drs v3 rule book 2008 - bolton nhs ft

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DRS v3

Rule Book2008

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ContentsIntroduction ��2

1� Template - New Deal ��31.1. Group..................................................................................................................................... 31.2. Band ..................................................................................................................................... 31.3. Specialty ...............................................................................................................................111.4. Grade ...................................................................................................................................111.5. Resident ...............................................................................................................................111.6. Criteria R ............................................................................................................................. 121.7. Work pattern length .............................................................................................................. 131.8. Work pattern expansion ....................................................................................................... 131.9. Duty type ............................................................................................................................ 141.10. On-call ............................................................................................................................... 141.11. Full Shift .............................................................................................................................. 151.12. Partial Shift ......................................................................................................................... 161.13. 24 hour Partial Shift ............................................................................................................ 181.14. Hybrid patterns................................................................................................................... 181.15. On-call frequency ............................................................................................................... 181.16. Normal working week ......................................................................................................... 191.17. Duty - what is included ....................................................................................................... 201.18. Prospective cover ............................................................................................................... 211.19. Average weekly hours of duty ............................................................................................. 251.20. Average weekly hours of work ........................................................................................... 271.21. Duty length ........................................................................................................................ 281.22. Shortest off duty period ..................................................................................................... 281.23. Longest off duty period ...................................................................................................... 281.24. 2nd longest off duty period ................................................................................................ 291.25. Maximum consecutive duty days ....................................................................................... 291.26. Average total rest ............................................................................................................... 301.27. Weekends and rest ........................................................................................................... 31

2� Template and Working Time Directive ��332.1. Work and rest ...................................................................................................................... 332.2. Average hours of work ......................................................................................................... 342.3. Reference period ................................................................................................................ 352.4. Leave ................................................................................................................................... 362.5. 11 hours rest ....................................................................................................................... 362.6. Compensatory rest .............................................................................................................. 372.7. Rest in seven or 14 days ...................................................................................................... 38

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3� New Deal and Monitoring Analysis ��403.1. Study ................................................................................................................................... 403.2. Start times, end times and rest ............................................................................................ 403.3. Diary card analysis .............................................................................................................. 403.4. Combined diary cards and template analysis ....................................................................... 413.5. Shortest off duty period ....................................................................................................... 423.6. Longest duty period ............................................................................................................ 423.7. Natural breaks ...................................................................................................................... 423.8. Duty hours outside 7am to 7pm Mon - Fri ............................................................................ 423.9. Prospective cover and diary card analysis ........................................................................... 433.10. Type of day ........................................................................................................................ 443.11. Average hours of work ........................................................................................................ 443.12. Average hours of duty ........................................................................................................ 463.13. Continuous rest .................................................................................................................. 463.14. Percentage of duties with adequate out of hours rest ......................................................... 463.15. Total rest (On-call intensity weekdays only) ......................................................................... 473.16. Number of weekends worked ........................................................................................... 473.17. Banding calculations ........................................................................................................... 473.18. Ministerial return - banding supplements ........................................................................... 483.19. Real diary cards ................................................................................................................. 48

4� WTD and Monitoring Analysis ��504.1. Average weekly work hours .................................................................................................. 504.2. Less than 11 hours rest in 24 ............................................................................................... 504.3. Doctors without adequate breaks ........................................................................................ 514.4. 20 minute break................................................................................................................... 51

5� References ��52

6� Appendix - NHS Employers Specialty List ��53

7� DRS Rulebook v1�1 - Summary of Amendments ��54

Rule Book prepared by Skills for Health - Workforce Projects Team in conjunction with the Rules Advisory Group:

• Dr Yasmin Ahmed-Little - European Working Time Directive manager, Medical Workforce Development Team, NHS Northwest

• Dr Alison Hill - former medical workforce and clinical improvement programme lead, South East Coast SHA

• Ellie Pattinson - manager, Doctors’ Working Lives Team, Imperial College Healthcare NHS Trust

• Dr Ian Proctor - SpR, University College London Hospitals NHS Foundation Trust

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IntroductionThe Doctors Rostering System (DRS) is a piece of software developed within the NHS to help trusts manage their junior doctors within the Working Time Directive and the New Deal requirements. It provides analysis and data management tools, along with Ministerial Returns and re-banding functions.

DRS version 3 is a fully web based version of DRS. It also includes an improved and much simplified user interface, integrated updates, secure data management on dedicated servers, and additional workflow tools allowing inter-trust cooperation on data collection and compliance management.

The Rulebook is designed to define the analysis and calculations that occur in DRS version 3 for the benefit of DRS users at Trust and SHA level. It has been produced in conjunction with a Rules Advisory Group (RAG) consisting of DRS users and New Deal and EWTD experts who have assisted with the development of this document. The DRS RAG will meet on a quarterly basis to review the Rulebook.

For each element of DRS, this document will present the New Deal or EWTD rule or part of the regulations and then describes how DRS follows this rule. All of the references within this document are included in section 5.

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1� Template - New Deal

1�1� Group

1�1�1� New Deal rule

n/a

1�1�2� DRS definition

A group is the set of posts that would be considered to fulfil the same work on a single work pattern. Typically this would be a number of posts that provide a particular level of cover in a particular speciality, eg 6 Paediatric ST1s working together to provide a 1 in 6 out of hours shift for emergency work. It is important to distinguish between posts and the individuals who fill them because very often several different sets of individuals might take up the same post over a period of time and sometimes a single post may be split between two or more individuals.

1�2� Band


From Terms and Conditions of Service, September 2002 (Version 8 - 30 July 2007)

Controls on Hours

20. The following controls on hours of duty shall apply to practitioners in the training grades working on-call rotas, partial shifts, 24 hour partial shifts, full shifts or hybrids (except in circumstances where they are acting up as a consultant):

a. On-call rotas

i. Employing authorities shall ensure that the maximum average contracted hours of duty for practitioners working on on-call rotas do not exceed 72 per week, including handovers at the start and finish of duty periods.

ii. Practitioners in higher specialist training may contract for duty for up to a maximum average of 83 hours per week when it would be to the benefit of their training and they wish to do so, providing the proper supporting staff structure exists and providing the duties are not harmful either to the trainees or to patients.

iii. Employing authorities shall ensure that no period of continuous duty for practitioners working on on-call rotas is longer than 32 hours during the week and 56 hours at the weekend, except that for a transitional period of two years from 1 September 2002 practitioners in public health medicine may, in consultation with organisers of training schemes in public health medicine, choose to continue to work for a week at a time on call, provided that the average weekly hours of work do not exceed 48 and they can expect to receive 11 hours continuous rest between 9 pm and 8 am on at least 75% of

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nights when on call. Practitioners undertaking a week on call meeting the above criteria shall not be entitled to Band 3.

iv. Employing authorities shall ensure that practitioners working on on-call rotas have a minimum period of 12 hours off duty between periods of duty and one minimum continuous period off duty of 62 hours and one minimum continuous period off duty of 48 hours in every period of 21 days.

b. Partial shifts and 24 hour partial shifts

Employing authorities shall ensure that:

i. The maximum average contracted hours of duty for practitioners working a partial shift or 24 hour partial shift do not exceed 64 per week, including handovers at the start and finish of shifts.

ii. No period of continuous duty for practitioners working partial shifts is longer than 16 hours, including the time required for handovers.

iii. No period of continuous duty for practitioners working 24 hour partial shifts is longer than 24 hours, including the time required for handovers.

iv. Practitioners working partial shifts and 24 hour partial shifts have a minimum period of 8 hours off-duty time between shifts; do not work more than 13 days without a minimum period of 48 hours of continuous off-duty time; and have one minimum continuous period off-duty of 62 hours and one minimum continuous period off-duty of 48 hours in every period of 28 days.

c. Full shifts


i. The maximum average contracted hours of duty for practitioners working a full shift do not exceed 56 per week including handovers at the start and finish of shifts.

ii. No period of continuous duty for practitioners working full shifts is longer than 14 hours, including the time required for handovers.

iii. Practitioners working full shifts have a minimum period of 8 hours off duty between shifts; do not work more than 13 days without a minimum period of 48 hours of continuous off-duty time; and have one minimum continuous period off duty of 62 hours and one minimum continuous period off duty of 48 hours in every period of 28 days.

d. Hybrids

Employing authorities shall ensure that the maximum average contracted hours of duty for practitioners working an hybrid arrangement do not exceed a point, calculated as a proportion of the part that each arrangement makes to the hybrid, between the average maximum contracted hours of duty for each of the working arrangements which comprise the hybrid arrangement.

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e. Hours protection

i. Following the changes in contractual terms on 1 December 2000, any substantive change to the working arrangement of any existing post which might lead to an increase in the number of hours of work can only be introduced with the agreement of the practitioner in post and the approval of the regional improving junior doctors working lives action team (or equivalent). The nature of the approval system is described in guidance accompanying HSC 2000/031.

f. Not allocated.

g. Not allocated.

h. Employing authorities shall ensure that practitioners in the training grades comply with the relevant controls on hours of duty. Practitioners and their employing authority shall agree to work together to identify appropriate working arrangements or other organisational changes in working practice to ensure the controls on hours of duty, actual work and rest described in sub-paragraphs 18.b, 20.a to d above and 22.a below are met for practitioners in all training grades, and to comply with reasonable changes following these discussions; changes to working arrangements shall be monitored by regional improving junior doctors working lives action team’s (or equivalents)

Assessment of Pay Supplements

22. Subject to paragraph 24 below, the assessment of pay supplements for staff in the training grades shall be made as follows:

a. Band 3 shall apply to full time and part-time practitioners in posts which do not comply with the controls on hours of duty described in paragraph 20 above or with the controls on hours of actual work or rest described below (refer HSC 1998/240 and HSC 2000/031 including agreement to modify weekend rest requirements for on-call rotas) applicable to their working pattern.

i. That practitioners working any of the working arrangements defined in paragraph 19 above, work on average no more than 56 hours of actual work per week;

ii. That practitioners working on on-call rotas have rest equivalent to at least one half of the out of hours duty period, with a minimum of 5 hours continuous rest between 10pm and 8am, on 75% of occasions when on-call;

iii. For practitioners working at weekends on an on-call rota, if the agreed total rest expectation of 50% of the out of hours duty period within the duty period is achieved (see paragraph 22.a.ii. above), this is acceptable. For a weekend duty period of 9am Saturday to 5pm Monday, this would mean a total of 24 hours rest during that period; or

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iv. For practitioners working at weekends on an on-call rota, if the rest requirement equivalent to that for a weekday is achieved (8 hours for 24 hour period, 5 continuous between 10pm and 8am, on at least 75% of duty periods - see paragraph 22.a.ii above), but the total rest does not meet the requirement for the weekend (at least 50% of the out of hours duty period on 75% of occasions - see paragraph 22.a.ii above), the requirements for the controls on hours governing weekend rest will still be met if - “equivalent paid rest” is built into the rota for each weekend worked, in the form of working days or half days (to count as a day or half day on duty for total hours purposes - see Junior Doctors Contract: A general guide to the new pay system. This rest should be taken by the end of the Monday of the following week (ie within 8 days). However, in exceptional circumstances, the period of equivalent paid rest built into the rota may be taken at another time in the rota cycle. This must be with the agreement of the individual trainee and apply to no more than 25% of weekends worked; and the employing authority clearly demonstrates that the post is fully compliant with all other aspects of the New Deal, including the 56 hours of actual work limit.

v. That practitioners working partial shifts have rest for at least one quarter of the out of hours duty period on at least 75% of occasions; and where there is no out of hours duty that practitioners have natural breaks at any time during the whole of each duty period.

vi. That practitioners working 24 hour partial shifts have 6 hours rest during the duty period with a minimum of 4 hours continuous rest between 10pm and 8am on at least 75% of occasions; and that practitioners are not on duty for more than four hours following the 16 hour period of out of hours duty, and the next duty period should not start until at least the beginning of the next normal working day.

vii. That practitioners working full shifts shall have natural breaks as minimum rest during the whole of each duty period with at least 30 minutes continuous rest after approximately 4 hours continuous duty.

viii. That practitioners working a hybrid arrangement shall receive the appropriate controls on hours described in paragraphs 20 and 22 above that applies to each of the working arrangements that comprise the hybrid arrangement.

