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Case studies

Approaches to WTD compliance

Contacts & useful links

Q&As

Communicating withpatients & public

The ‘Hospital at Night’project

Key messages

Welcome

WelcomeBack to start

Close toolkitWorking Time Directive communications toolkitThis toolkit has been prepared jointly bythe Department of Health and the NHSModernisation Agency to supportcommunications leads throughout theNHS. Its aim is to help you develop yourcommunications with staff, patients and the public about the EuropeanWorking Time Directive (WTD) and about some of the changes in roles andways of working which will need tohappen to facilitate compliance.

The toolkit offers an overview of the WTD,detailed information on the experiences of the WTD pilot sites and other resourcesincluding research findings to help youshape your own communications activities and materials.

Viewing tip:The toolkit has been produced in PDFformat and is designed to be used onscreen where you can click between thedifferent sections and link to other relatedmaterial on the web. For maximum clarity– go to the top of your Adobe Readerscreen, select the ‘window’ option andthen select ‘full screen view’ from thedrop-down menu.

Printing tip:PDF is a printer-friendly format so you caneasily print the toolkit for reading off-line.

WTD overview

Enter toolkit here

Welcome to the

Case studies



Q&As




Close toolkitWorking Time Directive overviewThe Working Time Regulations areembodied in UK Health and Safetylegislation which enacts the EuropeanWorking Time Directive (EWTD). Theregulations already apply to most UKemployees. One of the few exceptions hasbeen doctors in training, but that willchange from August 2004.

From August 2004, doctors in trainingshould be working an average of no morethan 58 hours a week. By August 2009,this is reduced to 48 hours a week. Thereare also specific rest provisions that mustbe met, including:

■ 11 hours’ continuous rest in every24-hour period

■ a minimum 20-minute break when ashift exceeds 6 hours

■ a minimum 24-hour rest in every 7days or minimum 48-hour rest inevery 14 days.

The New Deal for junior doctors isalready in place and sets a contractual limit of 56 hours’ work per week fromAugust 2003. Under the New Deal,doctors can be on duty for up to 72 hoursa week, providing their hours of actualwork do not exceed 56. However, tworulings in the European Court of Justice(SiMAP and Jaeger) mean that time spentresident on call by doctors must beregarded as working time, even if thedoctor is resting. Current working patternsfor residents on call will generally not becompatible with the Working TimeDirective.

In order to achieve compliant workingpatterns for junior doctors, the NHS isbeing encouraged to:

■ make effective use of the plannedgrowth in the medical workforce

■ use more cross-cover betweenspecialities, and fewer tiers of cover to reduce the number of out-of-hoursrotas staffed by junior doctors

■ use non-medical practitioners more effectively

■ improve team working and redesignworking patterns for staff

■ develop new service models thatsupport improved patient care andlocal access to services, whiledelivering WTD compliance.

The 20 WTD pilot projects, set up by theDepartment of Health in 2002 andmanaged by the NHS ModernisationAgency, were designed to test thesechanges and evaluate their impact on bothWTD compliance and the quality of patientcare. See Approaches to WTDcompliance for more details.

From August 2004, doctors in training should be working an average of no more than 58 hours a week

WTD overview

Key messages

WTD overview

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Q&As




Close toolkitSharing the key messages on WTD■ Working Time Directive (WTD)

compliance is achievable - some placeshave already done it. But we recognisethat a small number of specialties andcertain types of organisation will haveparticular challenges in meeting theAugust deadline

■ support is available for those parts ofthe NHS which, because of their size orlocation, are struggling to achievecompliance by August

■ professional organisations, governmentand NHS staff are working together toensure effective solutions which benefitboth patients and staff

■ the key principle for compliance will beto redesign how services are provided

■ WTD compliance – as part of the widerwork on service redesign - is ensuringpatients receive fast, efficient treatmentby appropriately skilled staff inappropriate settings

■ solutions to the challenges presented by the WTD need to be identified bylooking at the whole health systemlocally. For example, providing enhancedservices in primary care, maximising thepotential of Treatment Centres andencouraging appropriate use of servicessuch as minor injuries units

■ any changes to the way services aredelivered must be made with the fullinvolvement of patients and in thecontext of ‘Keeping it Local’

■ the WTD is not a threat – whereorganisations have already movedsuccessfully towards compliance, it hasencouraged greater flexibility and moreinnovative thinking

■ successful implementation will ensuredoctors are not tired. It will enhanceother measures already being taken toimprove safety and quality of care

■ more money is coming into the systemthan ever before – that goes hand inhand with changes to the way thesystem works

■ there is no single ‘one size fits all’solution – health economies will identifywhat works best locally

The key principle for compliance will be to redesign how services are provided

Key messages

WTD overview

Key messages

Case studies


Q&As




Close toolkitWTD pilots: what they’re testing and achieving

Key messages

By February 2004 ten pilots had achieved WTD compliance for junior doctors


There are 20 pilot projects, each testingapproaches to achieving WTD compliancefor doctors in training.

