We’ve all been slaves to a rolling rota. Whenever my wife and I change jobs we have to spend about 2 hours simulating the compatibility of various slots to work out when we can do flippant things like pick up our child from nursery, or go on holiday together. We are all used to stories such as having to fight for time off for your own wedding, or having to work nights during paternity leave, losing annual leave allowances because there is no ‘space’ for you to take it. We’ve all been there.
Time to come clean. I found another way. It took me 6 months, and it’s not perfect, but it works better than being a slot-slave. I’m not entirely sure medical personnel know what we’ve done, (they might know in a ‘don’t ask don’t tell’ kind of way). Cats out of the bag now, toothpaste well and truly out of the tube.
I can let everyone have what leave they want, WHENEVER they want it, AND we’ve improved cover in the department AND we’ve decreased the amount of shifts that we need locums for.
I took over running the Registrar rota at the hospital that I work at in July. We had a system whereby a genius registrar (who is now a consultant) looked at everyone’s requests and made a bespoke monthly rota that covered our nights, weekends, study leave and annual leave requests perfectly. I have no idea how she did it (I suspect she filled in all of the gaps herself).
I was semi-forced to take over. No one else wanted to do it, it was during the period of new junior doctor contract imposition, and HR were not happy with us continuing the old system. We had to have a rolling rota.
In June 2015 I met with the medical staffing person and devised two rota templates. One was for ‘proper’ regs (people you could leave in charge of the department overnight) and one for fellows (CT3s, Medical sprs, F3s and the like). At the meeting I raised self rostering. I was told that it was impossible given the complexities of the new JD contract.
I thought I’d been quite canny. I built a rota that had an 8 week cycle, had a combination of nights, 17-02, 13-23, and 8-6 shifts. The OOH work was clustered and the day shifts occurred during a 3 week period, so if people wanted a long period off they could get it. Now providing we were full we would have 2 doctors at least on during OOH, and up to 6 on during the day (I imagined a lot of people would take their AL then, so they’d be less). I’d also used the two rotas to mean we didn’t have to do 3 in 8 weekends (fellows would do day weekends and 1-11’s would be done by HSTs).
I also decided that i’d let people pick a new slot on the rolling rota every 8 weeks so they could fit in with important events. I also built in enough redundancy that people would be able to take AL on most shifts (apart from nights) as long as their ‘partner’ was covering the shift.
|Fellow rota – for OOPE, Medical rotations, Non-training grades who don’t do solo nights|
|Senior Reg Rota 3 (Modified) – HST’s only.|
The rota assumed we had 16 doctors (8 HST, 8 Fellows). Had we had that many full time equivalent’s things would have been peachy. However the reality was I had 7 HST FTEs, and 7 Fellows. 2 HSTs were imminently about to go on mat leave. I had 1 fellow who was 50% clinical and was doing doctoral research, one fellow who was 70% clinical doing education who couldn’t work the rolling template because of educational commitments, and a GP currently negotiating his contract which would be 50% in PAs and not compatible with the rolling cycle. I had two F3 fellows on an 80:20 education split who also had odd educational day requirements for their certificate in med ed that didn’t fit with the rota. On top of that I had also been asked to see if we could dovetail ACP support into the rota so we could spread our resource more efficiently. Again they couldn’t fit into a rolling rota based on JD contract as they were on the agenda for change contract which is based on a total of 40 hours, minus non-clinical commitments.
I created the first rota which worked (just about) but it was terribly threadbear in places. There were a number of night gaps where consultants had to act down and people who were paired with an empty slot couldn’t really take leave, or they could but would leave the department dangerously short staffed (which annoyed them because others could take leave). We had only one spr on 1-11 most days, and there were day shifts when we had 3 or 4 doctors on (usually on tuesday and wednesday when we didn’t need it).
I persevered, but the second cycle was worse (Sept – Nov). Another HST had CCTed, so our numbers dropped even further. Our rota gaps got worse; I had 24 nights with little cover, 3 empty weekends (out of 8). Looking ahead towards christmas I realised a few things:
a) Everyone was going to try and pick a slot that avoided Xmas.
b)The rota was going to very light over that period which would affect patient safety.
c)There was no ability to increase coverage over xmas shifts above what the rolling rota had already set up. We could only get ‘extra’ doctors by getting locums in.
Sometime in early October I decided that the best thing to do about Christmas was to make people pick shifts, working out how I would do this gradually morphed into the self rostering system we are using at the moment.
Now most of the stuff I’d read about self-rostered rotas was based around annualising and consultant working. Everything was in PAs, and no one had managed to set up and run a self-rostering rota with doctors on the new JD contract. All of the places that had one were in hunt free zones, or using trust grade contracts (which are like the old JD contract).
At some point in October I had a moment of inspiration; as the new JD contract is based on the split between social and antisocial hours during a reference period if everything averaged out over that reference period the shift pattern wouldn’t matter.