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b. Band 2A shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average more than 48 but less than or equal to 56 hours of actual work per week; and:

i. To practitioners on on-call rotas who either work an on-call rota of 1 in 6 including prospective cover or more frequently, or who work 1 in 3 weekends or more frequently; and who have an expectation that, for 50% or more of their out of hours duty periods, either they will work after 7pm and will be required, for clinical or contractual reasons, to be resident at their place(s) of work when on-call, or they will be non resident and required to work, for clinical or contractual reasons, for 4 hours or more after 7pm; or

ii. To practitioners on partial or full shifts or hybrid arrangements for whom one third of their hours of duty fall outside the period 7am to 7pm Monday to Friday; or who work 1 in 3 weekends or more frequently.

c. Band 2B shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average more than 48 but less than or equal to 56 hours of actual work per week; and who do not fulfil the criteria for Band 2A described in sub-paragraph 22.b above.

d. Band 1A shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average 48 hours or less of actual work per week; and:

i. To practitioners on on-call rotas who work an on-call rota of 1 in 6 including prospective cover or more frequently; or

ii. To practitioners on on-call rotas who either work an on-call rota of 1 in 8 including prospective cover or more frequently, or who work 1 in 4 weekends or more frequently; and who have an expectation that, for 50% or more of their out of hours duty periods, either they will work after 7pm and will be required, for clinical or contractual reasons, to be resident at their place(s) of work when on duty out of hours, or they will be non resident and required to work, for clinical or contractual reasons, for 4 hours or more after 7pm; or

iii. To practitioners on partial or full shifts or hybrid arrangements for whom one third of their hours of duty fall outside the period 7am to 7pm Monday to Friday; or who work 1 in 4 weekends or more frequently.

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e. Band 1C shall apply to full time and part-time practitioners who work within the controls on hours applicable to on-call rotas as described in sub-paragraphs 20.a and 22.a above, and who work on average 48 hours or less of actual work per week and, for part-time practitioners, more than 40 hours; and who work an on-call rota of 1 in 8 without prospective cover or less frequently and are not required to be resident, for clinical or contractual reasons, at their place(s) of work when on duty out of hours.

f. Band 1B shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average 48 hours or less of actual work per week and, for part-time practitioners, more than 40 hours; and who do not fulfil the criteria for Band 1A or 1C described in sub-paragraphs 22.d and e above.

g. Band FA shall apply to part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average less than 40 hours of actual work per week; and:


ii. To practitioners on on-call rotas who either work an on-call rota of 1 in 13.5 including prospective cover or more frequently, or who work 1 in 6.5 weekends or more frequently; and who have an expectation that, for 50% or more of their out of hours duty periods, either they will work after 7pm and will be required, for clinical or contractual reasons, to be resident at their place(s) of work when on duty out of hours, or they will be non resident and required to work, for clinical or contractual reasons, for 4 hours or more after 7pm; or

iii. To practitioners on partial or full shifts or hybrid arrangements for whom one third of their hours of duty fall outside the period 7am to 7pm Monday to Friday; or who work 1 in 6.5 weekends or more frequently.

h. Band FC shall apply to part-time practitioners who work within the controls on hours applicable to on-call rotas as described in sub-paragraphs 20.a and 22.a above, and who work on average less than 40 hours of actual work per week; and who work an on-call rota of 1 in 13.5 without prospective cover or less frequently and are not required to be resident, for clinical or contractual reasons, at their place(s) of work when on duty out of hours.

i. Band FB shall apply to part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average less than 40 hours of actual work per week; and who do not fulfil the criteria for Band FA or FC described in sub-paragraphs 22.h and i above.

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j. No supplement shall apply to:

i. Full time practitioners who work within all the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average 40 hours or fewer all between 7am to 7pm, Monday to Friday;

ii. Part time practitioners who work within all the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a above, and who work on average less than 40 hours all between 7am to 7pm, Monday to Friday.

These rules are shown in a flowchart which is taken from A General Guide to the New Pay System, October 2000.

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DRS rule

DRS calculates the band applicable to the rota by using the criteria in 1.2.1.

Dec

200

0D

ec 2

001

Dec

200

2

Band

3Th

ose

wor

king

out

side

the

New

Dea

l62

% (1.

62)

70%

(1.7)

100%

(2.0

)

Band

2A

Thos

e w

orki

ng m

ore

than

48

hour

s, m

ost a

nti-s

ocia

l50

% (1.

5)60

% (1.

6)80

% (1.

8)

Band

2B

Thos

e w

orki

ng m

ore

than

48

hour

s, le

ast a

nti-s

ocia

l42

% (1.

42)

42%

(1.42

)50

% (1.

5)

Band

1A

Thos

e w

orki

ng m

ore

than

48

hour

s or

less

, mos

t ant

i-soc

ial

42%

(1.42

)42

% (1.

42)

50%

(1.5)

Band

1B

Thos

e w

orki

ng m

ore

than

48

hour

s or

less

, mod

erat

e an

ti-so

cial

30%

(1.3)

30%

(1.3)

40%

(1.3)

Band

1C

Thos

e w

orki

ng m

ore

than

48

hour

s or

less

, lea

st a

nti-s

ocia

l20

% (1.

2)20

% (1.

2)20

% (1.

2)

Crite

ria R

- A

re y

ou

resi

dent

and

car

ryin

g ou

t an

y w

ork

afte

r 7pm

or

non-

resi

dent

and

doi

ng 4

ho

urs

wor

k af

ter 7

pm o

n 50

% o

r mor

e oc

casi

ons?N

oNo

Yes

No

Yes

Yes

No

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

No

No

No

Yes

No

Yes

No

Yes

Yes

No

Do

you

com

ply

with

New

Dea

l ho

urs

and

rest

lim

its?

Do

you

wor

k m

ore

than

48

hour

s of

ac

tual

wor

k?

Do

you

wor

k an

on-

call

rota

?

Do

you

wor

k an

on

-cal

l rot

a?

Do

you

do a

1 in

6

(inc

PC) o

r mor

e fr

eque

ntly

? Do

you

do a

1 in

8

(inc

PC) o

r mor

e fr

eque

nt, O

R w

ork

1 w

eeke

nd in

4 o

r m

ore

freq

uent

ly?

Do

you

do a

1 in

8

with

out P

C or

less

fr

eque

ntly

?

Do

you

fulfi

lCr

iteria

R?

Do

you

fulfi

lCr

iteria

R?

Are

you

resi

dent

fo

r clin

ical

or

cont

ract

ual

reas

ons?

Do

mor

e th

an 1

/3 o

f you

r dut

y ho

urs

fall

outs

ide

7am

to 7

pm

Mon

-Fri

OR

do y

ou w

ork

1 w

eeke

nd in

4 o

r mor

e fr

eque

ntly

?

Do

mor

e th

an 1

/3 o

f yo

ur d

uty

hour

s fa

ll ou

tsid

e 7a

m to

7pm

M

on-F

ri O

R do

you

w

ork

1 w

eeke

nd in

3

or m

ore

freq

uent

ly?

Do

you

do a

1 in

6 (i

nc

PC) o

r mor

e fr

eque

nt,

OR

wor

k 1

wee

kend

in 3

m

ore

freq

uent

ly?

Doc

tors

doi

ng o

ut

of h

ours

wor

k*

Whi

ch b

and

will

I be

in?

* Th

is fl

ow c

hart

doe

s no

t cov

er fl

exib

le tr

aine

es w

ho d

o le

ss th

an 4

0 ho

urs

of a

ctua

l wor

k pe

r wee

k

Defi

niti

on fo

r ban

ds

Prec

ise

crite

ria h

ave

been

dra

wn

up to

de

term

ine

who

goe

s in

to w

hich

ban

d.

The

diag

ram

on

the

left

sho

ws

how

th

is w

ould

wor

k, b

ut in

bro

ad te

rms

the

defi n

ition

s ar

e as

bel

ow:

Sala

ry m

ultip

lier

Juni

ors

wou

ld b

e pa

id a

sup

plem

ent

on to

p of

thei

r bas

ic s

alar

y ac

cord

ing

to th

eir o

ut o

f hou

rs w

ork.

The

su

pple

men

t is

pric

ed a

s a

prop

ortio

n of

bas

ic s

alar

y. T

otal

sal

ary

wou

ld b

e a

mul

tiple

of t

he b

asic

sal

ary.

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1�3� Specialty

1�3�1� New Deal definition

NHS Employers issue a specialty list that covers all junior doctors (see appendix)

1�3�2� DRS rule

DRS uses the specialty list issued by NHS Employers for Ministerial Returns. A specialty must be chosen for the group so that the group can be correctly identified.

1�4� Grade


There are several different grades doctors work in. There is currently a transitional period from one training system to a new one (MMC) which is changing the grades doctors work at.


Members of staff working on a rota may be of various grades. Different staff grades can have quite different parameters for the purposes of analysis in terms of the New Deal, for example leave allocations or rules to be followed. DRS includes grades for the old system as well as MMC. This can include non medical staff under the ‘Other’ grade category.

1�5� Resident


Duties are considered resident if a junior doctor is required to be present on site by the employer during all of that duty. If they are able to be on-call from home while on duty (coming into work when necessary) then this duty is defined as non resident on-call. If a junior doctor takes up, for reasons of convenience, on-site rest facilities provided by an employer, but there is no requirement made by the employer that the junior doctors take their rest on site for that duty, then a duty will be considered non resident. It is not apparent that there is a formal definition of residency under the New Deal. (NB the Medical Act no longer requires F1 doctors to be compulsorily resident.)


DRS records whether a shift is resident or non resident to support analysis of rotas against New Deal and WTD criteria. The user will have defined residency using the appropriate guidelines for that employer. This should be recorded in an individual’s contract of employment.

