Standards for safe staffing ?

As we all know the next Industrial Action by Junior Doctors will be at the end of the month. I know from a personal viewpoint and as a member of UK-Consultants Committee that the BMA regret that this action has become necessary and the “Senior doctors delivered emergency  care”  for the end of this month will need a lot of planning by the management,

The BMA Industrial action guidance for non junior doctors can be found at

https://www.bma.org.uk/-/media/files/pdfs/working%20for%20change/contract%20negotiations%202015/2016/20150832%20guidance%20for%20hospital%20docs%20not%20involved%20in%20ia%20v8.pdf

The BMA are being and would like to be seen as being responsible in these difficult times and help to reassure juniors who are concerned about a full withdrawal of their  labour . The principles should be in general a one-for-one replacement of all juniors by appropriate consultant or SAS doctors who have the right current skills or can be made current. Each of these Doctors must be identified and specifically named in advance. There should be absolute clarity for all crash teams. It is not safe for people to be expected to do two tasks (eg  simultaneously doing a clinic and also be covering an absent on-call junior).

It would be hoped that the Chair of the Local Negotiating Committee of each hospital would be kept informed of the following by MD/Management:-

  1. Has every emergency role normally filled by a junior doctor got an identified person filling it for the planned days of action? The LNC should be allowed to see the list of names.
  1. Has everyone filling an emergency role in place of a junior doctor been briefed about their role and who else they will be working with? (e.g. who else will be turning up to cardiac arrests to join them)
  1. Has everyone filling an emergency role in place of a junior doctor been formally released from their non-emergency work for that period?
  1. Has everyone filling an emergency role in place of a junior doctor been trained with any additional skills they might need (e.g. how to complete electronic discharge summaries)?
  1. Has appropriate planning been carried out in elective care to work out what realistic levels of elective care can be provided without compromising the emergency cover?
  1. Have non-medical staff been briefed about the IA and the Trust’s response to it and how they can access emergency support for their patients during the IA? (e.g. nurses to be told they can bleep the usual on-call bleep numbers as needed, etc.)
  1. What arrangements would the MD like to make around calling staff back in if a major incident occurs? (i.e. the same approach as last time)

Official updated BMA guidance may well come out. As a Consultant Histopathologist I am “past my sell by date” to offer clinical guidance in most areas however one of my clinical colleagues on UK-CC did give an example: –

“Minimum advised standard for safe staffing – during full withdrawal of junior doctors labour”

Cardiac arrest team:
Led by resuscitation officer = medical registrar role in terms of ensuring protocol followed;
Outreach nurse;
Named anaesthetics consultant/SAS = airway;
Named medical consultant/SAS = medical registrar role (might be most appropriately an acute medicine consultant or a medical consultant who has recently obtained CCT or an SAS doctor who would anyway have the role or who has the appropriate current skills);
Named intensivist consultant/SAS;
Nurses, ODP etc as usual.

Paediatric crash team:
As above except named paediatric consultant/SAS = paediatrics registrar role (again, if a consultant might best be a recent CCT, or someone who is an APLS instructor, etc)

Trauma team:
Led by named A&E consultant;
Named orthopaedic consultant/SAS;
Named surgical consultant/SAS;
Named anaesthetics consultant/SAS;
Named intensivist consultant/SAS;
Nursing staff/ODP, resuscitation officer as usual;
Resus officer if currently attends in trust.

Neonatal crash team:
Resus officer lead;
NICU/SCBU nurse;
Named paediatrics consultant/SAS – paediatrics registrar role (leading the resuscitation);
Named anaesthetics consultant/SAS for airway management;
Named paediatrics consultant/ SAS – for procedures and intubation if required (in some cases paediatrician may be more confident in intubating a neonate than the anaesthetist – but the anaesthetist would then be able to take over maintaining the airway and ventilation).

Maternal arrest:
Everyone from crash team, everyone from neonatal team, named cons obstetrician, named midwife, nursing staff etc

Major haemorrhage:
Named consultant/SAS haematologist

Ward teams – 3 doctors for every ward:
Named consultant who will lead the ward round (morning session – can be released for different afternoon activity if usually done)
Named consultant/SAS x2 (for ward team) – must stay on ward all day as per juniors

ICU:
Consultant staffing as usual
One-for-one replacement of absent juniors with anaesthetic/intensivist consultant/SAS

A&E:
Nurse triage direct to appropriate speciality on-call team, discussed with A&E consultant first if unsure of which speciality
If no clear specialty seen by A&E consultants and SAS
On-call speciality teams: one-for-one replacement of usual on-call juniors for every speciality by consultant/SAS doctors – and those doctors to be present in A&E (as there may not be sufficient A&E SAS/consultants to cover for absent A&E junior doctors)
Nurse/other staff as usual

Haematology/oncology day unit:


Named haematology consultant
Named oncology  consultant

Renal unit: ward team and named consultant  covering each of the junior bleeps (referrals reg/renal reg etc)

Stroke/thrombolysis calls: named consultant for either geriatrics or neurology however managed in hospital

Acute g-i bleed:
Named gastroenterology consultant

etc

Morning post take ward round team
Named consultant (not on one of the allocated roles above)
2 named consultants/SAS covering the absent juniors

I would value any comments on the above including additions and also is this of any use ?

Send any comments back to me through e-mail JohnFirth@nhs.net

Any comments will be anonymsed but may be circulated to a wider audience

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