Transcript Changes in working practices

Changes in working practices
The consultant physician perspective
RCP Workforce Unit
Role of the College
To improve the quality of patient care by
continually raising medical standards
Key areas pertinent to today:
• Monitoring physician numbers
• Setting standards for acute care including
handover
• Reviewing impact of EWTD
Consultant delivered service
Specific issues:
•
•
•
•
EWTD
Consultant and registrar expansion
Patient/doctor ratios
Quality of training
EWTD on patient care and training
Much
better
Better
No change
Worse
Much
worse
Has EWTD changed the quality of
your training?
0.9%
5.1%
44.8%
37.8%
11.4%
Has EWTD changed the amount of
specialty training you undertake?
0.6%
4.5%
42.9%
41.0%
11.0%
Has EWTD changed the amount of
GIM training you undertake?
0.7%
6.7%
52.8%
30.0%
9.8%
Has EWTD changed the quality of
patient care?
0.7%
4.6%
36.5%
42.0%
16.2%
Has EWTD changed the quality of
patient care relating to continuity
of care?
0.6%
2.3%
25.5%
32.6%
39.0%
Has EWTD changed your quality of
life at work?
0.9%
10.5%
39.7%
40.1%
8.8%
Has EWTD changed your quality of
life at home?
4.2%
23.8%
47.5%
16.8%
7.7%
Have you had problems implementing
EWTD? 68% said yes
• “Multiple. Junior presence on the wards is fewer, patient care
has been compromised. Occasionally Consultant has cancelled
elective activity to cover juniors’ jobs.”
• “Cannot find any external locums.”
• “If there is even a single person off sick or on unexpected
leave there are insufficient junior staff hours to adequately
cover all the requirements for the functioning of the firm as a
whole.”
• “Major problems, need to beg/force internal locums to help at
short notice causing unhappiness.”
• “Yes – shift pattern very disruptive to training.”
How often do you use locums?
Strongly
agree
Agree
Neutral
Disagree
Strongly
disagree
Internal locum cover is easy to
organise
1.6%
6.3%
12.7%
46.0%
33.3%
External locum cover is easy to
organise
1.6%
4.8%
6.5%
30.6%
56.5%
Internal locums are usually
reliable
25.8%
71.0%
3.2%
0%
0%
External locums are usually
reliable
1.6%
19.4%
45.2%
30.6%
3.2%
Internal locums are usually high
quality
23.8%
57.1%
17.5%
1.6%
0%
External locums are usually high
quality
0%
9.7%
41.9%
40.3%
8.1%
1.6%
3.2%
9.5%
66.7%
19.0%
Patient care is usually worse
when internal locums are
employed
Patient care is usually worse
when external locums are
Sickness rates
T otal epis odes of s ic k leave taken
40
Episodes
35
30
8/2006 - 8/2007
25
8/2007 -8/2008
20
15
10
5
0
HO
S HO
T ra ining g ra de
EG
TraRining
How to we solve EWTD and H@N?
Increasing the number of consultants
• Benefits
–
–
–
–
–
–
Shorter patient stay
Reduced mortality
Improved patient safety
More trainers
Less restrictions within EWTD
Low sickness rates
• Drawbacks
– ?Increased readmission rate
– Cost
Early discharge and consultants on AMU
McNeill et al, Clin Med 2009
Consultant numbers and expansion
England, Wales and Northern Ireland 1994 - 2002
United Kingdom 2003 - 2008
10,000
9
9,500
8
Total number of consultants
7
8,500
8,000
6
7,500
5
7,000
6,500
4
6,000
3
5,500
5,000
2
4,500
Total number of consultants
4,000
Annual % consultant expansion
1
3,500
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
Census year
2003
2004
2005
2006
2007
2008
Annual % consultant expansion
9,000
Cardiology trainee’s future
Since 2001:
Registrar numbers have increased by 66.3%
Consultant numbers have increased by 25.9%
My team – April-June 2009
50
45
40
35
30
25
20
15
10
5
0
Patients per doctor
Summary
• EWTD has stretched the profession
• Night-time care is currently maintained but
under threat in the future
• Consultant expansion is needed
• There is a large emerging workforce which
could be used