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1�6� Criteria R


From Terms and Conditions of Service, September 2002 (Version 8 - 30 July 2007):

22b. Band 2A shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a, and who work on average more than 48 but less than or equal to 56 hours of actual work per week; and:

i. To practitioners on on-call rotas who either work an on-call rota of 1 in 6 including prospective cover or more frequently, or who work 1 in 3 weekends or more frequently; and who have an expectation that, for 50% or more of their out of hours duty periods, either they will work after 7pm and will be required, for clinical or contractual reasons, to be resident at their place(s) of work when on-call, or they will be non resident and required to work, for clinical or contractual reasons, for 4 hours or more after 7pm; or

ii. To practitioners on partial or full shifts or hybrid arrangements for whom one third of their hours of duty fall outside the period 7am to 7pm Monday to Friday; or who work 1 in 3 weekends or more frequently.

22d. Band 1A shall apply to full time and part-time practitioners who work within the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22.a, and who work on average 48 hours or less of actual work per week; and:


ii. To practitioners on on-call rotas who either work an on-call rota of 1 in 8 including prospective cover or more frequently, or who work 1 in 4 weekends or more frequently; and who have an expectation that, for 50% or more of their out of hours duty periods, either they will work after 7pm and will be required, for clinical or contractual reasons, to be resident at their place(s) of work when on duty out of hours, or they will be non resident and required to work, for clinical or contractual reasons, for 4 hours or more after 7pm; or

iii. To practitioners on partial or full shifts or hybrid arrangements for whom one third of their hours of duty fall outside the period 7am to 7pm Monday to Friday; or who work 1 in 4 weekends or more frequently.

Part b.i. and part d.ii. of these rules are referred to as Criteria R in the banding flowchart (see page 9) in A General Guide to New Pay System, October 2000:

Criteria R - Are you resident and carrying out any work after 7pm or non resident and doing 4 hours work after 7pm on 50% or more occasions?

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When designing a rota in DRS there is a box to tick for whether the rota meets criteria R or not. This question relates to the definition above and DRS uses this information to assess which banding supplement will apply to the rota. This is because DRS cannot work out criteria R from the work pattern information as the timing of work and rest within a duty period is not entered. Instead, the criteria R result must be entered on the work pattern input screen. When a new work group is created, criteria R defaults to ‘not satisfied’. This rule is only relevant for on-call rotas.

Resident and carrying out any work after 7pm on 50% or more occasions

It is assumed in DRS that ‘after 7pm’ covers the time period 7pm to 7am. If the total amount of rest defined for the duty does not cover the whole of any duty time in the 7am to 7pm period then we will assume there is work in this period and criteria R if fulfilled.

Non-resident and carrying out 4 hours or more work after 7pm on 50% or more occasions

It is assumed in DRS ‘after 7pm’ covers the time period 7pm to 7am. If the total amount of rest defined for the duty plus 4 hours does not cover the whole of any duty time in the 7am to 7pm period then we will assume there is work in this period and criteria R is fulfilled.

The 50% rule is checked by examining all the on-call duties in the work pattern (normal days are ignored).

Using this, a resident on call 9am to 9am with 12 hours of rest is OK, but with 11 hours’ rest triggers criteria R.

1�7� Work pattern length


n/a


The work pattern cycle length describes the number of weeks in one cycle of the rota. It usually conforms with the number of full time posts or equivalent between which work is shared: ie a work pattern where cover is provided by x number of FTEs (full time equivalents) will be a 1 in x pattern and have a pattern length of x weeks. In some circumstances where a pattern provides only part of the cover in a particular service, the work pattern cycle length might be different to the number of FTEs. For example, a work pattern for supernumerary flexible trainee with a FTE of 0.6 might have a cycle length of 16 weeks to capture an accurate picture of work carried out or a cross cover rota might have to have a longer cycle.

1�8� Work pattern expansion


The work pattern will need to be expanded where the rota cycle length is not long enough for all New Deal rules to be checked. These include the rules on maximum continuous duty days and rest requirements. See Annex A of HSC 1998/240.

14


The work pattern is specified as a standard working week and a repeating number of weeks (the analysis period) of non standard days, on call duties, rest days or leave days. For the purpose of performing rules analysis that require reference periods longer than the pattern entered, DRS projects the work pattern forward by multiples of the ‘pattern cycle length’, allowing the measurement of targets over their full reference period.

To achieve this, the work pattern is expanded to cover a period of 393 days (365 days + 28 days : the maximum days needed to check ahead for rest analysis) by repeating the analysis period of non standard days and filling any gaps in this with standard working week days.

1�9� Duty type


Duty type is the type of shift or work pattern a doctor works. There are four duty types - on-call, full shift, partial shift and 24 hour partial shift. Details of these duty types are given in paragraphs 1.10 - 1.13.


When setting up duties for a rota in DRS the duty type will need to be nominated by the user so that DRS can assess whether the controls on hours and rest requirements are being met for this duty. DRS cannot define the duty type for the user from the information given about the hours and rest. The user will need to assess the most appropriate duty type to enter by considering the intensity and rest anticipated for the rota. The duty type entered into DRS should match the duty type put into the contracts of the doctors in the group.

1�10� On-call



19a. On-call rotas

Practitioners on on-call rotas usually work a set working day on weekdays, from Monday to Friday. The out of hours duty period is covered by practitioners working “on call” in rotation. Practitioners are rostered for duty periods of more than 24 hours. The frequency of on-call depends on the number of practitioners providing cover and is normally expressed as 1 in 4, 1 in 5, etc. Practitioners working on on-call rotas shall have adequate rest during a period of duty.

20a. On-call rotas


15

ii. Practitioners in higher specialist training may contract for duty for up to a maximum average of 83 hours per week when it would be to the benefit of their training and they wish to do so, providing the proper supporting staff structure exists and providing the duties are not harmful either to the trainees or to patients.

iii. Employing authorities shall ensure that no period of continuous duty for practitioners working on on-call rotas is longer than 32 hours during the week and 56 hours at the weekend, except that for a transitional period of two years from 1 September 2002 practitioners in public health medicine may, in consultation with organisers of training schemes in public health medicine, choose to continue to work for a week at a time on call, provided that the average weekly hours of work do not exceed 48 and they can expect to receive 11 hours continuous rest between 9pm and 8am on at least 75% of nights when on call. Practitioners undertaking a week on call meeting the above criteria shall not be entitled to Band 3.

iv. Employing authorities shall ensure that practitioners working on on-call rotas have a minimum period of 12 hours off duty between periods of duty and one minimum continuous period off duty of 62 hours and one minimum continuous period off duty of 48 hours in every period of 21 days.


DRS analyses on-call rota templates in accordance with the information given above as well as details given in 1.2.1. Users will sometimes need to add a duty period which is a day after on-call. If this is as per the normal day set for the rota eg 9am - 5pm, the normal day can be left in place. If it is different from the normal day, then the duty period should be set as an on-call. If a full shift duty is used this means the rota is classed as a hybrid which would be inappropriate. This is in accordance with T&Cs para. 19 and 20.

The post on-call duty is then added onto the on-call and analysed against on-call rules. This will apply only if it is a normal day or on-call duty entry - not if partial, 24hr partial or full shift.

1�11� Full Shift



19c. Full shifts

A full shift will divide the total working week into definitive time blocks with practitioners rotating around the shift pattern. Practitioners can expect to be working for the whole duty period, except for natural breaks. Practitioners will be rostered for duty periods that do not exceed 14 hours. Practitioners working on full shifts shall have adequate rest during a period of duty.

16

20c. Full shifts


i. The maximum average contracted hours of duty for practitioners working a full shift do not exceed 56 per week including handovers at the start and finish of shifts.

ii. No period of continuous duty for practitioners working full shifts is longer than 14 hours, including the time required for handovers.

iii. Practitioners working full shifts have a minimum period of 8 hours off duty between shifts; do not work more than 13 days without a minimum period of 48 hours of continuous off-duty time; and have one minimum continuous period off duty of 62 hours and one minimum continuous period off duty of 48 hours in every period of 28 days.


DRS analyses full shift rota templates in accordance with the information given above as well as details given in 1.2.1.

1�12� Partial Shift



19b. Partial shifts

i. On most weekdays practitioners on partial shifts work a normal day. But, at intervals, one or more practitioners will work a different duty for a fixed period of time, eg evening or night shifts. Practitioners can expect to work for a substantial proportion of the out of hours duty period, during which time they will expect to achieve some rest in addition to natural breaks. Practitioners will be rostered for duty periods of not more than 16 hours. Practitioners working on partial shifts shall have adequate rest during a period of duty;

ii. 24 hour partial shifts: Weekdays are usually worked as normal days. In rotation, a duty period is rostered, not exceeding 24 hours including handovers, for the weekend and out of hours cover. Practitioners will be rostered for duty periods of more than 16 hours, but less than or equal to 24 hours. Practitioners working 24 hour partial shifts shall have adequate rest during a period of duty.

20b. Partial shifts and 24 hour partial shifts


i. The maximum average contracted hours of duty for practitioners working a partial shift or 24 hour partial shift do not exceed 64 per week, including handovers at the start and finish of shifts.

ii. No period of continuous duty for practitioners working partial shifts is longer than 16 hours, including the time required for handovers.

iii. No period of continuous duty for practitioners working 24 hour

17

partial shifts is longer than 24 hours, including the time required for handovers.

iv. Practitioners working partial shifts and 24 hour partial shifts have a minimum period of 8 hours off-duty time between shifts; do not work more than 13 days without a minimum period of 48 hours of continuous off-duty time; and have one minimum continuous period off-duty of 62 hours and one minimum continuous period off-duty of 48 hours in every period of 28 days.

18


DRS analyses rota templates in accordance with the information given above as well as details given in 1.2.1.

1�13� 24 hour Partial ShiftSee 1.12.

1�14� Hybrid patterns


From HSC 1998/240, Annex D:

Hybrid working patterns

Definition

1. A hybrid working arrangement is a working pattern in which junior doctors’ out of hours duty comprises work of substantially different levels of intensity due to different clinical responsibilities. As a result the post or placement comprises elements of two or more distinct working arrangements, usually combined within a time limit of one month or less.

2. Where a particular duty is in a clearly identified block of at least a month’s duration before change to another duty of different intensity then this is not a hybrid but rather a change between two working patterns. Where the different duties alternate or are mixed within the same rota then this is a hybrid.

and from Terms and Conditions of Service, September 2002 (Version 8 - 30 July 2007)

20d. Hybrids

Employing authorities shall ensure that the maximum average contracted hours of duty for practitioners working a hybrid arrangement do not exceed a point, calculated as a proportion of the part that each arrangement makes to the hybrid, between the average maximum contracted hours of duty for each of the working arrangements which comprise the hybrid arrangement.


DRS allows hybrid rotas to be created and calculates whether the rota is compliant by using the information given above. See 1.18 and 1.19 for how the average duty and work hours are calculated for hybrid rotas.

1�15� On-call frequency


See flow chart at end of section 1.2.1 for details of how the on-call frequency affects the pay banding supplement.

19


The frequency will be calculated by dividing the total number of weekdays in the pattern by the total number on-call weekdays. If the weekend on-call frequency is different to the weekday frequency it is best to input a considered average for the frequency of the rota.

The test “Do you do a 1 in 6 (inc prospective cover (PC)) or more frequent?” is changed for patterns without prospective cover to “Do you do a 1 in 5 or more frequent?”