The pilots are taking place in a variety of clinical services, including medicine,general surgery, A&E, orthopaedics,cardio-thoracic surgery and cardiacintensive care, mental health and elderlycare. There is also a pilot testing new waysof working in anaesthesia that covers fivedifferent NHS trusts. It will result in anational curriculum, developed with theRoyal College of Anaesthetists and theNHS University, for training non-medicalpractitioners to work in the anaestheticteam. The pilots started in 2002, andmost finish in 2004.

The pilot projects are testing threedifferent approaches to achieving WTDcompliance for junior doctors:

■ Rota redesign – changing the workingpatterns of junior doctors, consultants,other medical staff and nurses

■ Role redesign – introducing roles such as medical emergencyassistants; perioperative specialistpractitioners, (associate) mental healthpractitioners and surgical assistants

■ Redesign of services – introducingchanges such as a consultant-staffedhelpline for GPs in A&E to reduceadmissions; medical emergencyassistants to undertake ward workfollowing admissions; nurse-ledservices; new admissions units tocentralise work on assessing; and ‘pointof care’ testing to speed up diagnosisand treatment decisions.

Most pilots are testing more than oneapproach. Changes to one part of aservice – such as rotas – often lead tochanges in the roles of other staff and the way the service is delivered.

The pilot projects have demonstrated a range of successful outcomes. Nine of the pilots had finished their workby June 2004. Others, though not yetfinished, have already achieved significantoutcomes. To date:

■ 12 pilots have achieved WTD compliancefor junior doctors in the pilot area

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Close toolkitWTD pilots: what they’re testing and achieving■ 13 pilots have saved significant

amounts of time for junior doctors thancan contribute to compliant solutions

■ 8 pilots have demonstrated measurableimprovements to patient care as a resultof changes made through the pilot.

Full details of the pilots are available onthe Modernisation Agency website atwww.modern.nhs.uk/workingtime

Successful Outcomes cont’d:These included faster access to medicines;better recording of medicines on drugcharts; quicker diagnosis; fewer cancelledclinics and operations; shorter waitingtimes for appointments, operations, x-raysand transfer to ward from A&E; shorterhospital stays; and earlier discharge.

The pilot programme is entering its finalmonths, with three pilots finishing by April 2004, eight finishing by August2004, and the rest finishing in late 2004or early 2005.

See Case studies for more detail on what is happening at specific pilot sites.For a full list of the WTD pilots see TheModernisation Agency’s WorkingTime web pages

Key messages

By February 2004 ten pilots had achieved WTD compliance for junior doctors


WTD overview


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http://www.modern.nhs.uk/scripts/default.asp?site_id=50&id=18829

Case studies



Q&As



Close toolkitOOH cover defined by competency not grade

Key messages

The concept is one of a multidisciplinary team providing cover across the whole hospital during the night

The ‘Hospital at Night’ project

The Hospital at Night project is being led by The Modernisation Agency andaims to redefine how medical cover isprovided in hospitals during the out-of-hours period. The concept is one of amultidisciplinary team providing coveracross the whole hospital during the night. The approach requires a move away from cover requirements that aredefined by professional demarcation and grade, towards cover defined by competency.

A key element of the Hospital at Nightstrategy is to minimise the out-of-hoursworkload through changes to daytime and evening practice.

Changes in who does the work and when should be evidence based. Thisapproach is being tested in a number of pilot sites.

How the Hospital at Night team will work:In future, hospital cover at nights andweekends is likely to be provided throughteams of health professionals with theappropriate skills and experience to cover allclinical needs - though arrangements maydiffer in ITU, paediatrics and obstetrics.Members of the team will work to agreedprotocols and will have to demonstrateparticular competencies, whatever theirprofessional background. The team will beable to manage all immediately-necessaryinterventions and have the capacity to call inspecialist expertise from close at hand.

