Guardians of safe working: a view from junior doctors

Guarding the guardians

It is essential that guardians hold no other trust management responsibilities and we are pleased that this is a recruitment requirement for the role. However we are still unclear as to who will “guard the guardian.” We need assurance that guardians will be acting independently and not be pressured by management to downplay junior doctors’ concerns.

Rapid recruitment

We appreciate that the recruitment process was carried out according to due process, but the timescale was too short. This meant that some trusts may not have had enough time to find those with the necessary training for the job. Furthermore, the fact that NHS Employers was continuing to send trusts advice on guardian recruitment in early August 2016 suggests that some had not appointed their guardian by the time of the first guardians conference at the end of July 2016. From a junior doctor’s perspective, it is alarming that the conference was not held once all guardians were appointed with their attendance being mandatory.

Appointments

The appointment panel for guardians is split 50:50 between junior doctors and management. We are deeply concerned by reports that, at some trusts, junior doctors have found themselves outnumbered by management on the appointment panel on the day of guardian recruitment. In fact, given the importance of the role to juniors, we would have advocated a ratio weighted in favour of junior doctors so they did not feel pressured by management during the appointment process.

Time for job

A benchmark for the time allocated for the guardian post has been provided by NHS Employers. But it remains vague and open to interpretation.

It is suggested, for example, that the time be in keeping with other medical managerial posts. However this is an exceptional role that is at the heart of the junior doctor contract dispute. Without a clear calculated estimation of workload per size of junior doctor workforce we are concerned that the role may be pigeonholed by trusts and time allocated may not match that needed to carry out the range of responsibilities the guardians have.

Confidentiality

This is the area that causes us the greatest concern. Our progression through training requires sign-off from both our clinical and educational supervisors, as well as from multisource feedback. We still have doubts as to whether junior doctors could be regarded as “troublemakers” if completing multiple exception reports. This may be a fear based on historical hierarchal attitudes in medicine and unjustified today, but it is a fear perpetuated by reports of negative consequences for whistleblowers in the NHS. http://www.telegraph.co.uk/news/2016/08/20/whistleblowers-being-blacklisted-by-nhs-as-staff-records-state-t/

We welcome exception reporting and the introduction of more regular hours monitoring, but we are mindful that this individualised approach and the resultant work reviews may disproportionately focus on the individual junior doctor reporting, as opposed to the workload of the rotation as a whole. Clearly an important priority is preventing rotating junior doctors encountering the same problems.

Overall, we believe that the guardian role represents an opportunity for a cultural move towards a value based approach to trainees as opposed to the blame culture often encountered in the past.

Mind the gap

A pressing concern across medicine is the increasing number of rota gaps. We welcome the introduction of a guardian annual plan to tackle this problem. But this must not allow abdication of the issue at a national level. We echo recent calls by junior doctors for the Department of Health and NHS Employers to improve transparency around rota gaps and to seek to understand the root causes of these gaps.

Is there an app for that?

We hope that technology can be developed to allow easy, accessible, but sufficiently data protected, reporting of working hours. Technological advance in the NHS is often slow and painful. We hope exception reporting will not add to this burden.