The test “Do you do a 1 in 8 (inc PC) or more frequent?” is changed for patterns without prospective cover to “PRHO - Do you do a 1 in 6.5 or more frequent?” or “Grades other than PRHO - Do you do a 1 in 7 or more frequent?”

The test “Do you do a 1 in 8 (without PC) or less frequent?” is changed for patterns with prospective cover to “PRHO - Do you do a 1 in 9 or less frequent?” or “Grades other than PRHO - Do you do a 1 in 10 or less frequent?”

Tests from Banding Criteria, Department of Health Junior Doctors Contract letter 19th September 2000

1�16� Normal working week


Taken to mean the standard Monday - Friday hours the doctor does between 7am and 7pm. Terms and Conditions par 22. j:

No supplement shall apply to:

i. Full time practitioners who work within all the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22a above, and who work an average of 40 hours or fewer all between 7am to 7pm, Monday to Friday;

ii. Part time practitioners who work within all the controls on hours applicable to their working arrangement as described in paragraphs 20 and 22a above, and who work an average of less than 40 hours all between 7am to 7pm, Monday to Friday.

DRS rule

DRS allows users to enter start and finish times for normal days in the normal working week and then populates the whole of the work pattern with these hours.

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1�17� Duty - what is included


From Terms and Conditions of Service, September 2002 (Version 8 - 30 July 2007) Extract from paragraph 18b.

Hours of duty include periods of formal and organised study (other than study leave), training, all rest while on duty, and prospective cover where applicable.


It is important to make a distinction between duty types as they exist in the New Deal contract and as they exist as general descriptions. Under the New Deal, duty types are narrow descriptions of the expectation of duty, work and rest expected to be carried out in a 24 hour period such as full shift, on-call, partial and 24 hour partial. Names of duty types in the New Deal are often confused with the activity being carried out, such as holding a bleep etc. New Deal descriptions of duty types never relate to types of activity being carried out, only to expectations of duty, work and rest.

21

1�18� Prospective cover


From A General Guide to the New Pay System, Department of Health, October 2000. This document goes on to detail two forms of cover as detailed below:

Prospective cover is defined as:

When the doctor is contracted to provide internal cover for colleagues when they are on annual and/or study leave, ie if no locums are provided. Prospective cover is also in operation when on-calls are required to be swapped when taking leave or when leave is fixed in advance. When a doctor not on the rota acts as a ‘floater’, ie covering any doctors on the rota who are away on holiday, prospective cover is not in operation.

There are two available forms of prospective cover calculation, 2002 calculation and the Riddell formula. Both will cause an adjustment to the average hours for the theoretical work pattern but use of the Riddell formula will cause an adjustment to be added to monitoring analysis results as well.

a. 2002 Calculation

This was included in guidance jointly published by the Department of Health and the British Medical Association, Guidance on Working Patterns for Junior Doctors, November 2002, Appendix A. An extract is given below:

Calculating actual hours of work:

Length of Normal Working Day x Number of Days Worked per Week = a

Number of Hours of Actual Work on Weekday on call periods = x

Number of Hours of Actual Work on Weekend on call periods = y

Number of doctors on rota = z

Actual Hours of Work on call = (5 times x) + y = b z

Therefore Total Actual Hours of work = a + b

Calculating actual hours of work where prospective cover is in operation using the above variables, and where:

Total Study and Annual Leave for individual on rota = L days

PC Hours = (b times L) = c

(365 - L)

Therefore Total Actual Hours of work including PC = a + b + c

22

b. Riddell Formula

The formula is (from the Junior Doctors Handbook 2005/06):


a. 2002 Calculation

When the user has chosen to use the 2002 calculation then DRS calculates prospective cover for the rota according to the 2002 calculation set out 1.18.1.

b. Riddell

This formula can be mathematically simplified by cancelling B on the top and bottom and multiplying through by 52 to give:

Duty or work hours/week =(Ave Wkly duty or work Hrs * 52 - A*C)

(52 - A)

This version is used in DRS.

c. Doctor Numbers

DRS allows the user to enter up to four different sets of doctor with different leave entitlements that are on the rota and that will be used for prospective cover. The numbers of doctors in the set must be entered. If no numbers are entered, it will be assumed that prospective cover is not to be used with this work pattern. If no leave entitlement is entered then DRS will prompt the user to enter this. If two sets of StR doctors are on the rota with different leave entitlement they should be entered as different sets even though they are of the same grade.

The total number of doctors specified should be equal to the total number of doctors on the tier of the rota being analysed.

Duty or work hours/week =(D - (E * C))

(B - E)

Where:

A = total leave for the year in weeks

B = number of weeks in a rota cycle

C = number of hours in a leave week

D = total hours duty or work in a rota cycle if no leave taken

E = weeks leave in the rota cycle (A/52)*B

23

d. The Scope of Prospective Cover

To work out how many days leave to enter, the number of annual, study and statutory days leave per doctor that need to be covered should be calculated. The user should take into account the amount of leave the doctor is entitled to and whether these days will be covered by doctors on the rota or whether locums will be used. For example, if the doctors on a rota were going to cover themselves for annual and statutory leave of 35 days but study leave would be covered by locums then only 35 days should be entered.

For the 2002 calculation DRS also has options for which shifts prospective cover should be added to:

• All duties - select this button if prospective cover is provided for all duties ie during the normal working day and out of hours

• Duties outside normal hours - this is to be used if the prospective cover is only for out of hours duties. This will be hours outside the normal working week specified by the user

• Selected duties - this adds prospective cover to those duties that have been selected for prospective cover

• Selected out of hours - this adds prospective cover to those duties which have been selected for prospective cover but only adds it for out of hours periods of these duties. To select prospective cover for a duty the PC box should be ticked when entering the duty type.

For the Riddell formula there are no options for which shifts need to be covered as the formula does not require this information.

e. Prospective cover calculation - days

The total days to be covered is calculated by multiplying leave days by the number of doctors in each grade group. This is totalled and divided by the number of doctors available to supply cover (assumed to be the same as the sum of the number being covered for)

The number of days to be covered by one doctor is multiplied by the average duty hours for the work pattern to give the total hours that must be covered in a year. Normally only hours outside the standard 40 hour working week are considered in the calculation. DRS also allows other options. All duty hours can be included, or selected on call duties can be specified as needing cover (in this case, each additional duty to be covered must be flagged with a tick). In the latter case, all the duty or only the portion outside 9am to 5pm can be specified.

The extra hours for the year is divided by 365 less the average leave for the pattern, to give the average extra hours a doctor needs to be on-call in a week.

For a hybrid pattern, the prospective cover is calculated for each duty type separately.

The above calculations give the duty hours prospective cover which must be added to the calculated duty hours in the pattern.

24

f. Work Hours Prospective Cover

To calculate the total work hours with prospective cover, the methods are different depending on the type of prospective cover.

If “all hours” type of Prospective Cover:

A simple pro-rata based on average duty and work hours.

Work Prospective

Cover= Duty PC *

Average Work Hours

/Average

Duty Hours

If an ‘out of hours only’ type of prospective cover:

Rest is removed from the duty prospective cover assuming the minimum amount of rest specified in the New Deal is taken.

Where:

PCFull is full shift intensity prospective cover

PCPartial is partial shift intensity prospective cover

PCOnCall is on-call intensity prospective cover

Work PC = PCFull + PCPartial*�75 + PCOnCall*�5

If the Riddell Formula is used:

The average duty hours in the formula is replaced by the average work hours and the calculation repeated.

g. Examples

2002 Calculation method

Consider a group of four SHO grade doctors working a rota with average duty hours of 72 per week. Each doctor will cover for both the annual leave and study leave of the others in the group. Prospective cover is to be calculated on duties outside normal hours only.

Prospective cover calculation:

Total number of days of leave

(incl annual / statutory and

study

by number of doctors

Total number of days to be covered

Hours to cover

Standard weekx -

Number of days in the

year

Number of days each

doctor has to cover

-

= x

Days of year

Number of days to be covered-

Total number of days of

leave*

Hours to be covered

40hr standard week-x

55 x (72 - 40 = 32)

(365 - 55)=

1760

310=

5.67 extra hours

For this example this is:

* If group of mixed grades were being used then would calculate fully total number of days to be covered using different leave entitlements and then divide by doctor for this figure.

25

Riddell Formula

Consider a group of four SHO grade doctors working a rota with average duty hours of 72 per week. Each doctor will cover for both the annual leave and study leave of the others in the group. Prospective cover is to be calculated on duties outside normal hours only.

Days to be covered=10+25+20 =55, for 4 doctors this is 220 days/annum.

There are 4 doctors, so each must cover 220/4=55 days = 11 holiday weeks. (In this case it is an obvious calculation, but is necessary if a group of mixed grades is involved).

Number of hours in a leave week is 40.

Using the raw Riddell formula

(D - (E * C))/(B - E)

E=(11/52)*6=1.2692

Adjusted duty hours/week = (72 - (1.2692*40))/(6-1.2692) = 80.585

The DRS version of the formula:

(Wkly Hrs * 52 - Hol Wks * Hrs in Leave Wk)/(52 - Hol Wks)

Adjusted duty hours/week = (72*52 - 11*40)/(52-11) = 80.585

The extra per week/doctor is 8.585 hours.

h. Negative prospective cover errors

If the average working hours are less than the normal working week on a rota then a negative prospective cover calculation will be produced. This is then not used as it is not appropriate to add in negative prospective cover. In this instance local interpretation of the overall hours calculation is required.

See paragraph 2.2.2 for how prospective cover affects WTD calculations in DRS.

1�19� Average weekly hours of duty


Duty is defined above in paragraph 1.17. The Medical and Dental Terms and Conditions of Service, September 2002, refer to ‘maximum average’ when describing the controls on hours:

20a. On-call rotas


‘The Guidance on Working Patterns for Junior Doctors’ (Department of Health/BMA, November 2002) also gives a formula for working out hours of duty:

Calculating actual hours of duty

This is calculated by adding all duty periods over a complete cycle of the rota, and dividing by the number of weeks in the rota cycle.

26


DRS therefore calculates average duty for the work pattern entered using this formula and then adding prospective cover:

If leave days are specified in the analysis period, these are deducted from the analysis period. So, an analysis period of 12 weeks that contains 5 days of leave would use a divisor of 11 to calculate average duty hours.

All duties starting within the analysis period are taken into account. A duty that starts on the last day of the period and finishes on the following day is still counted in full.

If prospective cover has been defined for the work pattern, it is added to the average duty hours. See the Prospective Cover calculations section 1.18.

The New Deal target for average duty hours depends on the intensity of work for the on call days. For hybrid patterns (on-call duties of mixed intensities), the target is determined by a pro-rata calculation.

Where:

Full - the total of full shift duty hours in the analysis period

Part - the total of partial shift duty hours in the analysis period

OC - the total of on call duty hours in the analysis period

Not Standard = Full + Part + OC

The target is given by

56 * Full / Not Standard + 64 * Part / Not Standard + 72 * OC / Not Standard

Prospective cover+

Total number of duty hours in the work pattern

Total number of weeks in thework pattern

Average duty hours

=

27

1�20� Average weekly hours of work


Guidance on Working Patterns for Junior Doctors, Department of Health/BMA, November 2002:

Definition of work

For banding purposes, the definition of actual hours of work is as per the New Deal (2). This is ‘all time spent carrying out tasks for the employer, but does not include rest while on call’. (Note: this is different from the Working Time Directive definition of work, which defines working time as “… any period during which the worker is working, at the employer’s disposal and carrying out his activity or duties, in accordance with national laws and/or practice.”)