The project:The project has involved the collection of alarge amount of data about what happensin hospitals during the out-of-hours periodand how they are handled. Alongside

thorough analysis of the data, the projectteam has worked closely with stakeholders to ensure informedprofessional input to advise on bestpractice, minimum competencies and new models of working. This is beingfollowed by robust evaluation andfeedback to the NHS.

Preliminary indications are that theteam-based approach is welcomed bystaff and also benefits patient outcomes.

The project is aiming to establish coreprinciples and approaches to staffing thehospital at night which are endorsed by theRoyal Colleges and other professionalbodies. The Academy of Royal Collegesand the BMA are part of the professional steering group for the project.

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Close toolkitOOH cover defined by competency not gradeThe project cont’d:Another important aim is to identify a number of solutions or models which trusts might adopt, and develop amethodology which trusts can use to redesign out-of-hours cover which is WTD compliant.

Advantages of the new approach:Current working practices - long anti-socialshifts worked by comparatively junior staff -can result in errors that threaten patientsafety. These practices also consume asignificant proportion of scarce medical staff capacity at a time when clinical activity is lowest.

The new approach should lead toimprovements in the timeliness and quality of patient care. It should help trusts make best use of scarce clinicalresources available at night, while

also supporting them in achieving WTD compliance.

The quality of clinical training and supervision for staff working shifts isalso expected to improve.

How the Hospital at Night project can help specialist services achieve WTD compliance:The project has gathered data from twoteaching hospital sites offering significantlevels of specialist services. The data hasdemonstrated that most highly-specialistservices have very small levels of specialistactivity after 9pm. This would suggest, withappropriate specialist nursing cover on site,many highly-specialist services should notneed to keep junior medical staff residentduring the night.

Although the success of this approachwill depend on the individual hospital’s

activity, the Hospital at Night methodologyprovides a valuable way for trusts todetermine the level of cover needed.

Where the project is at now:Initial data was gathered by the pilot sites inJune 2003. Pilots began implementing newnight-time models during Autumn 2003. Apreliminary evaluation is underway and finalevaluation will take place in October 2004. For more information visit:www.modern.nhs.uk/hospitalatnight

Key messages

The concept is one of a multidisciplinary team providing cover across the whole hospital during the night

The ‘Hospital at Night’ project

WTD overview


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http://www.modern.nhs.uk/hospitalatnight



Q&As




Close toolkitNew roles in pharmacy support WTDBasildon & Thurrock UniversityHospitals are reducing the workload ofjunior doctors by appointing pharmacy technicians to manage patient medicines.The technicians document medicines history for all adult patients on admission,and manage medicines from admissionthrough to discharge.

Julia Keating, Principal Pharmacist at the trust, says, "Junior doctors werespending significant amounts of timeobtaining and documenting drug historieson admission, prescribing drugs onadmission, transcribing prescriptionsduring a patient’s stay and preparingmedicines information at discharge.

"The trust felt these tasks could becompleted by non-medical staff while atthe same time improving the accuracy ofdrug documentation."

The trust appointed a Principal Pharmacistin Clinical Development and developed an in-house training programme onmedicines management for pharmacytechnicians. This has enabled technicians to achieve competencies in a number of tasks previously completed by junior doctors.

Results so far from the pilot have been promising and have shown both a saving in junior doctors’ hours and an improvement in the accuracy of drug documentation.

"The new roles have saved almost 35hours per week of junior doctor time –time that was previously spent on drugdocumentation tasks," adds Julia.

"The accuracy of rewritten drug chartshas improved significantly, with only 4% of charts requiring pharmacist intervention

when they have been completed bypharmacy technicians - a drop of 43%from when they were completed by junior doctors."

Contact Julia Keating at:[email protected]

Key messages

The new roles have saved almost 35 hours per week of junior doctor time

Case study 1

WTD overview

Case studies

Case study 2 Case study 3 Case study 4 Case study 5 Case study 6

mailto:[email protected]



Q&As




Close toolkitWTD compliance in a small district general hospitalDue to its size and location, NorthernDevon Healthcare has faced verydifferent challenges to the other WorkingTime Directive (WTD) pilot sites. Thehospital is situated in a rural area and has345 in-patient beds serving a population of 150,000.

Donna Knight, Project Manager for thepilot explains: "We looked at cross-coverat night between surgery and medicine,but the different activity levels out-of-hours meant this was not feasible."Instead, the trust looked at changing the rotas worked by PRHOs and SHOs in medicine to a full shift pattern. This has resulted in the trust achieving WTDcompliance ahead of the August 2004 deadline.

