Hospital changes as a result of reduced NCHD working hours

drzhivago

In Hospitals with 24 hour A&E there are essentially two hospital systems
Elective system - Outpatients/clinics/day wards/ elective theatre cases / endoscopy rooms / multipdisciplinary team meetings / case conferences / xray conferences / etc
Emergency system - predominantly arises from patients admitted to A&E, can happen 24 -7 but bulk of this work 8am-10pm (not in teh A&E but in the hospital when the patient is admitted), the type of work here is true emergency surgery, delayed emergency surgery, stabilisation surgery, admissions to ICU/Coronary care/ acute admissions with serious medical conditions

what the HSE dont say in their press releases is that the BULK of work in a hospital is not emergency work but elective work

Millions of patients go to out patients appointments annually, these are all scheduled Monday - Friday 8am-6pm generally, very rare to go beyond that
day surgery/Day procedures are booked Mon-friday same as above

NCHDs or Junior doctors are doctors training to become specialists. If they want to be a cardiologist they need to be present at
out patient clinics to see the range of problems people can have
procedure clinics where stress tests are done to understand how to perform and interpret the stress test
ECG clinics where patienst gets ent in from GPs either with ECGs they are worried about or to get an urgent ECG on a patient they are worroed about
theatres sessions to learn how to do angiograms - the technical skill
angiogram reporting sessions - to learn how to interpret the tests above (different to actually doing the test as it is read later)
ECHO clinics to learn how to do and interpret ECHO cardiology Ultrasound tests on the heart
surgical case conferences with cardiac surgeons to learn which patienst will benefit from surgery or not as the case may be
patient counselling sessions to learn hopw to deal with the different psychological issues that affect patients and their families when given a serious diagnosis and how to deal with same

All of this above list happens during hours of 8am-6 or 7pm and Monday to friday as it is elective work

It is during these hours that the junior doctors learn how to become a specialists cardiologist. If they are not there at those times how do they become trained to be a cardiologist

The Hospitals also have a requirement to run an emergency service over the rest of the 24 hour period. From a cardiology perspective the types of presentations that arise here are
Chest pain
heart attacks
Very high blood pressure
severe heart failure and very low blood pressure
very fast heart rates
very slow heart rates

These are the main types of problems and there are others but these are the most common. They can present any time of the day or night. It is one aspect of learning to be a cardiologist, an important one but only one aspect

The Hospital managers see this as a more urgent problem for them as they do not have arrangements where they can roster consultants over the 24 hour clock, mainly because they do not have enough consultants

The recent deal in the labour court allows them to roster NCHDs at any time of day or night with no guarantee of how much time they will spend doing the elective work as outlined above

It will mean less junior doctors around during the day period of a hospitals activity as hospitals strive to guarantee they have a minimum level of cover available in a 168 hour week when they can only roster junior doctors to work 48 hours.

Up to now in many hospitals these doctors will have been working 70/80 or more than 90 hours depending on where they work

Yes many of them will lose money, some will lose a lot BUT there are no additional junior doctors being hired. there are certainly not going to be additional consultants hired between now and 1st august

9 years ago HSEA undertook to hire additional staff to do ECGs, to take blood etc in hospitals so that junior doctors would not have to do taht and it would have helped to reduce their hours without reducing the amount of actual medical work they needed to do

Again this has not happened

So the position as it is

The Junior doctors hours are being reduced
No replacements have been hired
most patients going to clinics are treated by junior doctors so less people will be scheduled for clinics and waiting lists will grow unless there are additional consultants hired urgently


OH and BY THE WAY

For a hospital to get an additional consultant they have to drop 2 junior doctors

So currently 6 junior doctors and 2 consultants
Each junior doctor working 70+ hours per week (6*70 + 2*40)
Come August junior doctors hours cut to 48 = 6*22 hours less in system

get an extra Consultant = lose two more junior doctors = lose 96 more hours

Now 4 junior doctors * 48 hours
3 consultants * 40 ish hours on site

whatever way you look at that each service in a hospital will lose a lot of medical hours without any replacements

It is being put across as doctors trying to preserve OT but if they didnt do the OT there would be no service and OT was mandatory

