Better Training. Better Care.

Rotas

This Charter divides rotas into four parts: structure, training, culture and leave. This list represents what is required. Advances in rota management, as well as specific local circumstances, will lead to new best practices developing. Responding to this is key. Good rotas are not just created, they require nurturing, and their management must be resourced.

​

The structure will include:

​

1. Rotas that reflect the intensity of working in Emergency Medicine. Trainees should not be frequently worked to the limits of current compliance recommendations.

2. Forward-rotating rota designs (day-evening- night) which minimise the frequent transitions between day and night shifts.

3. Not rostering staff onto late or night shifts on the final day of a contract when they are due to start in a new post the following day.

4. Empowering staff to take ownership of their working patterns to facilitate balance and quality of service, which may include engaging with intelligent, annualised or e-rostering solutions.

​

Trainees need time for training. Rotas can facilitate this. As such, this department will ensure:

​

1. Facilitating training via protected shift allocation, e.g. ensuring a spread of shifts in areas such as resus, paediatrics and minors where available.

2. That the requirement to attend all mandatory and regional training is built into the roster, such that the onus does not fall on the trainee to organise swaps.

3. That it follows the Royal College of Emergency Medicine Training Standard Committee recommendations of SPA time to meet broader curriculum objectives.

4. Protected, paid, time for local teaching and training to meet the curriculum objectives, WPBAs and training requirements

​

Recognising the importance of culture. This department will prioritise:

​

1. Eradicating a culture which pressurises staff to cover rota gaps or provide last minute cover and will offer a choice of financial remuneration or time off in-lieu for those who offer to cover such gaps.

2. Creating clear escalation policies for staff to raise concerns with roster patterns if they arise, free of intimidation or fear for doing so, including via monitoring or exception reporting systems.

3. Shift patterns developed locally through open and transparent consultation with all staff to ensure the best possible use of resources in meeting service and training requirements.

​

Leave is vital for sustainable careers, therefore the department will build rotas with:

​

1. The assumption that doctors can take their full allocation of annual and study leave. If, due to circumstances beyond the doctor’s control, a reasonable request is made for leave outside the minimum six weeks’ notice period, then the department will fairly consider this request while paying due regard to service requirements.

2. Compassionate leadership by respecting the need for time off for significant life events, as defined by the trainee, and support trainees in receiving this.

3. Support for staff in taking sick leave when required and not discouraging them from doing so.

​

​

Rest                                         

This department will recognise that staff fatigue represents a clinical risk and will:

​

1. Ensure that all staff are aware of the importance of taking their breaks, fostering a culture which expects all breaks to be taken as a core element of patient safety.

2. Give information about the location of break and rest facilities and how to access them.

3. Support doctors in raising issues about missed breaks, e.g. through monitoring or exception reporting systems and create action plans committing the employer to ensure all breaks are taken.

4. Provide basic education on sleep and working nights, preferably at induction.

5. Provide an appropriate sleep facility for doctors, free of charge, if they feel unable to travel home after a shift due to tiredness. Where this is not possible, ensure that alternative arrangements are made for the doctor’s safe travel home.

​

​

Reciprocity

The trainees in this department will:

 

1. Be expected to provide the required notice for leave requests, except in exceptional circumstances, working collegiately with rota planners to do so.

2. Work together, particularly at night, to ensure all staff are well and have taken their breaks.

3. Look out for fatigue in their colleagues and speak up when there are concerns.

4. Reflect on their own sleep habits and strive to improve their sleep hygiene to optimise their rest opportunities away from work.

5. Play an active role in assisting the department in improving the rota and working conditions and apply a constructive and measured approach to feedback in doing so.

6. Recognise the stressful environment we are all working within and escalate concerns supportively and empathically, assisting others to do similarly.

7. Recognise the role we have in nurturing a positive training environment and delivering professionally on teaching opportunities as they arise.

8. Arrive on time for the start of shifts, fit to work, and ensure continuity of care is maintained through timely and appropriate handover at the end of shift.

​

Further resources

​This charter is designed to be read in conjunction with RCEM Sustainable Working EMPOWER Documents and the RCEM Promoting Excellence Document. It would be advised that departments also consult documents written by other senior organisations such as the NHS Employers Good Rostering Guidance and BMA Fatigue & Facilities Charter.

​