Throughout the trust, directorates are now reviewing their workingarrangements and exploring different

ways to address WTD compliance. Butthere’s still a lot of work to be done toachieve full compliance trust-wide.

"Through the pilot we have been ableto move to a 24-hour medical assessmentunit (MAU) with integrated workingbetween medical and nursing staff andimproved patient care," adds Donna.

"But, although we have improved waysof working and started to reduce junior doctors hours, it’s become clear that wedon’t have the staff resources to achievethe ultimate target of a 48-hour week forjunior doctors without a radical change inthe way that the hospital functions out of hours."

The trust has now set up a steeringgroup led by the Chief Executive to examine the ‘Hospital at Night’ approachto achieving WTD compliance.

See the ‘Hospital at Night’ section ofthis toolkit for more details.

Contact Donna Knight at:[email protected]

Key messages

We don’t have the staff resources to achieve the ultimate target of a 48-hour week for junior doctors withouta radical change in the way that the hospital functions out of hours

WTD overview

Case studies

Case study 1 Case study 2 Case study 3 Case study 4 Case study 5 Case study 6




Q&As




Close toolkitTwo new roles in surgeryFor Kettering General Hospital Trust,one of the 20 Working Time Directivepilot sites, reducing hours for juniordoctors has meant exploring two newinnovative practitioner roles in surgery.

First to be developed was the role ofTrauma Nurse Practitioner within theTrauma and Orthopaedic Directorate.Starting in April 2003, the new nursepractitioners initially focused on patientswith fractured necks or femurs.

Maintaining close links with theaccident and emergency department, the practitioner’s role is to administer pain relief under a patient group directive and arrange any necessaryfurther tests.

Once the patient is stabilised, thepractitioner facilitates their transfer to thetrauma assessment area. This is not onlyreducing workloads for medical staff but

is also having a significant impact ontrolley times. The service is governed by fixed protocolsand underpinned by a thoroughoperational policy. Additional benefits ofthe role include:

■ improved communication overplanned care

■ fast-tracking of patients to thetrauma unit

■ senior trauma nurse expertise forward-based staff.

The second role developed by the trust isFirst Assistant in general and orthopaedictheatres. The First Assistant covers a 24-hour period, Monday to Friday. Theyhave developed new skills in skin closures

and male catheterisation. Each firstassistant has an assigned consultantmentor and must complete a competency pack for the role.

Once the role has been established ingeneral and orthopaedic theatres, thelong-term plan is to extend the service toother specialties by training more nursesand operating department practitioners in the role.

Introducing the new roles has meantclose co-operation with the surgical teamsto ensure that junior doctors’ trainingneeds in theatres are met.

ContactClare Beattie at:[email protected]

Key messages

Trauma Nurse Practitioners are reducing workloads and having a significant impact on trolley times

WTD overview

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Q&As




Close toolkitSupporting patients at nightCity Hospitals Sunderland Trust hasadopted a broad organisational approach to implementing the WorkingTime Directive.

The trusts was faced with a significantnumber of doctors working well over 56hours per week, and with work intensityrequiring band 3 payments. Their solution involved replacing the role of the most junior medical staff with NightNurse Practitioners.

This team of experienced nurses worksacross specialties and is the first point ofcontact for all medical enquiries regarding in-patients between midnightand 8am.

The trust already had considerableexperience of senior nursing staffundertaking extended responsibilities in avariety of clinical environments, includingclinical nurse specialists and nurse

consultants. These initiatives had beensuccessful and the employment of sixNight Nurse Practitioners (NNPs) wasconsidered the best option in meeting theobjectives of the pilot.

Role preparation and support for theNNPs proved crucial. These practitionerswould work beyond conventional nursingboundaries in busy clinical environmentswhere high-quality clinical decision-making would be essential. A clinical skillsprogramme, a competence-basedassessment and the incorporation of aclinical and nursing supervision frameworkhave all been important factors in settingup the role.

The NNPs have gained a high level ofcredibility with patients and colleagues.Overall they have been welcomed byjunior doctors and the role has helped toidentify different ways of working for

doctors. The introduction of NNPs has also allowed the junior doctors to become more involved in complex cases, enhancing their training opportunities.

Now the trust is looking at ways of improving how NNPs are prepared for their new role and identifyingbetter opportunities for their ongoing development.

Contact Kirsty Murray at:[email protected]

Key messages

The Night Nurse Practitioners have gained a high level of credibility with patients and colleagues

WTD overview

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Close toolkitWorking to support SpRsWinchester and Eastleigh HealthcareTrust is an acute trust in Hampshiresupporting a population of 240,000. In order to implement the Working TimeDirective for SpRs in medicine and elderly care, the trust decided to explore different ways of working for consultantsand nurses.

