Prospective Cover
The "Prospective Cover" screen must be used to input details if a calculation of prospective cover is to be included in the calculations for the work pattern.
Type of Prospective Cover
DRS offers three different ways to calculate prospective cover:
· The calculation from the document "Guidance on Working Patterns for Junior Doctors" published in 2002. This was produced jointly by the Department of Health, the National Assembly for Wales, the NHS Confederation, and the BMA. A copy of this document can be viewed in PDF form from the DRS "Help" menu.
· The calculation from the Junior Doctors Contract. This is very similar to the calculation from the document above, but works in terms of weeks of leave rather than days so small differences due to rounding are possible.
· The Riddell Formula as described in the Junior Doctors Handbook 2003/2004. This uses a different approach to the two above and can in some cases produce significantly different results.
The type of prospective cover selected is stored with the pattern and will not effect any other patterns. The default method to be used is specified on the "DRS Configuration" screen (under the "Supervisor" menu).
It should be noted that the first two methods only effect the theoretical pattern analysis, but use of the Riddell formula will cause an adjustment to be added to monitoring analysis results as well.
Doctor Numbers
The numbers of doctors (by grade) in the group that provide prospective cover for each other must be entered. If no numbers are entered, it will be assumed that prospective cover is not to be used with this work pattern. The total number of doctors specified should be equal to the total number of doctors on the tier of the rota being analysed. If a grade other than those allowed for on the screen is part of the group, or non standard leave is involved (perhaps leave is built into the work pattern), then the "other" slot should be used and the amount of leave specified in days per annum. Where there is more than one non-training post - the average leave for this group should be entered. When evaluating the hours worked, extra time will be added to cover standard leave for the grades specified.
If the amount of leave to be covered is different from the standard for a grade (see table below), the amount of leave required can be entered for the grade and will be used instead of the standard figures. If entered, the leave will be the total of annual and study leave for the year. Just one of the "cover annual leave" and "cover study leave" needs to be ticked if a non standard total leave is entered.
The Scope of Prospective Cover
The calculation can be set to cover any or all of statutory holidays, annual leave and study leave by checking the appropriate options. Statutory holidays is assumed to be 10 days/annum. The amount of holiday for the other categories will depend on the grade.
For traditional prospective cover which duties or parts of duties to be covered must be selected.
- Cover for all duty periods. Select this button if prospective cover is provided for all duties i.e. during the normal working day and out of hours.
- Cover only duties outside normal working hours. Select this button if prospective cover is only provided for the on call out of hours work. Only hours above 40 in the week require prospective cover (the normal week is assumed to be 40 hours). This option is the default.
- Cover for selected duty periods (all hours) Select this button if prospective cover is not provided for all duties and should be selected when, for example, a doctor on a partial shift is not allowed to take leave during a week of nights. Out of hours cover is therefore provided for any other out of hours work e.g. weekend day work. An additional column will be provided when defining duties on the work pattern input screen which will require a Y or N for each duty entered.
- Cover for selected duty periods (time outside normal working hours) Select this button if prospective cover is provided for only the out of hours portion of selected duties (hours outside 9:00AM to 5:00PM). An additional column will be provided when defining duties on the work pattern input screen which will require a Y or N for each duty entered.
For the Riddell formula, this is replaced by the number of hours in a leave week. This is normally the number of hours in a normal working week (i.e. 40). See the documentation on the Riddell formula for more details and examples.
PROSPECTIVE COVER CALCULATIONS
When the system analyses a work pattern, it is possible for the calculations to include an estimate for prospective cover. For this to happen, the numbers and grades of doctors involved must be supplied on the "Prospective Cover" data entry tab.
If selected, it is assumed there will be 10 days of public holidays. On top of this, annual leave and/or study leave also need to be covered. Again, this must be specified on the "Prospective Cover" screen.
|
Grade |
Annual Leave (days) |
Study Leave (days) |
|
HO |
25 |
0 |
|
SHO |
25 |
20 |
|
SPR(1-2) |
25 |
20 |
|
SPR(3+) |
30 |
20 |
The total leave is the sum of the above elements required. Public holidays are always included, but annual leave and study leave must be specifically requested. For example if an SHO requires cover for all leave, this will be 8+25+20 days of leave in a year. The total days to be covered is calculated by multiplying the doctor numbers specified for the grade by the number of weeks for the grade. If there are doctors involved with leave allowances different to the above, the amount of leave should be specified in the "other" category on the prospective cover input screen. If the "other" category, involves a mixture of holiday requirements, an average value should be used.
The total days is divided by the number of doctors available to supply cover (assumed to be the same as 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 Y). In the later case, all the duty or only the portion outside 9:00AM to 5:00PM 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. The result is rounded up to the nearest hour unless the result is only just greater than a whole hour.
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. To calculate the total work hours with prospective cover, a simple pro rata calculation is used based on the percentage increase in duty hours caused by the addition of prospective cover.
Examples
"Guidance on Working Patterns for Junior Doctors" 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.
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. (In this case it is an obvious calculation, but is necessary if a group of mixed grades is involved)
Hours to cover/wk (remove 40 Hr normal week)=72-40=32
Apply the standard formula for prospective cover. Extra hours per week, per doctor=32*55/(365-55) =5.677 Hours
Junior Doctors Contract 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.
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 = 7.9 weeks. (In this case it is an obvious calculation, but is necessary if a group of mixed grades is involved)
Hours to cover/wk (remove 40 Hr normal week)=72-40=32
Apply the standard formula for prospective cover. Extra hours per week, per doctor=32*7.9/(52-7.9) =5.732 Hours
Riddell Formula
The formula is (from the Junior Doctors Handbook 2003/04):
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
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
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.
