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WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY SENATOR S.C. FERGUSON
ANSWER TO BE TABLED ON TUESDAY 29th MARCH 2011
Question
Will the Minister refer to her answer to Question 6123 on 15th March and confirm the arrangements for work on a rota for Middle Grade doctors? Could the Minister advise whether the Middle Grade doctors in Ophthalmology undertake on call' work?
In all the specialties where Middle Grade doctors undertake "38.5 normal working week plus on - call duties 1 week in 2 weeks" or "40 normal working week plus on-call duties 1 week in 4 weeks" or "40 normal working week plus on-call duties on a 1 in 5 rota" etc what is the maximum number of hours on call a Middle Grade doctor may undertake per week when all team members are present, and what is the maximum number of hours on call a Middle Grade doctor may undertake per week when there is staff absence due to sickness, annual or study leave?
In what circumstances, in each specialty listed in the reply, are locum doctors appointed to cover staff absence, and in what circumstances, in each specialty, are Middle Grade doctors contracted to cover staff absence?
What, in each specialty listed in the reply, are the arrangements for day time rest after a night on call?
Answer
Different medical specialities have different levels of demand across any given day and therefore it is not possible to provide fixed answers relating to maximum and minimum hours per week as these will be subject to variation.
Middle grade doctors who participate in the provision of out of hours' services are either resident on-call (ie. in the hospital) or perform their on-call duties from home (non-resident). Resident doctors tend to work in hard pressed specialties and work full shift patterns, with a maximum 13 hours on duty followed by an 11 hour period off duty, during their on-call week. Specialties operating a resident full shift system are General Medicine, Intensive Care and Emergency Medicine.
Non-resident on-call is appropriate for specialties which are less hard-pressed and afford the doctors substantial rest periods during the out-of-hours shift. Typically, the doctors would cover their normal working day duties but may also provide on-call cover after 5pm or at weekends. Total actual hours on duty' could reach 100 hours per week when doctors are rostered to cover the weekend however, on average non-resident doctors would expect their actual hours of work' to range between 40 and 60 hours per week dependent on the whether they are rostered for on- call at weekends.
There is a clear distinction to be made between actual hours of duty' and actual hours of work'. General Medicine middle grades participate in a week of nights every eight weeks, totalling 91 hours during that week. In other weeks the hours are significantly less and would bring their average hours below 51 per week over the eight week cycle.
This is typical of the working arrangements for doctors across the UK when it is anticipated that for at least half of the on-call shift, the doctor will be inactive and resting.
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All middle grade doctor working arrangements include one half-day off duty per week to compensate for high frequency on-call commitments.
Most middle grade doctors are contracted to provide prospective cover for planned absence (annual and study leave), meaning doctors cover each other out of hours to maintain 24-7 service provision. The exceptions are Obstetrics & Gynaecology and Paediatrics, where gaps in out of hours' cover due to planned absence are provided by agency locums.
Middle grade doctors are not contracted to prospectively cover for unplanned absence (e.g. sickness) but can be asked if they would be willing to cover colleagues in unforeseen circumstances for additional remuneration. Doctors agree to provide additional cover on a voluntary basis, appreciating the need to provide 24-7 cover and continuity of care for our patients.
Middle grade doctors in Ophthalmology do participate in on-call rotas and are rostered to backfill and cover Consultants who are absent on planned leave.