Jayne Turnbull, Programme Director forModernisation for the trust says: "Toachieve WTD compliance by August 2004,it was essential to look beyond merelychanging the rotas of the SpRs. We had tolook at ways in which existing staff couldwork differently and new roles could beimplemented to meet WTD requirementsand improve patient care."

In November 2003 the trust introducedthe role of Medical Assistant to supportthe junior doctors in medicine, assistingthem in their clinical work - particularly

their acute and emergency work. MedicalAssistants carry out a variety of tasksincluding cannulation, ECG and venepuncture.

Another new role introduced by theWTD pilot is the Cardiac NursePractitioners. These practitioners workmainly in A&E providing assessment andinitial treatment of cardiac patientspresenting with acute chest pain.

The role involves diagnosis of patientssuffering acute myocardial infarction.Following the agreement of trustprocedures, the aim is also to include theprescription and administration of thrombolytic therapy.

The trust has also introduced a clinicalpharmacy service to the medical assessment unit (MAU) where pharmaistsassist with accurate medication history taking, post-take ward rounds, undertake

medication reviews and improve communication with patients and GPs.Two pharmacists provide the service onweekdays from 8am to 7pm.

The trust has already seen significantachievements through the pilot:■ Medical Assistants are saving around

eight hours of junior doctor time in a16-hour weekday period

■ Cardiac Nurse Practitioners are completing 70 hours of work in a weekwith cardiac patients in A&E whichwould previously have been completedby junior doctors

■ a survey with the SpRs estimates thatthe new ways of working with pharmacy staff saves them approximately 24 hours each week.

Contact Jayne Turnbull at:[email protected]

Key messages

Medical Assistants are saving around eight hours of junior doctor time in a 16-hour weekday period

WTD overview

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Q&As




Close toolkitWTD impacts on consultants tooGloucestershire Royal Hospital has successfully developed 48-hour rotas andshifts for its trainees in obstetrics andgynaecology, which are compliant with theWorking Time Directive and the New Deal.

However, progress here has had aknock-on effect for consultant staff whoare working a 1 in 6 on-call rota. Althoughthe 48-hour average working week is notbeing exceeded, the requirements for restperiods are not being met. The positionhas been compounded by the restrictionon SpR numbers in the specialty in recentyears; the increasing requirements of training programmes; and the gradualdiminution in trainee experience, resultingin increasing demands on consultants.

A number of alternatives were considered to bring the consultant jobsinto compliance, but all would have amajor impact in reducing clinical activity

by up to 20%. The trust was looking forways of enhancing quality, not just quantity, in the service it provides.

The trust carried out a study toevaluate the effect of an additional consultant working within one of the three consultant teams in the department.

The study focused on clinical activity,direct consultant involvement in the acuteaspects of patient care and the trainingand supervision of trainees. In addition itlooked at the acceptability of a new pattern of working which included being resident on duty at nights and weekends.

Comparing activity with the same teamlast year and other teams in the department over both years showed that,as well as ensuring WTD compliance forthe consultants in the pilot team, there hasbeen a dramatic reduction in the numberof outpatient clinics reduced, cancelled or

held without direct consultant supervision. This has had an important effect on

clinical activity. In addition, there has been a significant increase in the direct supervision of trainees - both in electiveand out-of-hours areas – and an increase in the number of patients seeing a consultant.

The changes have been well received bytrainees, nursing and midwifery staff aswell as the consultants themselves.

Contact Mr Mike Read at:[email protected]

Key messages

The trust was looking for ways of enhancing quality, not just quantity, in the service it provides

WTD overview

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Case studies



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Close toolkitGauging patient reaction to WTDThe Department of Health commissioned a programme of qualitative research tofind out more about how aware patientsand the public are about the WorkingTime Directive (WTD), and to identify thebest ways of engaging them in WTD implementation issues at national and local level.

Twelve focus groups were set up and 12in-depth, face-to- face interviews werecarried out across the country, covering thegeneral public, prospective patients waiting for treatment and regular users of out-of-hours and emergency services. The following is a summary of thefindings. You may find it useful in helpingto shape your own WTD communicationsactivities with patients and the public.

SummaryAwareness of current change within the NHS was very poor and none of the respondents had any understanding of new services or initiatives to promotequality of care, such as the new primarycare contracts.