If they hired 2,000 extra junior doctors no need for OT BUT there is a ban on hiring additional junior docs


Clinics will either reduce the numbers of patients they can see, reduce the number of clinics they run in a week or else close access to clinics when waiting times exceed a year

WE ARE GOING TO HELL IN A HANDBAG of the Mary Harney variety

Dont blame the docs for this it is not our fault

AmcD

There is so little point in having fewer NCHDs around in the daytime. This is when all the other healthcare staff are around (physios, OTs, cardiac technicians, radiographers etc etc). Daytime is when most of the work gets done because everybody is present.
So now there will be NCHDs doing shifts around the clock. Ironically the ones present outside 9-5pm will have less to do because they will be limited in the services they can access.
I dread to think what the outpatient clinics will be like. God forbid anybody takes holidays/does exams/gets pregnant.

Traumadoc

A lot of the reduction in Junior staff hours will be used to "reconfigure services"
Essentially closing acute services and concentrating them in bigger hospitals. initially smaller country hospitals but eventually they will limit emergency rooms to 4 hospitals in Dublin.

drzhivago

AmcD wrote: »

There is so little point in having fewer NCHDs around in the daytime. This is when all the other healthcare staff are around (physios, OTs, cardiac technicians, radiographers etc etc). Daytime is when most of the work gets done because everybody is present.
So now there will be NCHDs doing shifts around the clock. Ironically the ones present outside 9-5pm will have less to do because they will be limited in the services they can access.
I dread to think what the outpatient clinics will be like. God forbid anybody takes holidays/does exams/gets pregnant.

Along with all the new roster changes are new permission forms for leave etc

Any NCHD who requests maternity leave must do so 1 year in advance in writing and produce documentary evidence the baby is actually theirs before maternity leave will be granted with a 10 month delay in application processing

Hmmmm

drzhivago

Traumadoc wrote: »

A lot of the reduction in Junior staff hours will be used to "reconfigure services"
Essentially closing acute services and concentrating them in bigger hospitals. initially smaller country hospitals but eventually they will limit emergency rooms to 4 hospitals in Dublin.

I think you may be right about the reconfiguration bit but the time scale doesnt really allow for that

They want these new rosters in for July 1st per the High court and Labour court

As a senior doc trauma I hope you have an idea about the rostering because I think he/she who shouts loudest in next few days is going to get their way on this

Traumadoc

I leave my senior co workers to worry about that little nugget.;)

drzhivago

The art of delegation has not left you then

Traumadoc

It has not been delegated to me yet. Although I fear the day may be coming soon.

PoleStar

Heres another interesting quandary:

What if I call in sick?

My colleagues cant cover (too many hours).

Get a locum?

But sure now we are only registered to work in our training post.

Hmm......

beeno67

PoleStar wrote: »

Heres another interesting quandary:

What if I call in sick?

My colleagues cant cover (too many hours).

Get a locum?

But sure now we are only registered to work in our training post.

Hmm......

No. the rest of the team carry on without you. Pretty much the same as happens today.

PoleStar

beeno67 wrote: »

No. the rest of the team carry on without you. Pretty much the same as happens today.

Ya I had kinda thought of that.

But say with that, what if its OPD, and due to rostering for example, the consultant gets landed on his own?

But anyway, getting away from that, what I was really referring to was, what happens if I am sick on Saturday?

No one else to cover. No one CAN come in to cover due to restricted hours.

No locums anymore due to silly medical council rules.

drzhivago

PoleStar wrote: »

Ya I had kinda thought of that.

But say with that, what if its OPD, and due to rostering for example, the consultant gets landed on his own?

But anyway, getting away from that, what I was really referring to was, what happens if I am sick on Saturday?
No one else to cover. No one CAN come in to cover due to restricted hours.
No locums anymore due to silly medical council rules.

about the locum if you are in an SHO /REG/SPR post there are locums, medical council has not stopped them

The locum will be on the general register and hospital must be satisfied they are experienced to carry out the job but there are locums available the issue really will be will the hospital go looking for an external locum that will cost them money and that will be down to the NCHDs on the ground and the rostering committee in the hospital and whichever admin person is on call at weekends to deal with gaps in rotas.

drzhivago

Traumadoc wrote: »

It has not been delegated to me yet. Although I fear the day may be coming soon.

