous trusts, and the rota system has been adopted by many other trusts, as well as outside ED (see the Table below).
Table: Trusts that have adopted the rota
| Trust | Department |
|---|---|
| Guy’s & St Thomas’s Hospital | Paediatrics |
| Belfast City Hospital General medicine | General medicine |
| John Radcliffe Hospital | Intensive care |
| Steyning Health Centre | General practice |
| Royal Victoria Hospital | RVH medicine |
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