Our reference period was 8 weeks. During that time there were 7 nights, 5 late shifts (5-2), 7 mids (for HSTs, 5 for fellows) and 12 or 14 day shifts. Including in that count was one weekend daytime shift. As long as people kept to those shifts they could do them in any order and everything would be ok. It mattered less what the split was for people on trust or old contract, as the ‘1A banding’ is a pretty broad church.
|So in 8 weeks||HST||Fellow||Fellow 80:20||Fellow 70:30|
|Nights (22-08:30)||7||7||7||7||inc 1 weekend|
|Days (8-18)||12||14||8||5||inc 1 weekend fellows|
|Mids (1-23)||7||5||5||5||inc 1 weekend HST|
|Total Clinical shifts||30||31||25||22|
(You might have noticed I got rid of 10-20 shifts, no one liked them, and they were *NEVER* filled.)
I emailed all the doctors on the rota and explained the plan. We would have a rota meeting, people would have complete freedom to pick their shifts.
I drew up the rota using google sheets and I realised something quite fundamentally important.
A rolling rota is an inefficient way of spreading resource.
Looking at the rota we wanted two people on nights, 1 on a 5-2, 2 on a 1-11 and 2 on a day shift. Now my rolling rota plan had redundancy built in so that sometimes they’d be 2 people on a 5-2, or up to 6 on during the day to account for study and annual leave. If we were self rostering we didn’t need that. This meant that we could radically change the pattern of shifts on offer based on demand within the department. We needed fewer doctors to guarantee the same level of cover.
I looked at Christmas, and added extra shifts all over. For example I put an extra 5-2 on for New Years Eve which was a Saturday, where we normally wouldn’t have that shift, and I did similar things with boxing day and christmas week. Increasing our numbers during 1-11 to deal with increasing demand (as the rest of the NHS was closed).
Then I looked at the rolling rota job plan for each doctor. I turned this into a balance of different types of shifts; Nights, Lates, Mids and Days. We give everyone non clinical days but I didn’t count these, as I was only concerned with providing cover for the department. I totalled up everyone’s contribution which gave me a pool of shifts.
This is what I had
|TOTAL MG CAPACITY||345||-15|
|TOTAL NIGHT CAPACITY||88||-24|
|TOTAL LATE CAPACITY||62||14|
|TOTAL MID CAPACITY||68||-34|
|TOTAL DAY CAPACITY||127||29|
I had 360 shifts in total to allocate, I was only down by 15, however there was a discrepancy as to where these shifts were. I had more days and lates than I felt I needed, and I was down by many mids and nights. This also allowed me to explain where I thought gaps would be before the rota had been written.
We’d had a long standing agreement to compensate people for extra night shifts – essentially getting a lieu/training day, instead of having to work on the shop floor. I was allowed to continue offering this deal to cover more night gaps.
I was very nervous on the day of the rota meeting, I had my google spreadsheet and the giant pages of rota, with stickers representing everyone’s shifts ready. I had a powerpoint with a brief explanation of what we were doing, and a flipchart with Jeremy Hunt’s safe rostering rules. I had got permission from the consultant body to get EVERYONE on my rota into a room for 2-3 hours to construct the rota. One person even took part via whatsapp (they were in New Zealand).
The meeting ran well. We started with christmas. I didn’t let Christmas go until we had each contributed 8 shifts to the two week period around it.
A funny thing happened…
It worked. No big arguments. That was it. It took about 3 hours, but our coverage smoothed out. There were no days with 5 people on day shifts, and no one on during the night. Despite there being fewer doctors in this 8 week cycle than the last, the coverage got better.
Everyone got the time off they wanted and Everyone got their study leave.
We’ve done this 3 times now. We are in self roster cycle 3. HR kind of know. I’ve been able to fold in a GP, and the ACPs because their contribution to the rota is worked out, and THEN they contribute to it, not trying to shoehorn them into a slot. Things have become easier for our fellows too. Their project work is easier to organize because they’ve not got to squeeze it into a rolling rota. It also means I can accommodate wierdo doctors too. We’ve just added someone who doesn’t work monday or tuesday because they are dissecting corpses (I think for educational reasons, AND they are 60% LTFT). How would you even fit that into a slot? LTFT trainees don’t need to slot share, they can just provide a pro-rata’d amount of shifts.
In my original rota I had 360 shifts to allocate, in this current rota I’ve got 394 as we’ve added in more 1-11 and 5-2 shifts during busy periods we need, but not when we don’t. Each rota cycle the pattern of shifts can change to allow for special events. We’ve still got gaps (21 shifts available from 12th of march to 6th of May) but nothing like we had before. I’m also able to support more SL and AL requests (50 days of AL between everyone this cycle).
Now I’m not saying that this system is perfect, far from it, but doing it this way improves morale, training opportunities, and coverage while simultaneously reducing locum spend. I’m also very thankful for the support and latitude I’ve received from my local medical staffing team, consultants and our operations management team.
So if you are a slave to a rolling rota, break free. If you are a rota-master – make your life easier; try something like this.