Fear not the great leap into the abyss of rostering
It leads perchance to hope of fostering
systems of training we can all rely on
to bring junior to senior without indecision

RobFowl

PoleStar wrote: »

Ya I had kinda thought of that.

But say with that, what if its OPD, and due to rostering for example, the consultant gets landed on his own?

But anyway, getting away from that, what I was really referring to was, what happens if I am sick on Saturday?

No one else to cover. No one CAN come in to cover due to restricted hours.

No locums anymore due to silly medical council rules.

People on the general and spediaclist register will be allowed do locum work. I fear it'll lead to an underclass of professional locums who will have no route towards the specialist register (hang on thats how we treat our non EU solleagues already )m

PoleStar

RobFowl wrote: »

People on the general and spediaclist register will be allowed do locum work. I fear it'll lead to an underclass of professional locums who will have no route towards the specialist register (hang on thats how we treat our non EU solleagues already )m

Here here, I totally agree with this.

Sad times I see ahead for all.

drzhivago

RobFowl wrote: »

People on the general and spediaclist register will be allowed do locum work. I fear it'll lead to an underclass of professional locums who will have no route towards the specialist register (hang on thats how we treat our non EU solleagues already )m

There is a route to specialist register but many seem afraid to ask about it

It arose from Buttimer

Trainee can ask to have their cv and experience evaluated, the particular college then must identify areas of deficiency in training and suggestions how to rectify those

As these are training job and meant to be individual for the trainee there is also meant to be a mechanism whereby someone in this position can secure a job which will help satisfy requirements to get on register

a few have taken this route and succeeded

i am surprised more havent tried

drzhivago

Now the ballot has passed, just got the email from the IMO, it is time for us to put pressure on hospital management to put money where their respective mouths are and show the public how they are going to run the service with at leats 30% less clinical hours from NCHDs

RobFowl

drzhivago wrote: »

There is a route to specialist register but many seem afraid to ask about it

It arose from Buttimer

DrZ is correct here. There are GP's who are not vocationally trained who have obtained access to the specialist register through a CV evaluation.
My concern is that certain groups of doctors will end up in limbo condemed to a lifetime of non approved ex NCHD jobs.

drzhivago

RobFowl wrote: »

DrZ is correct here. There are GP's who are not vocationally trained who have obtained access to the specialist register through a CV evaluation.
My concern is that certain groups of doctors will end up in limbo condemed to a lifetime of non approved ex NCHD jobs.

As the GPs above did so should these NCHDs
If the particular training body says the doctor needs 1 year or 2 years focussed training the role of the hospital/hse should be to ensure that this actually can be facilitated in their working environment

If it cannot can that particular job be a training job at all

The reason NCHDs have been outside the terms of the working Time directive for so long was because ALL of the posts were supposed to be training jobs, if that is not the case then the individual NCHD would have recourse to the courts on the basis of false advertising and also breech of Working Time Acts etc for a prolonged period.

Might not get all they want out of it but could get something

DrIndy

I got an e-mail from the RCPI recently rejecting the new working arrangements - shame they decided to lump in long after the debate and not provide more public support earlier.

drzhivago

DrIndy wrote: »

I got an e-mail from the RCPI recently rejecting the new working arrangements - shame they decided to lump in long after the debate and not provide more public support earlier.

Such a shame
They were on
Manpower Forum
Taskforce on medical staffing
Hanly
Buttimer
NIG

as far as I know they didnt raise those concerns there from the way these reports are written

I would think it more likely they are getting flak now from consultants wanting RCPI to stand against it

This is all they can do

Go to RCP London website and they have detailed documentation and section of site dedicated to EWTD shows the effort they have put in to offer guidance to their fellows and members

Go to RCPI site and what do they have, this single document released yesterday 5 weeks before the final implementation of the Law in ireland, 5 years later it began to be implemented. Their advice and recommendations dont even come close to what the Law was 5 years ago let alone today or the final Law in 5 weeks time

whats the story really???