For the purposes of defining work after 7pm ‘work begins when a doctor is disturbed from rest and ends when rest is resumed’ (1). This, therefore, includes providing telephone advice; or time waiting to perform a clinical duty, such as waiting for an operating theatre.

1 - Pay and Conditions of Service of Hospital and Dental staff and Doctors in Public Health Medicine and the Community Health Service’ Advance Letter (MD) 1/01

2 - Junior Doctors - The New Deal NHS Management Executive June 1991


DRS therefore calculates the average work hours for the work pattern using the principles above and adding in prospective cover:

This is almost identical to the average weekly duty hours calculation but any rest specified on work days is removed from the totals. The New Deal target is the same for all intensities, so no pro-rata calculation is needed.

If prospective cover is required it is added in.

Prospective cover+

Total number of duty hours in the work pattern

Number of weeks in work pattern

Average work hours

=

28

1�21� Duty length


The limits on duty lengths are containing in paragraph 1.10 - 1.14. Duty length in these paragraphs is referred to as ‘period of continuous duty.’


DRS analyses work patterns in accordance with the rules given in paragraph 1.10 - 1.14. ‘Period of continuous duty’ is referred to in DRS as ‘duty length’. If the start of the next day’s duty is the same or before the end of the previous day’s duty, then work is continuous, and the length of the duties are added together for analysis purposes. The duty type to be used for analysis - ie whether it is to be analysed as an on-call, 24 hour partial, partial or full shift - is taken from what is entered for the first duty in the sequence.

For an on call duty, the limit for the longest duty is different for weekend and weekday. If the duty, or last duty of a sequence starts after 19:00 on a Friday, or at any time on Saturday or Sunday, then it is considered to be a weekend duty. Otherwise, it is a weekday duty. For a hybrid pattern, each intensity is considered separately when assessing the longest duties.

1�22� Shortest off duty period


The limits on shortest off duty periods for all shift patterns are contained in paragraph 1.10 - 1.14 above (includes extracts from Terms and Conditions, September 2002)


DRS analyses work patterns in accordance with the rules given in paragraph 1.10 - 1.14. The first day of the pattern is added to the end of the pattern so that the gap after the last duty can be calculated.

1�23� Longest off duty period


The Terms and Conditions of Service, September 2002, paragraph 22 detail two minimum continuous off duty periods for each shift. The whole of this paragraph is given in paragraph 1.10 - 1.14 of this paper. The relevant parts of this paragraph are detailed below:

On-call - 20.a.iii

Full shift - 20.c.iii

Partial and 24 hour partial - 20.b.iv

29


DRS measures the longest off duty period in every relevant period - ie 28 days for full shifts- to ascertain whether the required minimum continuous off-duty period of 62 hours is built into the work pattern. From each day with a duty start, DRS looks forward 28 days (21 days for on call rotas) in the work pattern (weeks from the start of the pattern are added to the end where necessary). If there is not at least a 62 hour break and a 48 hour break in this period, then a ‘Fail’ is indicated.

1�24� 2nd longest off duty period


See paragraph 1.23.


DRS measures the 2nd longest off duty period in a work pattern against the target of the 48 hour off-duty period (see paragraph 1.23). From each day with a duty start, DRS looks forward 28 days (21 days for on call rotas) in the work pattern (weeks from the start of the pattern are added to the end where necessary). If there is not at least a 62 hour break and a 48 hour break in this period, then a ‘fail’ is indicated.

1�25� Maximum consecutive duty days


The Terms and Conditions of Service September 2002 paragraph 20 gives maximum consecutive duty days for each type of shift. The relevant parts of this paragraph is given in paragraph 1.10 - 1.14 of this paper. The relevant parts of this paragraph are detailed below:

On-call - 20.a.iv

Full shift - 20.c.iii

Partial and 24 hour partial - 20.b.iv

Also see HSC 1998/240, Annex A.


DRS calculates the maximum consecutive days which have duties entered against them in the work pattern and measures this against the limits given in the paragraphs above. DRS only looks at duty starts when counting consecutive duty days. If a duty ends after midnight, it is not counted as a duty on the day after it started as well. Any day without a duty start constitutes a break in a sequence of duties. DRS runs the end week into the start week to check for maximum consecutive days when the rota is set in a cycle. A run of 13 days is only allowed if it is immediately followed by 48 hours of rest.

30

1�26� Average total rest


The Terms and Conditions of Service September 2002 paragraph 22 detail average total rest requirements. The relevant parts of this paragraph is given in paragraph 1.2.1 of this paper.

These rest requirements are also shown also in the table from HSC 1998/240, Appendix B:


Rest requirements apply on ‘a one instance of a duty per 24 hours’ basis. Each target must be met at on at least 75 percent of the occasions which apply (as indicated in the table in 1.26.1) with the exception that the shift length target must never be breached. Failure to meet rest requirements means the rota is shown to be noncompliant in DRS.

Working pattern Natural breaks

Minimum rest during the whole of each duty period

Minimum continuous rest guide Timing of continuous rest

Full shift Natural breaksAt least a 30 minute continuous

break after approximately 4 hours continuous duty

At least a 30 minute continuous break after approximately 4 hours

continuous duty

Partial shift

Natural breaks if no out-of-hours duty. Otherwise one quarter of

the out-of-hours duty period, eg:5pm-9am (Mon-Fri) = 4 hours9am - 9pm (Sat/Sun) = 3 hours

Frequent short periods of rest are not acceptable

At any time during the duty period

24 hour partial shift 6 hours 4 hours Between 10pm and 8am

On-call rota One half of the out-of-hours duty

period, eg:5pm - 9am (Mon-Fri) = 8 hours9am - 9am (Sat/Sun) = 12 hours

Minimum 5 hours Between 10pm and 8am

Summary of rest periods

Reasonable expectation of rest: In each of these working patterns, rest targets must be met during at least three quarters of all rostered duty periods. Where this target is not met, urgent consideration will need to be given to changing the working pattern, or reviewing working practices within the existing working pattern, to reduce work intensity to acceptable limits.

* This working pattern should only be used where it is the most appropriate option.

31

1�27� Weekends and rest


From A General Guide to the New Pay System, October 2000:

Revision of weekend rest requirements for on-call rotas

Important note: this amends and replaces the definition contained in HSC 1998/240

1. If the agreed total rest expectation of 50% of the out of hours duty period within the duty period is achieved, this is acceptable and no further action is needed. For weekend duty period of 9am Saturday to 5pm Monday, this would mean a total of 24 hours rest during that period.

or

2. At weekends, if the rest requirement equivalent to that for a weekday is achieved (8 hours for 24 hour period, 5 continuous between 10pm and 8am, on at least 75% of duty periods), but the total rest does not meet the requirement for the weekend (at least 50% of the out of hours duty period on 75% of occasions), the requirements of the New Deal will still be met if:

i. “Equivalent paid rest” is built into the rota for each weekend worked, in the form of working days or half days (to count as a day or half day on duty for total hours purposes). This rest should be taken by the end of the Monday of the following week (ie within 8 days).

However, in exceptional circumstances, the period of equivalent paid rest built into the rota may be taken at another time in the rota cycle. This must be with the agreement of the individual trainee and apply to no more than 25% of weekends worked.

and

ii. The trust clearly demonstrates that the post is fully compliant with all the other hours limits and rest requirements of the New Deal, including the limit of an average 56 hours a week of actual work. Equivalent paid rest will be awarded for each weekend worked where the total rest requirement is not met, on the following basis:

Total rest achieved per 48 hours weekend Equivalent paid rest

Greater than 20 hours, less than 24 Half day (4 hours)

Less than/equal to 20 hours Full day (8 hours)

If less than 16 hours rest is attained, the post is New Deal noncompliant and changes must be made to the working pattern. In the meantime, full day equivalent paid rest will be awarded on such occasions.

3. If the conditions at 1. and 2. cannot be met, other actions will be necessary in order to meet the New Deal requirements governing weekend rest.

32


DRS measures the total rest for the weekend and assesses whether there is adequate rest in line with the requirements set out in 1.27.1. If there is inadequate rest, DRS will look forward for the next 8 days and check for Equivalent Paid Rest (EPR). Any EPR found will be added to weekend days with inadequate rest and the duty will be deemed compliant with rest requirements. If there is not any rest in the following 8 days then DRS will flag the duty as noncompliant.

DRS does not check for exceptional circumstances where EPR may be taken at other periods in the cycle on 25% of weekends (see above part 2.i. of A General Guide to the New Pay System, October 2000). This is because it would not be possible to check for this in a work pattern as it would not be something that could be built into a rota. There is a case for checking for this in diary card analysis but there would not be enough data in a two week monitoring period to be able to check this. Therefore this has not been developed as a function in DRS and would need to monitored by the user separately.

33

2� Template and Working Time Directive

2�1� Work and rest

2�1�1� WTD rule

Extract from European Working Time Directive. Available at www.incomesdata.co.uk/information/worktimedirective.htm#Article2:

Article 2 - Definitions

For the purposes of this Directive, the following definitions shall apply:

1. Working time shall mean any period during which the worker is working, at the employers disposal and carrying out his activity or duties, in accordance with national law and/or practice

2. Rest period shall mean any period which is not working time

The SiMap judgement was also crucial in defining the distinction between work and rest for doctors on-call. The Department of Health produced a summary of the case available at www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/DH_4051942

Below is an extract from this summary:

The implications of the case are that, if there is a business and operational need for a healthcare professional to be present on-call at the premises and available for the purpose of providing continuity of service, this should be viewed as working time. Put another way, doctors resident on-call but asleep will count as working.


This depends on whether the duty period is resident or non resident. If the rota is resident then DRS counts all the hours in the duty period as work (even if under New Deal some of this duty is rest). If the duty period is non resident DRS does not count non resident duty as work and counts only those episodes recorded as work. This is in line with the EWTD and SiMap judgement outlined in 2.1.1.

http://www.incomesdata.co.uk/information/worktimedirective.htm#Article2

www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/DH_4051942



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2�2� Average hours of work


From Working Time (Amendment) Regulations 2003:

Doctors in training

25A

1. Paragraph (1) of regulation 4 is modified in its application to workers who are doctors in training as follows:

a. For the reference to 48 hours there is substituted a reference to 58 hours with effect from 1st August 2004 until 31st July 2007;

b. For the reference to 48 hours there is substituted a reference to 56 hours with effect from 1st August 2007 until 31st July 2009.

2. In the case of workers who are doctors in training, paragraphs (3)-(5) of regulation 4 shall not apply and paragraphs (3) and (4) of this regulation shall apply in their place.

3. Subject to paragraph (4), the reference period which applies in the case of a worker who is a doctor in training is, with effect from 1st August 2004:

a. Where a relevant agreement provides for the application of this regulation in relation to successive periods of 26 weeks, each such period; and

b. In any other case, any period of 26 weeks in the course of his employment.

