1. And its impact on GPStRs in practice Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

2. Several main features Compulsory mid shift break Essentially a lunch break Compulsory daily rest Compulsory weekly rest Maximum number hours worked per week Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

3. Deal with this first as it is easiest Maximum 48 hours is averaged Either over the duration of the post Or over six months whichever is shorter This will not affect GPStRs (unless they do locums) GPStR contract 40hrs +36 hours OOH (in 6 months) =41.5 hours per week averaged over six months Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

4. Exceeding this in any one week is OK As long as the compulsory rests periods are not lost Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

5. GPstR Contract 40 hrs 1 session protected teaching (Tutorial) 1 session self directed 1 session Half Day Release – when on Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

6. They must be allowed 20min break for working days that exceed 6 hours They must be free of duties completely The test - can they do what they wish during this time without notifying anyone else – if not they are not free of duties (See later for definition of work) Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

7. A minimum of 11 continuous hours rest in every 24 hours Please note not per day but for every (rolling) 24 hours After every working day – max shift 13 hours This usually means that time is required before and after an OOH shift Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

8. Continuous 24 hours rest after every 6 days OR Continuous 48 hours rest after every 12 days Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

9. Practice Meetings Personal Study Time (the half day) Half day Release Travel between sites (including HDR & OOH) Oh…………and seeing patients! NOT travel to work Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

10. BUT……. Yes – I know its not what we did in our day – I know its not how we work even now And – It IS the LAW – Breach of EWTD can incur a £5,000 fine Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

11. Some examples Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

12. Normal Day 9.5 hrs 08:3 0 18:0 0 08:3 0 Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

13. Normal Day 9.5 hrs OOH 19:00 - 01:00 Normal Day 9.5 hrs 08:3 0 18:0 0 08:3 0 Just get on with it – no longer an option Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

14. Normal Day 9.5 hrs OOH 19:00 - 01:00 Shortened Day 08:3 0 18:0 0 12:0 0 Evening Shift – let them start late 08:3 0 14 hours work – 7.5 hours rest (as a block) Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

15. Normal Day OOH 22:00 - 01:00 Normal Day 08:3 0 18:0 0 08:3 0 More than 11 hours – But not continuous Late Evening Shift Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

16. Shortened Day OOH 19:00 - 01:00 Shortened Day 12:0 0 18:0 0 12:0 0 Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

17. Normal Day Rest Day 11hrs 08:3 0 18:0 0 08:3 0 OOH 24:00 - 08:00 Overnight Shift Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

18. shortene d Day Rest Day 11hrs min 08:3 0 13:0 0 OOH 24:00 - 08:00 Guidance suggests that overnight shifts should be no longer than 8 hours. Difficulty for our registrars is the mixture of OOH and normal day time duties Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

19. Questions from September 2011 workshop Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

20. They cant They have a professional duty not to put themselves in breach of the EWTD In the event of a complaint it is likely this would be counted as contributory negligence If you collude and allow this you would be in breach of the EWTD Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

21. Yes it does Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

22. They are contractually obliged to inform you You must agree (also see longer hours) I would advise recording any such discussion on the Educators Notes taking into account their current progress Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

23. When calculating time spent on work, you should reasonably estimate the expected duration Perhaps ask them to complete a time / motion diary if in doubt Always taking one hour longer on clinics becomes a performance issue but still has to be taken into account when calculating time spent working Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

24. The time allocated for registrar doing house calls should vary depending on experience Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

25. Staying behind to finish off letters, reports, do lists etc - time for administration should be identified on the timetable Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

26. Yes As long as this does not include any work or expectation of work 20 minutes must be free from all duties – ie no phone calls, messages etc Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

27. The BMA is working on a updated version This will be released soon Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

28. A break of at least 20 minutes is required even when on call The simplest solution would be to pass the bleep to the supervisor for this time Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme

29. Trainers would find a sample timetable helpful Earlier allocation of NDUC sessions would help planning A consistent approach to working time lost from EWTD is required Asking registrars to work a number of extra sessions pre-emptively which can be cancelled if not required, is easier to manage than seeking extra shifts later on Dr Andy Downs, LTPD, Durham & Tees Valley GP training Programme