MEL(1999)23

Department of Health

Dear Colleague

THE NEW DEAL FOR JUNIOR DOCTORS' HOURS: STATISTICAL RETURNS FOR 31 MARCH 1999

Summary

1. This letter requests the completion and return of the attached data sheets on junior doctors' hours for the 6 months to 31 March 1999.

2. Trusts will be aware of the New Deal target implementation date of 31 March 1999 given in the Human Resources Strategy, reinforced by Mr Galbraith’s letter of 22 December. Completion of all possible action to ensure compliance (particularly with the non-hours standards) is therefore expected by that date. Great importance is also attached to the accuracy of these requested returns as an analysis will be prepared and presented to Ministers as part of a report on New Deal compliance in Scotland. The submission of timeous data is clearly essential.

Action

3. Trusts and Health Boards should:

- ensure that all necessary action to meet the New Deal targets and standards in full is undertaken and completed by the target date of 31 March 1999;

- provide statistical returns for the 6 months to 31 March 1999 by 16 April 1999 at the very latest. We are aware that some Trusts have had difficulty in complying with deadlines in previous rounds, but it is essential to have this information on time;

NHS MEL (1999)23

15^th March 1999
______________________________

Addressees

For action:
Chief Executives, NHS Trusts

General Managers, Health Boards

General Manager, Common Services
Agency

General Manager, State Hospital's
Board for Scotland

For information:
Executive Director, Scottish Council
for Postgraduate Medical and Dental
Education

Postgraduate Deans and Directors

Chief Executive, Health Education
Board for Scotland
______________________________

Enquiries to:
Mr K McMillan
Directorate of Human Resources
NHS Management Executive
Room 65
St Andrew’s House
EDINBURGH EH1 3DG

Tel: 0131-244 2476
Fax: 0131-244 2837
_______________________

- note the redesigned Form 7 on the non-hours standards which ties in with the Accommodation Questionnaire issued as MEL(1999)17 on 23 February and which seeks Trusts’ proposals for action in the event of standard failure;

- ensure that the validation sheet is considered and signed by both a junior doctors' representative and the Chief Executive/General Manager to give confidence that reliable figures are returned to the Management Executive. Any disagreement should be reported by one or other signatory. If, in exceptional circumstances, the signature of a junior doctors' representative cannot be obtained, return the forms with a letter of explanation;

- if the information requested is unknown, or known to be inaccurate, supply a letter of explanation which details the proposals to remedy this information gap;

- copy this letter to Medical, Clinical and Human Resource Directors for action as necessary.

4. Details of what is required are set out in Annex A attached.

Yours sincerely

GERRY MARR
Director of Human Resources

JUNIOR DOCTORS' HOURS OF WORK

Statistical Returns for 30 September 1998

1. The main findings of the monitoring exercise at 30 September 1998 were as follows:

Compliance with contracted hours target

99 posts (2.5%) in 8 Trusts did not comply with the contracted hours target compared with 102 (2.7%) at 31 March 1998.

Compliance with the actual hours worked target

216 posts (5.8%) did not comply with the actual hours target compared with 263 (7%) at 31 March 1998. If, however, those posts in receipt of Class 1 or Class 2 ADH payments, which have been omitted from the figures so far, are included, the corresponding figures are 359 posts (9%) at 30 September 1998 and 419 (10.6%) at 31 March 1998.

Compliance with the non-hours standards

13 Trusts (26%) failed to meet all non-hours standards (accommodation, catering and security) compared with 16 at 31 March 1998. Nine Trusts did not comply with one standard and 2 did not comply with 2 standards. Two Trusts failed all 3 standards.

New Deal target date

2. All Chairmen received a letter from Mr Galbraith dated 22 December in which he reminded Trusts and Health Boards that the Human Resources Strategy called for the requirements of the New Deal, both in hours and conditions of work, to be met by 31 March 1999. Mr Galbraith asked Chairmen to take personal responsibility for ensuring full compliance in their Trusts and underlined his own commitment to seeing full implementation of the New Deal.