However, reactions to the WTDinformation and the scenarios presentedwere generally positive:■ respondents saw the reduction in

doctors’ hours as obviously beneficial for patients

■ the idea of nurses taking a more high-profile clinical role was seen as logicaland sensible

■ flexible, team-based working was also seen as sensible and efficient –indeed, some respondents believed that the proposed changes would mean more resources for patients

and speedier treatment■ using new facilities and equipment,

as well as on-the-spot procedures, wasseen as modern and forward-looking.

Points of sensitivityAlthough the research indicated that thepublic would not be disturbed by newworking arrangements intended to give arange of staff more flexibility, there weresome points of sensitivity:■ new roles for nurses need explanation

and clarification – reassurance isrequired about their training and specialist knowledge

■ the possible absence of specialist doctors in key areas (such as paediatricsand A&E) needs careful management – otherwise an obvious reduction in carequality will be assumed

Key messages

Respondents saw the reduction in doctors’ hours as obviously beneficial for patients

Communicating with patients & public

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Close toolkitGauging patient reaction to WTD

Key messages

Respondents saw the reduction in doctors’ hours as obviously beneficial for patients

Communicating with patients & public

Points of sensitivity cont’d ■ care should be taken to ensure the

changes are not seen to be about saving money or compensating forstaff shortages by downgrading from expensive doctors to cheaper nursing staff

■ procedural changes to follow-up careand travel time for on-call doctors alsoaroused concern.

ConclusionsThe conclusions about the approach to communications suggest there should be:■ a local focus – talking about patients’

own GP practices and hospitals■ a rational message about necessary

re-organisation – emphasising that better working arrangements will meanthat all staff are now working to their

full potential for the benefit of patients■ a particular focus on promoting the new

roles of nurses■ a partnership between the NHS and

patients, with the NHS seeking to tailorcare for local needs and listening to thelocal population.

Key messages - the most positivelyreceived `ideas’ were:■ providing the services needed locally■ listening to patients■ providing care to suit patients■ a flexible workforce■ getting the most out of resources.

The most poorly received messageswere the ones that either:■ stated the WTD changes very plainly■ or emphasised aspects of NHS care that

the public assume should be provided as

a matter of course - a safe service, carefor everyone and a modern workforcefor instance.

Overall, the research shows that communications regarding the NHS andthe WTD should be relatively low-key, but reassuring. Providing that key uncertainties are tackled, including thosearound nurses and specialist care, then thelikely changes can be presented as broadlypositive. Respondents spontaneouslyassumed that a better service would result from the removal of over-tired hospital doctors. They were reassured bythe fact that staff will have the necessaryskills, training and experience to work differently and by the continued presenceof doctors in key care areas.

WTD overview

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Close toolkitWTD questions and answers

Key messages

The lessons learned through the WTD pilot sites will help other trusts manage change more quickly and effectively

Q&As

Q: What new roles can be used to helpreduce junior doctors’ hours?A: To determine which roles could help toreduce workload intensity of juniordoctors, we recommend that an analysis ofjunior doctors’ workloads is completedfirst. This will identify the tasks they areundertaking that could be carried out byother staff groups, and ways in whichworking practices could be improved. Forexample, bleep policies can be beneficial inhelping to control the workload of juniordoctors, and tasks such as taking drughistories may be able to be completed inpart by pharmacy staff. The Hospital atNight data collection tool can be used torecord the work of junior doctorsaccurately. See:www.modern.nhs.uk/hospitalatnight

Q: How can the pilot projects help us?A: The lessons learned through the WTDpilot sites will help other trusts managechange more quickly and effectively. Thepilots have produced a wide range ofprotocols, rotas, job descriptions,monitoring and audit tools and otherresources, all of which are available in anextensive ‘resource library’ at:www.modern.nhs.uk/workingtime/resources.The website also has regularly updatedprogress reports from each site, and willhave the final evaluation of each pilot as itfinishes.

Q: Are the pilot projects having anysuccess in achieving WTD compliance?A: Yes. Ten of the sites had alreadyachieved compliance in the pilot area byJanuary 2004. Ten have demonstrated

savings in junior doctors’ time that couldcontribute to new working patterns,enabling compliance to be achieved.

