For longer than the nine years that I have been a doctor, the rolling rota has been the standard rostering method. Unfortunately, this standard is a brute force technique which allows for minimal flexibility and correspondingly results in unnecessarily negative morale.
Styles of working have changed over time. An increase in out of hours demand and an uptake in less than full time working have put the traditional rolling rota model under pressure. It was never designed to be flexible and its continued existence seems to punish those that want to work more flexibly.
Over the last few years people have begun to challenge the status quo. I first became aware of alternatives to the rolling rota when watching a video by EM consultant Dr Rob Galloway. His Risky Business lecture in 2017 talked about the benefits of a “self-rostering” rota, I was intrigued. A self rostering post from St Emlyns in March 2017 talked further about the benefits, it including pictures of clever spreadsheets and ways of making it come together for a large group of doctors. This, I thought, was something that I could make work for ED registrars.
Unfortunately, both these rota systems were designed to allow consultants to work flexibly in an annualised fashion. The consultant contract is worked out really quite differently to a junior doctor. Junior doctors can probably work less flexibly than consultants, we need to work a specific amount of in-hours time to constitute training. If we work more out of hours time than predicted we should be paid more as stated in our contracts so our hours are fairly fixed.
Dr Tom Bircher published his “How to Self Roster for Registrars” blog post in February 2018 and summarised it in a poster on self rostering at EMTA ’18 in Cardiff. He showed that you can flexibly roster a group of registrars, meet their training and personal needs, provide better cover for a department and decrease your locum costs. While I use a different method in my rostering to Dr Bircher I certainly leaned heavily on his work in persuading various consultants that a different style of rostering can work.
I started in Leeds Emergency Department as a senior clinical fellow in September 2018. While I do a lot of undergrad education my other hat has been the rota coordinator. When I started, I altered the method by which the senior clinical fellows (6 HSTs on a 60:40 split contract) were put on their rota, from rolling with minimal flexibility to a self rostering system. We were able to better cover the gaps in the HST rota, allow the fellows to meet their non-clinical commitments and make everyone happier in the process.
In May, I got the go ahead to implement the same style of rota to the entire registrar body. To put this into context for Leeds, that is 34 registrar level doctors, a mix of Senior Clinical fellows, HSTs, Staff grades and PEMHSTs. This is a mixture of full time and less than full time trainees. Some of our staff grades are on fairly bespoke contracts and a mixture of both the 2016 contract and the pre-2016 contract. Leeds, although it is one trust, runs 3 emergency departments (St James’, Leeds general infirmary and Leeds Paediatric emergency department) which all have specific staffing needs. If I can make it work for this place there is no excuse why it can’t be rolled out everywhere!
What follows is the “how to” guide of what I did. My plan is to write a brief summary that anyone can skim over but then delve into some really quite fine points, because the fine points are often what makes the difference to trainees.