4. Where a doctor in training has worked for his employer for less than 26 weeks, the reference period applicable in his case is the period that has elapsed since he started work for his employer.

From Working Time Regulations 1998:

6. For the purposes of this regulation, a worker’s average working time for each seven days during a reference period shall be determined according to the formula:

A + BC

Where -

A is the aggregate number of hours comprised in the worker’s working time during the course of the reference period;

B is the aggregate number of hours comprised in his working time during the course of the period beginning immediately after the end of the reference period and ending when the number of days in that subsequent period on which he has worked equals the number of excluded days during the reference period; and

C is the number of weeks in the reference period.

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7. In paragraph (6), ‘excluded days’ means days comprised in -

a. Any period of annual leave taken by the worker in exercise of his entitlement under regulation 13;

b. Any period of sick leave taken by the worker;

c. Any period of maternity leave taken by the worker; and

d. Any period in respect of which the limit specified in paragraph (1) did not apply in relation to the worker by virtue of regulation 5.


In line with the directive, DRS calculates a raw EWTD average hours of work figure by dividing total time resident per week by the number of weeks in the reference period used. It is recognised that generally trusts do not monitor for the whole EWTD reference period (see below for details of this paragraph 2.3), so an average is given for the number of weeks entered for the work pattern cycle.

To try and comply with the Working Time Regulations stipulation that leave is excluded in the reference period (see 2.2.1 above). DRS applies prospective cover to the raw EWTD figure to give the average working hours.

Non resident rest is not included in the hours averaged. Prospective cover is added, but a fresh calculation is not performed. The prospective cover for duty hours is used (calculated from the appropriate formula) pro-rated down in the ratio EWTD hours divided by duty hours.

The actual calculations in DRS are:

EWTD hrs = Ave hours less non resident rest (call this A) + a proportion of prospective cover (or Riddell)

The proportion of ProspCover = Duty hrs ProspCover * A / (Ave duty hours - Duty Hrs ProspCover)

2�3� Reference period


Below is the relevant part of the Working Time Regulations 1998 for reference periods for doctors in training:

Paragraphs (3) and (4) shall apply to a worker who is excluded from the scope of certain provisions of these Regulations by regulation 21 as if for each reference to 17 weeks there were substituted a reference to 26 weeks.


See paragraph 2.2 for how DRS deals with the reference period issue.

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2�4� Leave


From EWTD available at www.incomesdata.co.uk/information/worktimedirective.htm#Article2

Article 7 - Annual leave

1. Member States shall take the measures necessary to ensure that every worker is entitled to paid annual leave of at least four weeks in accordance with the conditions for entitlement to, and granting of, such leave laid down by national legislation and/or practice.

2. The minimum period of paid annual leave may not be replaced by an allowance in lieu, except where the employment relationship is terminated.


DRS does not have a facility for measuring a work pattern against the leave targets. This is because trusts have not required this facility and use other methods for measuring whether leave is taken.

2�5� 11 hours rest



Daily rest

10. (1) An adult worker is entitled to a rest period of not less than eleven consecutive hours in each 24 hour period during which he works for his employer.


DRS checks this by examining the 24 hours following every start of duty. In general, a problem will be indicated if there is not a continuous period of 11 hours off duty in this 24 hours. For non resident work patterns, rest in the duty is counted towards the 11 hours.


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2�6� Compensatory rest



Compensatory rest

24. Where the application of any provision of these Regulations is excluded by regulation 21 or 22, or is modified or excluded by means of a collective agreement or a workforce agreement under regulation 23.a, and a worker is accordingly required by his employer to work during a period which would otherwise be a rest period or rest break -

a. His employer shall wherever possible allow him to take an equivalent period of compensatory rest, and

b. In exceptional cases in which it is not possible, for objective reasons, to grant such a period of rest, his employer shall afford him such protection as may be appropriate in order to safeguard the worker’s health and safety.

This part of the regulation has to be interpreted in light of the Jaeger case (Case C-151/02 Landeshauptstadt Kiel v Norbert Jaeger [2003] ECR I-8389)

Below is an extract from Department of Health guidance on the Jaeger judgement available at www.dh.gov.uk/en/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/DH_4068970:

Compensatory rest

6. The Regulations provide that compensatory rest must be given when the daily/weekly rest requirements cannot be met. Compensatory rest will most likely be necessary when staff are either:

• Working a shift pattern and the shift extends beyond thirteen hours due to an unforeseen situation or emergency, or

• Working on-call from home and are called upon to work during the period of duty, or

• Whenever staff are rostered to be resident on call for more than 13 hours continuously.

7. In each situation the rest provided should make up for the rest missed; and, under the provisions of the Jaeger judgment, should be taken immediately after the end of the working period. The implications of the Jaeger judgment are that it will not be sufficient to aggregate the rest available to an individual over a period and assume that the minimum requirements have thus been met.

8. The arrangements for taking compensatory rest will need to be determined locally in the light of circumstances.

http://www.dh.gov.uk/en/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/DH_4068970



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9. It is recognised in the Regulations that services such as the NHS and Social Care will have instances where a continuous emergency service must be maintained. Exceptionally, where it is not possible for objective reasons to grant a period of compensatory rest, an employer should afford the worker such protection as may be appropriate to safeguard the worker’s health and safety.

10. Employers must make sure that staff can take their rest so as not to compromise health and safety.

Department of Health have also recently produced Information Note on Exceptional Circumstances and Compensatory Rest (available at www.healthcareworkforce.nhs.uk/working_time_directive/wtd_resources/dh_-_information_note.html) which states:

Trusts must use their own judgement, informed by their own legal advice, based on particular local circumstances in deciding whether an exceptional case exists.


Where a shift is longer than thirteen hours, or rest between shifts is interrupted resulting in eleven hours continuous rest not being achieved, compensatory rest must be achieved immediately, in full and without further interruption, or DRS will return a failure. DRS will not flag failure where eleven hours rest is not achieved but compensatory rest has been achieved immediately following the duty period where the rest has been missed. Immediately means the rest is taken without a gap and before the start of the next period of work. This is an interpretation of the Jaeger ruling that compensatory rest must be taken ‘immediately’ unless there are exceptional circumstances (see 2.6.1). It is recognised that trusts may take a different interpretation of these definitions within the framework given in the Department of Health advice above.

2�7� Rest in seven or 14 days



Weekly rest period

11.

1. Subject to paragraph 2. below, an adult worker is entitled to an uninterrupted rest period of not less than 24 hours in each seven day period during which he works for his employer.

2. If his employer so determines, an adult worker shall be entitled to either:

a. Two uninterrupted rest periods each of not less than 24 hours in each 14 day period during which he works for his employer; or

b. One uninterrupted rest period of not less than 48 hours in each such 14 day period, in place of the entitlement provided for in paragraph 1.

http://www.healthcareworkforce.nhs.uk/working_time_directive/wtd_resources/dh_-_information_note.html


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4. For the purpose of paragraphs 1 to 3, a seven day period or (as the case may be) 14 day period shall be taken to begin -

a. At such times on such days as may be provided for the purposes of this regulation in a relevant agreement; or

b. Where there are no provisions of a relevant agreement which apply, at the start of each week or (as the case may be) every other week.

5. In a case where, in accordance with paragraph 4, 14 day periods are to be taken to begin at the start of every other week, the first such period applicable in the case of a particular worker shall be taken to begin -

a. If the worker’s employment began on or before the date on which these Regulations come into force, on 5th October 1998; or

b. If the worker’s employment begins after the date on which these Regulations come into force, at the start of the week in which that employment begins.

6. For the purposes of paragraphs 4 and 5, a week starts at midnight between Sunday and Monday.

7. The minimum rest period to which an adult worker is entitled under paragraph 1 or 2 shall not include any part of a rest period to which the worker is entitled under regulation 10 (1), except where this is justified by objective or technical reasons or reasons concerning the organisation of work.


In line with paragraph 11.7. above from Working Time Regulations 1998, which is taken to mean that no weekly rest period should include any part of a daily rest period, DRS analysis reports on the achievement of 35 or 59 hours rest over either reference period. This then indicates that an 11 hour rest period has been received in addition to a 24 hour or 48 hour rest period.

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3� New Deal and Monitoring Analysis

3�1� Study


New Deal documents do not usually refer to ‘study’ but instead uses the term ‘monitoring exercise’ or ‘monitoring period’. This is used in the Terms and Conditions and also Junior Doctors’ hours - Monitoring Guidance, October 2000. Hours can be monitored over a range of periods but ‘a monitoring period of two weeks is recommended.’ (Junior Doctors’ Hours - Monitoring Guidance, October 2000, p.4)


When DRS uses the term ‘study’ it is taken to mean ‘monitoring exercise’ or ‘monitoring period’.

3�2� Start times, end times and rest


There are New Deal limits of shift length and rest - see paragraph 1.10 - 1.14 for more information.


DRS records allow the user to record start and end times of duty periods and the rest received in these duty periods. This information will then be used to measure the duty periods against the New Deal targets detailed in paragraph 1.10 - 1.14.

3�3� Diary card analysis


This function of DRS supports the requirement to monitor hours that exists in New Deal - ‘The New Deal has required since 1991, an hours’ monitoring system capable of recording and checking hours worked by doctors in training against a set of hours limits and controls’ (Junior Doctors’ Hours - Monitoring Guidance, paragraph 1)


The summary analysis in the software analyses the work pattern entered against the New Deal targets (and EWTD targets) in order to check compliance with the New Deal and EWTD.

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3�4� Combined diary cards and template analysis


The Junior Doctor Contract states that 75% return rate must be achieved for diary card analysis to be valid for pay banding purposes:

Under this national framework a minimum return rate for monitoring data should be set at 75% of all doctors in training in each rota or shift (irrespective of grade) participating in the monitoring round, and at 75% of all duty periods worked over the monitoring period, provided this is deemed to be a representative figure in both cases. This threshold is important for making a valid and accurate assessment of hours worked and rest attained.

Junior Doctors Hours Monitoring Guidance


DRS has a function for analysing the diary cards and the template together. This analysis is based on the template however, start and end times for the standard working week duties and the start and end times and rest achieved for out of hours duties in the work pattern are replaced by average values obtained from the diary card study. The BMA Handbook 2005/06 indicates that adding template data to monitoring is helpful for occasions where less than 100% of diary cards have been received (p.61):

Non returned forms

Junior doctors are contractually required to comply with monitoring. Trusts are required to ensure that robust monitoring systems are in place. The New Contract states that a ‘minimum return rate for monitoring is 75% of all doctors in training on each rota…and 75% of all duty periods’. If this is met, the hours not accounted for by non returned forms must be accounted for in the assessment of monitoring data to ensure an accurate assessment of hours for banding. The missing data cannot be ignored because we may ignore a particularly quiet week, say 36 hours, which would artificially increase hours on monitoring and result in an inappropriately high band, and vice versa. Therefore, providing the minimum return rate is met, any shifts unaccounted for should be added to the monitoring data as per the rostered hours.

