Unless you live in a cave I am sure you will all be aware of the current level of discontent among doctors. Most of the discontent is being brought to a peak because of the contract “re-negotiations”, however beneath the headlines lie the same old issues that plaque a doctors working life.
Warning: this is about to become a rant…
A few days ago, a friend of mine asked me to look at their rota for their next job. The job is a 1a banded job doing acute medicine at a small hospital, that is part of a larger trust. The banding of 1a reflects the number of hours worked (40-48h/week) and the level of anti-social hours (>1/3) which correlates with an increase in pay above the base rate. So in effect this “contract” means that a doctor will be working 48h a week with on average 1 night and 1 weekend shift a week.
So far, so average, where is the rant I hear you ask?
If I were to say that 2 people were contracted to work the same hours and the same proportion of antisocial work, you would assume that they would get paid the same right? And vice versa, if I were to say one person was told to work more shifts, more antisocial hours and have less time off, that person should be paid more, correct?
Apparently not! The NHS seems to think it's perfectly fair to force some doctors to work more than their colleagues for exactly the same pay and sometimes less time off. How can this be fair? How can this be legal?
My friend sent me their rota on an Excel spreadsheet and within 10 minutes I was able to create the following table 1:
This table clear displays the total number of on call shifts for each junior on the rota, it shows their “zero hour” rota’ed off days to make them EWTD compliant, it also shows the “net” shifts which is the total minus the off days. It was not difficult to work out the mean number of shifts and off days per doctor. The cells highlighted in blue are the doctors who have got a “good” deal, by random chance they have less on calls and more off days than their fellows, while still getting the exact same pay. The cells highlighted in red are those who have got a “bad” deal with more on call shifts AND less days off. This rota is clearly NOT FAIR!
Every shift on this rota could be easily covered if 6 doctors worked 13 shifts and 3 worked 14 shifts. There are 3 antisocial shift groups, therefore 3 doctors take the extra shifts in each block, as seen in the below table.
Table 2 clearly shows that all of the shifts can be easily covered by a simple change in rota that now makes the rota completely fair, with equal antisocial hours, equal shifts and equal time off. Working this out has taken me exactly 20 minutes, including colour coding and table formatting. If I can do this then why can’t the rota “administrator” (NOT A MANAGER!!!)?
Why is it the “done thing” that rota “managers” are allowed to bully hard working doctors into accepting unfair rotas?
From personal experience, when these issues are raised with the incompetents in question they have a number of stock answers for dismissing any complaints. Here are a few:
“Doctors should get used to unfair rota’s as this will always happen, and is a random process, so at some future point you might end up doing less work with more time off, so don’t complain now.”
“The shifts can’t be organised any other way” – Please see table 2.
“The rota software won’t let us change the way the shifts are allocated” – then don’t use that software, use an Excel sheet that is perfectly plastic.
“The rota is calculated over x weeks (could be 9, 17, 23 or 56 weeks) and therefore if you stayed here longer it would all work out fairly.” – Junior doctors ALWAYS work the same number of weeks in each job. For Foundation doctors it is ALWAYS 4 months!!! Sooo… get off your lazy arses and write a NEW rota that works over 4 months, NOT 7.3 months or so other ridiculous, random length.
“The EWTD and New Deal don’t dictate individual doctors’ hours, only “rota” hours (averaged out over all doctors on the rota), therefore we don’t have to change anything, you just have to accept what we give you.” – I don’t care if the EWTD and New Deal are poorly written and designed, and so full of loop holes that they are almost entirely meaningless. It is lazy and CALLUS to force people to work harder for less money just because the rota is “technically” compliant with the law. It still feels illegal to me to make 1 individual work more hours and get paid the same as someone working less than them.
Rota’s are a constant issue for junior doctors, no matter what the technicalities of the exact contract are. Is it surprising that the morale of junior doctors is at an all time low when they are forced to work in conditions like this? The NHS bureaucracy is callus, lazy and full of “job’s worths” who couldn’t find their way out of a paper bag. These people should not be employed! They certainly should not be left in charge of organising a rota and they most definitely should not have a veto on the lives of over-worked, under-paid junior doctors. If I was ever put in a position of authority in an NHS organisation, on my first day I would FIRE the entire rota department and then hire just 1 intelligent individual to do the work of the current 10, but pay them a larger salary to actually attract someone who knows how to use Excel efficiently.
If I could make one plea here it would be for the NHS to give clinicians the power to design and control their own rotas. I would happily take on the responsibility of being in charge of the rota for whatever job I am working on and I am almost 100% sure that I would be able to make the normal working life of junior clinicians less stressful and improve their morale by letting them work in an environment that they think is fair and cares about their welfare. Is it too much to ask to be allowed to work in a FAIR working environment?