Q: Is this being achieved at the cost ofmissing other targets, or down-grading patient care?A: The Gloucester pilot has demonstratedthat the trust can achieve WTD compliancefor junior doctors while reducing waitingtimes for outpatient appointments,reducing cancelled operations and reducing waiting time for operations. TheKettering pilot has reduced time fromarrival in A&E to admission to the ward forpatients with fractured neck or femur by60%, and time from prescription toadministration of painkillers by 80%. TheBasildon & Thurrock pilot reduced the need for pharmacist intervention in

WTD overview

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Q&As

http://www.modern.nhs.uk/hospitalatnight

http://www.modern.nhs.uk/workingtime/resources

Case studies




The ‘Hospital at night’project


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Key messages

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Q&As In action: case study

Next steps

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Next steps

WTD overview

Q&As

Case studies






Close toolkitWTD questions and answersQ&As cont’dmedicine charts by 43%, to 4% of charts;they have also saved around 35 hours ofjunior doctors’ time per week. Overall, 8 of the pilot sites have been ableto demonstrate improvements to patientcare as a result of their project work.

Q: How have the pilot sites involvedthe public and patients in WTDimplementation?A: Pilots have tried to engage patientgroups in change at a strategic level in thetrust, for example by having a patientrepresentative on their project steeringgroup. Other methods have includedcontacting local voluntary organisations,involving the local media, holding specialpatient and public events and approachingPatient Forums. The Commission forPatient and Public Involvement in Health

(CPPIH) also has regional and nationaloffices that can advise.

Q: What measure should we be usingto track our level of compliance?A: You need to be measuring hoursactually worked by junior doctors,averaged weekly over the monitoringperiod, including hours spent resident on call, even if sleeping. This will be different from your measure ofcompliance with the New Deal for juniordoctors used to decide the banding of adoctor’s post. You need to continue tocollect that data for your bi-annual returns to the Department of Health.

Q: Can a trust simply ask juniordoctors to sign the ‘opt out’ of the WTD?A: Op-out waivers are not applicable to

doctors in training until 1 August 2004.Opting out of the Working Time Directiveis entirely voluntary, so no member of staffcan be required or pressured to sign up toit. As a result, it may not be possible toplan service delivery with certainty on thebasis of some staff being prepared to optout. Even if junior doctors opt out, theycannot exceed an average of 56 hours ofactual work per week - 72 hours including resident on-call time - as a resultof the New Deal.

Q: Will there be any funding in2004/05 to help with WTDimplementation?A: Yes. SHAs will receive money from theStrategic Change Fund to pump primework on achieving compliance. This will beallocated at the beginning of the 2004/05financial year.

Key messages


WTD overview

Q&As

Q&As

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Case studies






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Key messages

Did you know that more psychiatrists than any other specialty have been recruited as International Fellows?

Q&As In action: case study

Next steps





www.oncubineeret.co.uk

Next steps

WTD overview

Q&As

Case studies






Close toolkit

Key messages


WTD questions and answersQ: Is there any help to implementWTD for staff other than doctors?A: Other NHS staff should have beencompliant with WTD since 1998 (seeHSC 1998/204 on the DH website) –there is no programme in place now for other staff.

Q: Is there a simple guide to whatwe need to do to help new staff get up to speed?A: Yes. You can find an action planningframework, with links to all relevantdocuments and websites, on the DHwebsite

You might also like to use the algorithmproduced using lessons from the pilotprojects. See:www.modern.nhs.uk/workingtime

Q: Where can I find the guidancefrom the Department of Health on WTD?A: All the guidance issued by theDepartment can be found on the DHwebsite. This includes the original HealthService Circular relating to WTD (HSC1998/204) and subsequent guidance onmaking the necessary changes, togetherwith guidance on doctors’ workingpatterns and papers from the Academyof Medical Royal Colleges and the PostGraduate Medical Deans.

For more WTD questions and answers seeThe Department of Health’s EuropeanWorking Time Directive pages

WTD overview

Q&As

Q&As

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http://www.modern.nhs.uk/workingtime

http://www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/EWTDFAQ/fs/en?CONTENT_ID=4053234&chk=5%2BIfDI

http://www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/fs/en


http://www.dh.gov.uk/

Case studies


Q&As




Close toolkitContacts and useful links

Key messages

Contacts and useful links

Contacts:The Working Time Directive PilotsProgramme Team at the ModernisationAgency is providing support to the 20 pilot sites and sharing learning from the programme. ■ See the Modernisation Agency’s

Working Time web pages for more information on the team andcontact details

■ Or email Frances Neate in the WTDoffice in the first instance on:[email protected]

SHA and Workforce DevelopmentWTD contacts:■ Avon, Gloucestershire, Wiltshire SHA.