Trusts have the option to use this combined diary card analysis or the standard diary card analysis. They should use whichever they deem appropriate in the circumstances. Another way of counteracting the problem of missing diary cards is to add in ‘dummy’ data to the real monitoring data if appropriate. This is in accordance with the JDC guidance. (Average duty and average hours for the monitoring period will only be displayed if there is a 100% return of diary cards).

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3�5� Shortest off duty period


See paragraph 1.10 - 1.14 for details of the rules on shortest off duty periods.


In DRS these are the shortest periods off duty between duty periods.

3�6� Longest duty period


See paragraph 1.10 - 1.14 for the New Deal limits on duty periods.


DRS analyses the monitoring study and highlights duty periods that exceed the targets set out in paragraph 1.10 - 1.14.

If there is no gap between the duties of one day and the next they are added together. The duty type is taken from the duty types of the first duty in the sequence. For a hybrid pattern, each duty found is reported separately.

3�7� Natural breaks


A natural break as a rest requirement of a full shift is defined as ‘at least a 30 minute continuous break after approximately 4 hours continuous duty’ (HSC 1998/240, Annex B, Appendix 1).

It is debatable whether as part of the contract natural breaks are required to be taken 75% of the time or 100%. In HSC 1998/240 it states that “Reasonable expectation of rest: In each of these working patterns, rest targets must be met during at least three quarters of all rostered duty periods”. Advice from NHS Employers, has said that though natural breaks are not to be counted as rest the 75% rule still applies to them because of this statement. See www.idwl.info/natbreaks-gmsha.html for more details of this.


DRS allows users to record whether natural breaks were taken during the duty period and then reports noncompliance if natural breaks have not been achieved on 75% of occasions. This adheres to the NHS Employers view given in 3.7.1. See 4.2 for the DRS rule for the WTD 20 minute break.

3�8� Duty hours outside 7am to 7pm Mon - Fri


Duty outside 7am - 7pm Mon - Fri is considered out of hours work under New Deal. See paragraph 1.2.1 for how this affects the banding supplements for junior doctors.

http://www.idwl.info/natbreaks-gmsha.html

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In the monitoring analysis DRS calculates the percentage of out of hours worked. This affects the banding calculation for some rotas as shown in paragraph 1.2.1.

3�9� Prospective cover and diary card analysis


The 2002 prospective cover calculation does not make an adjustment to diary card analysis for prospective cover.


If the 2002 calculation is used then DRS does not make any adjustment to diary card analysis for prospective cover. The combined analysis makes a PC adjustment in line with any PC added to a particular associated work pattern. However the Riddell formula does make an adjustment to diary card analysis for prospective cover. Extract from BMA Handbook:

How to address annual leave in monitoring

Two problems arise when monitoring a rota. Firstly, it is unusual that a monitoring period will contain an absolutely representative amount of leave that would be expected on average to occur in a two-week period. Secondly, as discussed above, a worker is entitled to an average week as leave. However, many rotas allocate shifts to the annual leave week that may be worked if a junior is not on leave. These rarely equate to an average week. Therefore, we require a method that will standardise these two variable factors. Firstly, a ‘leave adjustment’ is calculated from the rota template using the following formula; Leave adjustment = (average hours worked - allocated leave week in hours) x leave entitlement 52. This should be calculated twice, once for actual hours and once for available hours.

Example:

If we look at our example five-week rolling on-call rota again we can see how the formula should be applied to monitoring data.

Mon Tues Wed Thurs Fri Sat Sun Avail Actual

1 On-call Day Day Day On-call - - 72 56

2 Day Day On-call Day Day - - 56 48

3 Day On-call Day Day Day On-call On-call 104 72

4 Day Day Day On-call Day - - 56 48

5 Day/AL Day/AL Day/AL Day/AL Day/AL - - 40 40

328 264

Day: 9am - 5pm = 8 hours On-call: 9am to 9am = 24hours, 16 actual hours (Weekend 10 actual hours)

From the calculations above we know that on paper this rota requires the juniors to be available for an average of 72 hours per week and to be actually

44

working for an average of 56 hours per week. This calculation uses the figures from the theoretical Riddell formula, so junior doctors need to use the average and adjustment from the template to make this calculation.

This is on the basis that the doctors cover all their leave internally and achieve the minimum rest requirements under the New Deal. To adjust for leave during the monitoring period we can apply the following formula:

Thus by providing internal cover, each doctor works on average an additional 6.4 available and 3.2 actual hours per week. These values must be added to the average hours determined during the monitoring exercise.

The Riddell formula includes an adjustment for diary cards and where a user elects to use the Riddell formula, the adjustment is included. For a study belonging to a group where the Riddell formula is used, no combined analysis is available, as this is superseded by the results of PC adjustment to pure diary card analysis.

3�10� Type of day


New Deal distinguishes between ‘normal days’ and ‘out of hours periods’.


DRS allows users to record whether the shift is ‘normal day’ or ‘out of hours work’. This allows the system to work out the percentage of shifts that are part of the normal working week.

3�11� Average hours of work


See paragraph 1.10 - 1.14 for details of New Deal rules on average hours of work.

Leave adjustment x

x

52=

-

-

Average week in hours Allocated leaveLeave entitlement

‘Available hours’ leave adjustment52

=6.4=

72 40 10.4

x-‘Actual hours’ leave adjustment

52=

3.2=

56 40 10.4

45


The basic calculation is very simple. DRS adds up all the recorded duty and work hours and divides by, the length of the study in weeks, times the number of doctors involved. This calculation is only possible if all the diary cards for the study are entered. This is because large errors can occur if the system attempts to guess the duty for just a single missing diary card. It is the user’s responsibility to that they enter reasonable data for each doctor and every day in the study period even if no card was completed by the doctor.

No prospective cover or 2002 prospective cover

Annual leave days are looked at for each doctor. These days may mask time worked by a locum which should be included in the averages.

If leave/sick days are recorded, DRS will take the following actions (NB different action is taken if the Riddell formula is in use - see below):

If a full week of leave is recorded (5 weekdays), that week will be ignored in the calculations (so a two week study for a doctor with 5 leave days will be reduced to a one week study for that doctor only). The effect is to reduce the divisor in the average hours calculation by one.

For isolated days of leave (less than whole weeks), each leave day will be replaced by a normal 8 hour working day with no rest.

For leave greater than a week but less than two weeks, a week is removed and the remainder treated as normal days (using the isolated days rule).

Leave of two full weeks (10 weekdays) will reduce the divisor in the average hours calculation by two.

Riddell Formula

If the Riddell formula is specified for use with this work group, additional hours will be added to these calculated averages. The figures to use are derived from the theoretical pattern and represent a correction for leave taken in the monitoring period.

Any days in the monitoring period recorded as annual leave or sick days will each contribute to the total work and duty hours one fifth of the hours of the normal week.

The formula for leave adjustment is taken from the Junior Doctor’s Handbook and is:

This is calculated for duty hours and work hours and added to the average weekly monitored duty and work hours.

x52

=- Average weekly duty hours Leave week

Leave entitlement weeks

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3�12� Average hours of duty


See paragraph 1.2.1, 1.10 - 1.14 and 1.18 for details of New Deal rules on average hours of duty.


The basic calculation is very simple. DRS adds up all the recorded duty and work hours and divides by, the length of the study in weeks multiplied by the number of doctors involved.

3�13� Continuous rest


See paragraph 1.2.1, 1.10 - 1.14 and 1.19 for details of New Deal rules on continuous rest. This is only applicable to on-call and 24 hour partial shifts.


The diary cards are examined for rest against the criteria given above. If work episodes are not recorded on the diary card, long rests cannot be calculated. If no work episodes are entered, DRS assumes that all the rest for the day (entered in the ‘Rest’ entry box) is continuous and in the required time period.

3�14� Percentage of duties with adequate out of hours rest


See paragraph 1.2.1 and 1.26.1 for details of New Deal rules on out of hours rest.


DRS analyses the monitoring data using the criteria in paragraph 1.26 and 1.10 - 1.14. If work episodes are recorded for the duty, the total out of hours rest is calculated accurately. If no work episodes are entered, but a total rest achieved figure is entered, it is assumed that this rest was achieved in the out of hours period.

The average rest and, rest requirement is calculated by intensity and for on-call by weekday (Monday to Friday) and weekend.

For on-call weekend days it is possible to get Equivalent Paid Rest (EPR) rest if there is inadequate rest on the day. If the total rest on the two weekend days together is adequate, then both days are counted as having adequate rest, subject to the restriction that each day must have at least 8 hours of rest. It is also allowed for rest to be taken from the 6 weekdays following the weekend if any days have excess rest. It is not possible to check this for the normal 2 week diary card study, so it is possible that some weekends may be counted as having inadequate rest when compensatory rest was available.

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3�15� Total rest (On-call intensity weekdays only)


See paragraph 1.2.1 and 1.26 for details of New Deal rules on total rest for on-call week days.


For on-call weekday duties there is a requirement for the total rest in the 32 hours following the start of the duty to be at least 8 hours. Every weekday is evaluated and the percentage that fulfils the rest requirement calculated. This is reported against the target that 75% of duties that require a rest element have adequate rest.

3�16� Number of weekends worked


A weekend is defined in A General Guide to the New Pay System, October 2000:

16. Definition of weekend - a weekend worked is one which involves the doctors being on duty at any time during the period from 7pm Friday to 7am Monday.

See paragraph 1.2.1 for details of the limits on weekends worked and how they relate to the banding supplement applicable to the group.


DRS regards a weekend to have been worked if there was any duty after 7pm on the Friday or on the Saturday or Sunday or before 7am on Monday. All recorded weekends are counted and compared to the number of weekends worked. This is used to calculate the banding supplement applicable to the group.

3�17� Banding calculations


See paragraph 1.2.1 for New Deal banding supplement rules and flowchart.


DRS follows paragraph 1.2.1 to calculate the banding supplement for a rota. Also please note the following:

Weekly Work Hours

If there are diary cards missing from the study, work and duty hours will not be displayed in the comparison table. In this case DRS will estimate average work hours and use this figure the banding calculation. The user should make sure that reasonable diary cards are submitted for every day of the study.

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Criteria R

Criteria R states “Are you resident and carrying out any work after 7pm, or non-resident and doing 4 hours work after 7pm on 50% or more occasions?” DRS will examine work episodes entered during the monitoring period to give an accurate value for Criteria R.

Weekend Work

For tests that involve weekend work, a weekend is deemed to have been worked if there was any duty after 7pm on the Friday or on the Saturday or Sunday or before 7am on Monday.

On-Call Frequency

The frequency of an on-call rota is calculated by comparing the total number of weekdays worked to the number of on call weekdays (1 in 6 etc.). Leave in the monitoring period can cause the figure based on diary cards to be different to the figure based on the pattern and result in a change of banding.

To avoid problems of this nature, the on call frequency used in banding is as follows:

• If a pattern has been entered, the frequency calculated from the pattern will be used. If there is no work pattern, then the frequency calculated will be based on diary cards that are available. The frequency calculated from the diary cards is presented in the analysis table even if it is not used in the banding calculation.

Prospective Cover

If prospective cover is included for the pattern, this fact will be used even if other information is taken from diary cards.

3�18� Ministerial return - banding supplements


There is no New Deal definition for this or any Department of Health guidance as it is not a contractual issue.