3. The Management Executive has taken forward this commitment by establishing an Audit Group to undertake a review of the performance of those Trusts experiencing particular difficulties in delivering the New Deal. It has sought to raise the profile of New Deal commitments with Trusts and has also underlined their responsibilities in achieving full compliance. The Group has just completed a series of visits at which the action taken by Trusts to comply with the New Deal was discussed and problems preventing further compliance were identified. As a result of this work, we expect to identify further supporting measures that will assist Trusts in completing all the action necessary to meet New Deal standards.

New Deal 4 software

4. Because these statistics will reflect the New Deal position at 31 March 1999, we expect that Trusts have not only been working towards improving and maintaining compliance, but have also been working to improve the accuracy of the statistics. To address these aims, the New Deal 4 system for monitoring junior doctors’ hours was issued to all Scottish Trusts by the Management Executive last year. The software is designed to analyse the hours information provided by junior doctors and to identify breaches of the targets.

5. A second series of New Deal 4 training days has just ended which revealed a high level of interest in the system. We hope, therefore, that most Trusts will be in a position to use the package for compiling this set of statistics so that comparable information is received from all Trusts. In any event, the Management Executive expects that all Trusts will be sufficiently familiar with the system to use it for the 30 September 1999 statistical returns.

Statistical Returns for 31 March 1999

6. A set of forms for completion at 31 March 1999 are attached. If any data is thought to be inaccurate or is not known, please forward a letter to explain the nature of the problem and to describe what action is to be taken to resolve it.

7. It is important to recognise that those posts in receipt of Class 1 or Class 2 ADH payments breach the New Deal guidelines. Until the work patterns or work intensity issues are resolved, these posts should be included in the posts failing the actual hours target.

8. All returns must be validated by a nominated juniors' representative and the Trust Chief Executive/General Manager. This gives both staff and management an opportunity to amend or comment on the returns in order to increase their reliability. Where significant problems are being encountered by Trusts and Units in reaching the targets, please give further details.

9. Trusts and Health Boards should ensure that all forms are completed and validated and then forwarded, along with any additional, explanatory information, to Mr K McMillan, Directorate of Human Resources, Room 65, St Andrew's House, Edinburgh EH1 3DG by 16 April 1999. Further advice may be obtained, if necessary, from Mr McMillan.

Trust/Health Board:_______________________________________________

SUMMARY

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Grade		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Senior Registrar
Registrar
Specialist Registrar
SHO
PHRO
TOTAL

Trust/Health Board:_______________________________________________

Grade: PRE-REGISTRATION HOUSE OFFICER

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Specialty		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Medicine
Surgery
O&G
Pathology
Anaesthetics
Paediatrics
A&E
Psychiatry
Dentistry
TOTAL

Trust/Health Board:_______________________________________________

Grade: SENIOR HOUSE OFFICER

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Specialty		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Medicine
Surgery
O&G
Pathology
Anaesthetics
Paediatrics
A&E
Psychiatry
Dentistry
TOTAL

Trust/Health Board:_______________________________________________

Grade: SPECIALIST REGISTRAR

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Specialty		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Medicine
Surgery
O&G
Pathology
Anaesthetics
Paediatrics
A&E
Psychiatry
Dentistry
TOTAL

Trust/Health Board:_______________________________________________

Grade: REGISTRAR

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Specialty		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Medicine
Surgery
O&G
Pathology
Anaesthetics
Paediatrics
A&E
Psychiatry
Dentistry
TOTAL

Trust/Health Board:_______________________________________________

Grade: SENIOR REGISTRAR

	Total Number of	Number of Posts meeting		Number of Posts Not Meeting Contracted and Actual Hours Targets
	Posts	Contracted Hours	Actual Hours	Contracted Hours			Actual Hours
Specialty		Targets	Targets	Full Shifts	Partial Shifts	Rotas	Full Shifts	Partial Shifts	Rotas
Medicine
Surgery
O&G
Pathology
Anaesthetics
Paediatrics
A&E
Psychiatry
Dentistry
TOTAL

Trust/Health Board:________________________________________

Enter YES in the boxes if the New Deal standards have been met in full or NO if they have not:

ACCOMMODATION	CATERING	SECURITY

If any standard has not been met, please refer to the Accommodation, Security and Catering Questionnaire issued for Junior Doctors on 23 February and detail below:

- the reasons for standard failure;

- the action the Trust proposes to take to achieve compliance;

- the timescale for the proposed action.

