The Working Week and The Junior Doctor Contract (JDC)
NOTE – JDC applies to all trainees who commenced GP training since Aug 2016
Please see some example timetables for doctors in training (DiT) in General Practice. These are guidelines which can be adapted to suit individual practices and trainee circumstances.
The basic working week requirements for doctors on the JDC and the old contract are the same with regard to proportion of clinical and educational activity. GP DiTs on the JDC are entitled to paid breaks and so these have to be included. OOH are part of the 40 hour working week, not in addition to it, for trainees on the JDC, see below for more details on JDC and OOH.
The 40-hour working week is divided into 10 x 4 hour nominal sessions (7 clinical and 3 educational) but this does not fit well with most GP working days so it is easier to think about it in terms of hours. So on average DiTs should do the following per week:
• 28 hours clinical activity - with 1 hour of clinical admin time for every 3 hours of patient contact (booked appointment, unscheduled care (duty doctor), visits) = 21 hours direct patient contact and 7 hours clinical admin.
• 12 hrs educational activity - 4 hours external structured education; 4 hours practice based structured teaching and 4 hours independent educational activity.
External structured education includes:
• Teaching Programme Induction days
• Half Day Release Course (HDRC)
• Topic Teaching
• AKT and CSA courses provided by local RCGP Faculty
• Careers Fairs
• Attending ST3 practice for ST2 trainees
Study leave is used for these sessions.
Practice based structured teaching includes:
• Joint surgeries
• Practice based learning events
• Some induction activities
Independent learning activity could include:
• Primary care team meetings e.g.practice meetings, CCG meetings, Federation meetings.
• Audit and research in general practice.
• Independent study/revision for AKT and CSA. Tutorial and teaching preparation.
• Commissioning services.
• Sitting in with other HCP eg nurse practitioner chronic disease management clinic
• Attending speciality clinics eg dermatology
• Time spent with other professionals who deliver services that are not considered part of general medical services, such alternative and complementary therapists.
• Time spent with professionals who have expertise in other matters that relate to aspect of healthcare and death administration, social workers and undertakers.
• Getting to know local healthcare professionals and helping the practice maintain links with the local community (COGPED, 2012).
• Planning and delivering medical student teaching in your GP training practice, up to 8 sessions maximum per year.
• Some of these will be induction activities.
These sessions should be planned and agreed with the educational / clinical supervisor to meet individual DiT’s learning needs and should be recorded in appropriate learning log entries to demonstrate learning achieved. It may sometimes be appropriate for this time to be used in gaining more clinical experience by seeing patients in surgery. It is anticipated that a significant amount of this time will be used to undertake quality improvement project(s) within the practice.
Study leave is NOT used for these sessions.
Every week will not be the same given study leave, annual leave and public holidays etc so over a 12-month ST3 year there should be approximately:
• 44 x 4-hour External Structured Teaching Sessions - comes out of study leave.
• 44 x 4-hour Practice based structured education (2 of 4 hours protected)
• 44 x 4 hour independent education activity sessions
For ST2s in a 6 month post the numbers would be halved.
The exact number and type of external structured teaching sessions offered by each program will vary.
ST3s are entitled to up to 30 days or 60 sessions (60 x 4 hours) of study leave so there will be approximately 16 sessions left to use once the external teaching sessions are accounted for. ST1/2s are entitled to up to 15 days (15 x 4 hours) study leave in a 6-month post so will have about 8 sessions left to use after external teaching accounted for. DiTs need to apply to use these additional days/sessions.
Doctors are also entitled to up to 5 days professional leave a year. Professional leave can be used for attending committee meetings, the PESC or EESC to help trainers, practice visits and similar activities that are not primarily educational but are of benefit to the medical community.
After these educational and professional activities have been scheduled the rest of the Doctor's time should be spent on clinical activity. In practice there is regularly an overlap between clinical and educational activity with debriefing and clinical supervision taking place at the same time as clinical activity.
LTFT Doctors in Training
Same principles as for full time doctors so all of the above pro-rata per year or count the total for however long they are ST2 or ST3 eg 20 months at 60% to complete 12 months FTE.
Working Week in Practice
Many GP days start with booked surgeries before 9am and go on until 6.30pm or beyond with extended hours and clinical administration. Unless Doctors in a GP placement are going to be scheduled strictly 9-5 and not be exposed to the full GP day they are going to need at least one shorter day to compensate for the longer days. Pragmatically many practices schedule in an afternoon off and for some this works well on a VTS teaching day, particularly if local geography means a significant travel time between the location of teaching and the practice.
Job plans should be shared with the doctor prior to starting a placement and include timetabled education sessions (not just “days off). A written plan including these sessions should also be available to show to HEE if requested.
Contract with paid breaks and OOH
This can be calculated in different ways. The 40-hour working week can be averaged out over 26 weeks and so could be considered over the whole 6 month time period, including annual leave and study leave.
For every period of work over 5 hours trainees have to have a 30-minute paid break so if they work on a usual work schedule of four 9 hour days in practice (tutorial and independent learning time timetabled into these days) and one 4 hour day when attending teaching at day release then need to factor in 2 hours for breaks. Then there is 36 hours of OOHs to consider – could either pay back some time each week and therefore reduce each week by 1.5 hours but this does not take account of weeks when on annual leave or study leave. It could be suggested that it is probably easier to give the 36 hours for OOHs back by giving four clinical days off (4 x 9 hour days making 36 hours) or other time back as agreed with the trainee. So if taking off breaks only and working on a four x 9 hour day plus one x 4 hour day gives the following proportions.
Contracted Hours Education Clinical Admin Direct Patient Contact
100% 38 hrs plus 2 hours breaks 11 hours 30 minutes 6 hours 30 minutes 20 hours
80% 30 hours + 2 hour breaks 9 hours 5 hours 16 hours
60% 22.5 hours +1.5 hours breaks 6 hours 30 minutes 4 hours 12 hours
The exact amounts for the 80% and 60% depend on how their week is structured for periods of work and therefore how much paid break time they have and would have to be calculated for each individual. For example, if they were working 4 days a week for 80% that would be 32 hours total which could be one 10 hour day, two 9 hour days and one 4 hour day (going to teaching), in which case you would still need 2 hours of breaks because any day over 9 hours needs 2 x 30 minute breaks.
NHS Employers TCS - https://www.nhsemployers.org/publications/tchandbook
Work Schedule guidance and Templates - http://www.nhsemployers.org/your-workforce/pay-and-reward/medical-staff/doctors-and-dentists-in-training/terms-and-conditions-contracts/work-scheduling-templates-and-guidance