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The BMA handbook indicates that adding template data to monitoring is helpful for occasions where less than 100% of diary cards have been received (p.61):

Non returned forms

Junior doctors are contractually required to comply with monitoring. Trusts are required to ensure that robust monitoring systems are in place. The New Contract states that a ‘minimum return rate for monitoring is 75 percent of all doctors in training on each rota… and 75 per cent of all duty periods’. If this is met, the hours not accounted for by non returned forms must be accounted for in the assessment of monitoring data to ensure an accurate assessment of hours for banding. The missing data cannot be ignored because we may ignore a particularly quiet week, say 36 hours, which would artificially increase hours on monitoring and result in an inappropriately high band, and vice versa.

The table below shows how the return rate for diary cards affects the calculation for the suggested banding for the Ministerial Return Annex in DRS:

Most recent diary card exercise return rate

Banding calculation taken from:

100%Most recent diary card exercise analysis

<100% >75%

Most recent Combined template and diary card analysis

<75%Previous study (Diary card analysis or combined -depending on return rate as shown above)

No previous study that meets the 75% return

rate requirementTemplate analysis

However, this banding supplement will always be overruled by any agreed banding entered for the junior doctor group.

If combined analysis is used then close attention needs to be paid to the diary card analysis for any natural break, rest or shift length breaches.

3�19� Real diary cardsA real diary card check box is included in the study supervisor’s diary card input screen. This is to allow the distinction between actual data from the doctor and appropriate theoretical data added by the study supervisor.

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4� WTD and Monitoring Analysis

4�1� Average weekly work hours


See paragraph 2.2.1 for the WTD definition of maximum average weekly work hours.


The average hours figure given is only an indication of whether the doctors are meeting the WTD requirements. To fully check for compliance each doctor would have to be monitored over the full 26 week reference period.

The figure used is derived in a manner almost identical to the “Average weekly hours of duty” for New Deal analysis. There are the following differences:

The combined template and diary card calculation is used to give a more accurate analysis�

Annual leave/sick days are not removed or replaced.

Study leave days can be defined with start and end times. If specified, these hours will be used. If they are not, 8 hours of duty will be assumed.

Riddell formula hours adjustment is not included.

For a non-resident duty, rest periods while on call are not counted as work and are not included in the calculated average work hours.

4�2� Less than 11 hours rest in 24


See paragraph 2.5.1 for WTD rule on daily rest periods.


DRS checks this by examining the 24 hours following every start of duty. In general, a problem will be indicated if there is not a continuous period of 11 hours off duty in this 24 hours. For non resident work patterns, rest in the duty is counted towards the 11 hours.

If this test fails, DRS will check for the availability of compensatory rest immediately following the 24 hour period. For example, 24 hours on duty followed by 22 hours of rest will be allowed. 22 hours is necessary to allow 11 hours compensatory rest from the previous 24 hours and 11 hours of rest for the current 24 hours. In such a case DRS will not flag a failure but will show a warning. A duty in excess of 24 hours will always fail this test. This only a warning to the user following DRS’ interpretation of the Working Time Regulations 1998. Employers will have to decide whether rest requirements have been met in line with their own local guidelines.

See paragraph 2.6.1 for details of WTD rules on compensatory rest.

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4�3� Doctors without adequate breaks


See paragraph 2.7.1 for WTD rule on adequate weekly breaks.


In line with the statement that the 24 hours rest every seven days or 48 hours rest every fourteen days must not run concurrently with the eleven hours rest in every 24, DRS analysis reports on the achievement of 35 or 59 hours rest over either reference period.

The rule is failed in DRS if there is no 35 hour break in the first week (the break must end before 9am on the Monday of the second week) and no 59 hour rest at any time in the monitoring period. It is assumed that any rest period at the end of the monitoring period will end at 9am on the day after the monitoring ends (usually a Monday).

This is only a warning to the user following DRS’ interpretation of the Working Time Regulations 1998. Employers will need to make their own decisions about whether rest requirements are met in line with their own local guidelines.

4�4� 20 minute break


Extract from Working Time Regulations 1998:

Rest breaks

12.

1. Where an adult worker’s daily working time is more than six hours, he is entitled to a rest break.

2. The details of the rest break to which an adult worker is entitled under paragraph 1, including its duration and the terms on which it is granted, shall be in accordance with any provisions for the purposes of this regulation which are contained in a collective agreement or a workforce agreement.

3. Subject to the provisions of any applicable collective agreement or workforce agreement, the rest break provided for in paragraph 1 is an uninterrupted period of not less than 20 minutes, and the worker is entitled to spend it away from his workstation if he has one.


DRS records New Deal and EWTD natural breaks together. New Deal natural break requirements are more stringent than EWTD breaks requirements. If a doctor achieves New Deal natural break requirements then they have also achieved EWTD 20 minute break requirements. However, if a doctor does not get their New Deal natural breaks then they are not necessarily breaching EWTD break requirements. DRS analysis provides a record of the percentage of shifts where the user did not consider that natural breaks had been achieved.

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5� ReferencesBMA, Junior doctors’ handbook 2005/06 (available from BMA)

Department of Health, 2000. Junior Doctors Contract - A General Guide to the New Pay System (online) Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Department of Health_4009033 (accessed 11th December 2007)

Department of Health, 2000. Junior Doctors contract banding system letter (online) Available at: http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingpay/Juniordoctorcontracts/Department of Health_4053873 (accessed 11th December 2007)

Department of Health/BMA, 2002. Guidance on Working Patterns for Junior Doctors (online) Available at: http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingpay/Juniordoctorcontracts/Department of Health_4053873 (accessed 11th December 2007)

Department Health. Information Note on Exceptional Circumstances and Compensatory Rest (online) Available at: http://www.healthcareworkforce.nhs.uk/working_time_directive/wtd_resources/dh_-_information_note.html (accessed 11th December 2007)

Department of Health, HSC 1998/240 - Reducing Junior Doctors’ Hours (online) Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/Department of Health_4003928 (accessed 11th December 2007)

Department of Health, 2005. The SiMap ruling (online) Available at: http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/Department of Health_4051942 (accessed 11th December 2007)

Department of Health, 2007. Jaeger judgment: Information for NHS and social care employers (online) Available at: www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/Department of Health_4068970 (accessed 11th December 2007)

European Working Time Directive - Available at: www.incomesdata.co.uk/information/worktimedirective.htm#Article2 (accessed 11th December 2007)

www.idwl.info Improving Doctors’ Working Lives website (accessed 11th December 2007)

NHS Employers, NHS Hospital Medical and Dental Staff and Doctors in Public Health Medicine and Community Health Service (England and Wales) Terms and Conditions of Service, September 2002 (Version 8 – 30 July 2007) Available at: http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm (accessed 11th December 2007)

Working Time Regulations 1998. SI 1998/1833 London: HMSO

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009033

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009033



http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingpay/Juniordoctorcontracts/DH_4053873

http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingpay/Juniordoctorcontracts/DH_4053873



http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4003928

http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4003928

http://www.dh.gov.uk/en/Policyandguidance/Humanresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/DH_4051942







http://www.idwl.info

http://www.nhsemployers.org/pay-conditions/pay-conditions-467.cfm

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A & E Accident and emergency

ANAESTHETICS Anaesthetics

DENTISTRY Dental medicine Specialties

DENTISTRY Dental public health

DENTISTRY Oral (and Maxillo-Facial) surgery

DENTISTRY Orthodontics

DENTISTRY Paediatric dentistry

DENTISTRY Restorative dentistry

GENERAL PRACTICE General practice

MEDICINE Audiological medicine

MEDICINE Cardiology

MEDICINE Cardio-vascular disease

MEDICINE Clinical genetics

MEDICINE Clinical immunology and allergy

MEDICINE Clinical Neurological Physiology

MEDICINE Clinical Pharmacology

MEDICINE Clinical pharmacology and therapeutics

MEDICINE Clinical physiology

MEDICINE Communicable Diseases

MEDICINE Community medicine (Public health medicine)

MEDICINE Dermatology

MEDICINE Endocrinology and diabetes mellitus

MEDICINE Gastroenterology

MEDICINE General medicine

MEDICINE Genito-urinary Medicine (Venereology)

MEDICINE Geriatric medicine

MEDICINE Infectious diseases

MEDICINE Intensive therapy

MEDICINE Medical oncology

MEDICINE Medical ophthalmology

MEDICINE Nephrology

MEDICINE Neurology

MEDICINE Nuclear Medicine

MEDICINE Occupational Health

MEDICINE Occupational medicine

MEDICINE Other

MEDICINE Palliative medicine

MEDICINE Primary Care in General Practice

MEDICINE Rehabilitation

MEDICINE Renal medicine

MEDICINE Respiratory medicine

MEDICINE Rheumatology

MEDICINE Thoracic Medicine

MEDICINE Venereology

O & G Obstetrics and gynaecology

PAEDIATRICS Paediatric cardiology

PAEDIATRICS Paediatric neurology

PAEDIATRICS Paediatrics

PATHOLOGY Blood transfusion

PATHOLOGY Chemical pathology

PATHOLOGY Clinical Cytogenetics

PATHOLOGY Clinical cytogenetics and molecular genetics

PATHOLOGY General pathology

PATHOLOGY Haematology

PATHOLOGY Histopathology

PATHOLOGY Immunology

PATHOLOGY Immuno-pathology

PATHOLOGY Medical microbiology

PATHOLOGY Medical Microbiology and Virology

PATHOLOGY Morbid anatomy and histopathology

PATHOLOGY Neuropathology

PATHOLOGY Virology

PSYCHIATRY Child and adolescent psychiatry

PSYCHIATRY Forensic psychiatry

PSYCHIATRY Learning disabilities

PSYCHIATRY Learning Disability

PSYCHIATRY Mental Illness

PSYCHIATRY Old age psychiatry

PSYCHIATRY Psychiatry

PSYCHIATRY Psychotherapy

RADIOLOGY Diagnostic radiology

RADIOLOGY Nuclear medicine

RADIOLOGY Radiotherapy (Clinical Encology)

RADIOLOGY Radiotherapy (Clinical Oncology)

SURGERY Cardio-thoracic Surgery

SURGERY General surgery

SURGERY Neurological surgery

SURGERY Neurosurgery

SURGERY Ophthalmology

SURGERY Orthopaedic surgery

SURGERY Otolaryngology

SURGERY Otolaryngology (ENT)

SURGERY Paediatric surgery

SURGERY Plastic surgery

SURGERY Thoracic surgery

SURGERY Traumatic and Orthopaedic Surgery

SURGERY Urology

6� Appendix - NHS Employers Specialty List

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7� DRS Rulebook v1�1 - Summary of Amendments

• Added additional information on Criteria R - 1.6.2

• Additional information on day after on-call - 1.10.2

• Amendment to definition of normal week following inclusion of an update from NHS employers. Normal week work of 40 hours for a basic salary is now to be between 7am - 7pm rather than 8am - 7pm - 1.16.1

• Additional information on combined diary card analysis - 3.4.2

• Information on real diary cards included - 3.19

• Information on the use of combined analysis and monitoring - 3.18.2

drs v3 rule book 2008 - bolton nhs ft

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