If, exceptionally, the accommodation standard cannot be achieved by 31 March 1999, please provide a detailed explanation below or on a separate sheet.

Trust/Health Board:________________________________________

SUMMARY

Col 1

Col 2

Col 3

Col 4

Col 5

Col 6

Col 7

Specialty

Total of

on-call or

hybrid

posts not

complying

30 September

PRHO POSTS

SHO POSTS

HST POSTS

Number of

claims

currently

in payment

30 September

Column 6 as a % of Column 2

Applied

Approved

Resolved

Applied

Approved

Resolved

Applied

Approved

Resolved

Medicine

Surgery

Paediatrics

O&G

Anaesthetics

Others

TOTAL

Notes:

Col 2 - This should show the total number of juniors' posts involved, rather than the numbers of joint claims by specialty or rota, even though many claims are pursued jointly

Cols 3, 4 & 5 -These should show the number of juniors' posts where claims have been processed under NHS MEL(1996)23 or MEL(1998)40.

Definitions:

Applied: Posts where the junior applied at any stage from 1 April 1996 to 31 March 1999

Approved: Posts where payment was made or agreed (even if not yet paid), including posts where such payment has now ceased for any reason

Resolved: Outcome should be broken down between moving on to a shift (A) or reducing intensity while remaining on-call (B)

DOCTORS IN HIGHER SPECIALIST TRAINING

WHO MAY BE CONTRACTED FOR MORE THAN 72 HOURS PER WEEK

(The "English Clause")

Trust/Health Board________________________________

POST¹

(GRADE)

SPECIALTY

HOSPITALS

WORK²

PATTERN

CONTRACTED HOURS

_________________________________

HARD
PRESSED

NON-HARD
PRESSED

HOURS ACTUALLY WORKED

NOTES:- 1. List each post by Grade on a separate line.

2. Indicate on-call rota, full shift or partial shift.

VALIDATION SHEET FOR FORMS 1-9

TRUST/HEALTH BOARD: __________________________________________________

The returns are now required to be validated by a representative of the junior doctors and by the Chief Executive/General Manager. Before being finalised, the forms should be passed to the junior doctor giving him/her the opportunity to amend or annotate them as appropriate on completion. The following questions should be answered by the juniors’ representative before signing and passing to the Chief Executive/General Manager for signing.

1. Have forms 1-9 been completed to your satisfaction?

YES/NO

2. Are there effective monitoring mechanisms within the Trust or Unit to determine actual hours of duty and actual hours of work?

YES/NO

3. Are you satisfied that these monitoring mechanisms are designed to provide an accurate account of the position on contracted hours of duty, actual hours of duty and actual hours of work?

YES/NO

4. If the answer to question 3 is YES, have the monitoring mechanisms been used in the completion of forms 1-9?

YES/NO

Any other comments (continue on a separate sheet if necessary):

_________________________________________________________________________________________

NAME (BLOCK CAPITALS): _____________________________________________________

TRAINING POST HELD: _____________________________________________________

REPRESENTATIVE CAPACITY: _____________________________________________________

SIGNATURE: _____________________________________________________

Please pass this form to the Chief Executive/General Manager.

I have seen the returns and am satisfied that any necessary checks have been undertaken and any problems concerning their completion have been resolved.

NAME (BLOCK CAPITALS): _____________________________________________________

SIGNATURE: _____________________________________________________

DATE: _____________________________________________________