Maurice Hakkak:[email protected]

■ Bedfordshire & Hertfordshire SHA.Gloria Barber: [email protected]

■ Birmingham & the Black Country SHA.Andrew Snowden: [email protected]

■ Cheshire & Merseyside SHA. Jackie Howard & Steve McManus:[email protected]@chma.nhs.uk

■ County Durham & Tees Valley SHARob White:[email protected].

■ Coventry, Warwickshire, Herefordshire &Worcs SHA. Rachel [email protected]

■ Cumbria & Lancashire SHA.Lesley French-Wollen:[email protected]

■ Dorset & Somerset SHA.Mark Appleby:[email protected]

■ Essex SHA. Neil Sellen:[email protected]

■ Greater Manchester SHA.Mike Burgess & Yasmin Ahmed-Little:[email protected]@gwh.pgmd.man.ac.uk

■ Hampshire & Isle of Wight SHA.Judy Curson & Clare [email protected]@porthosp.nhs.uk

■ Kent & Medway SHA.Alison Hill:[email protected]

■ Leicestershire, Northants & Rutland SHA.Olivia Frings & Wendy [email protected]@lnrwdc.nhs.uk

WTD overview

Contacts & useful linksPage 1 of 3





















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Close toolkitContacts and useful links■ Norfolk, Suffolk & Cambridgeshire SHA.

David Wherrett & Cheryl [email protected]@nscwdc.nhs.uk

■ North & East Yorkshire & Nth Lincs SHA.Adam Wardle & Helen Smith:[email protected]@neynlwdc.nhs.uk

■ North Central London SHA.Kevin Wood & Celeste [email protected]@nclwdc.nhs.uk

■ North East London SHA.Simone Lester, Victoria Monaghan& Astrid Thomas:[email protected]@[email protected]

■ North West London SHA.Alan Wishart:[email protected]

■ Northumberland, Tyne & Wear SHA.Jill Smth:[email protected]

■ Shropshire & Staffordshire SHA.Robert Bott:[email protected]

■ South East London SHA.Isobel Wroe & Jeff Lynch:[email protected]@selwdc.nhs.uk

■ South West London SHA.Sue Hitching & Deborah Fuller:[email protected]@epsom-sthelier.nhs.uk

■ South West Peninsula SHA.Georgia Jones: [email protected]

■ South West Yorkshire SHA.Dr Chris Bentley:[email protected]

■ Surrey & Sussex SHA.David Colley:[email protected]

■ Thames Valley SHA.Janet Polson & Sarah Darby:[email protected] [email protected]

■ Trent Valley SHA.Jane Johnson & Kate Caulfield:[email protected]@nottingham.ac.uk

■ West Yorkshire SHA.Jacky.Doyle & Barbara Willard:[email protected]@yorkshiredeanery.com

Key messages


WTD overview


http://wwmailto:[email protected]/workingtime

























Case studies


Q&As




Close toolkitContacts and useful linksUseful web links:■ See the Department of Health’s

European Working Time Directivepages for guidance and good practice; information about the pilots;and a range of tools for achieving WTD compliance

■ www.modern.nhs.gov.uk/workingtime for the NHSModernisation Agency website on theWorking Time Directive PilotsProgramme, including an extensiveresource library

■ www.modern.nhs.uk/cwp, for theNHS Modernisation Agency website onChanging Workforce Programme

■ www.rcplondon.ac.uk/news/ewtd.asp, for the Academy of RoyalColleges’ agreed statement on the ‘Outof Hours Medical Team’ (OoHMT)

■ www.modern.nhs.uk/hospitalsatnight, for NHS Modernisation Agency website on the ‘Hospital at Night’ Programme

■ www.modern.nhs.uk/esc, for NHS Modernisation Agency website onthe Emergency Services Collaborative

■ www.mmc.nhs.uk for theModernising Medical Careers website NHS Modernisation Agency website on Modernising Medical Careers Programme

■ You may also find that a number ofindividual Royal Medical Colleges, suchas the Royal College of Surgeons, havepublished position papers on the WTDon their own websites

Key messages


WTD overview


http://www.modern.nhs.uk/esc

http://www.modern.nhs.uk/hospitalsatnight

http://www.rcplondon.ac.uk/news/ewtd.asp

http://www.modern.nhs.uk/cwp

http://www.modern.nhs.gov.uk/workingtime

http://www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/EWTDFAQ/fs/en?CONTENT_ID=4053234&chk=5%2BIfDI

http://www.mmc.nhs.uk

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