Who Needs to do What?
Implementation of the EWTD is a legal requirement for the NHS. However, it is only part of much wider aims to improve the work/ life balance for NHS staff. These include existing initiatives such as "Improving Working Lives" and the "Changing Workforce Programme" (information is included in Annex B Background on relevant initiatives/ publications).
The EWTD is also much more than "just an HR issue". It will require a radical rethink of the way in which some services are provided but this needs to be done within the context of the wider modernisation agenda of providing a service that better meets the needs of NHS patients and those that care for them.
The Strategic Change Fund will be available to support some of the transitional costs of implementing EWTD but commissioners and providers will need to identify the recurrentcosts within Local Delivery Plans.
Strategic Health Authorities
In developing their Local Delivery Plans (LDPs), StHAs must address the workforce and service delivery implications of the EWTD. They will be supported in the production of the workforce element of these plans by the Workforce Development Confederation (WDC).
As part of their performance management, StHAs must ensure that their local Trusts have robust plans to achieve EWTD compliance for doctors in training from August 2004 and New Deal compliance from August 2003. Working through WDCs, they must also ensure that the pilot projects and other good examples of EWTD compliance are used to maximise delivery of the changes needed to achieve compliance.
NHS Trusts
As part of the LDP process, each NHS Trust will need to satisfy their StHA that they have a robust plan for meeting the requirements of the New Deal and EWTD. The immediate priority will be achieving compliance with the parts of the EWTD that cover doctors in training from 2004. However, Trusts must ensure that action taken in the run-up to August 2004 also support the longer-term changes that will be needed to meet the requirements of the directive from 2009 and the wider goals of service modernisation.
The aim of the pilot programme is to support Trusts in implementing the EWTD by providing examples of solutions that can be widely applied and by establishing raining programmes for Healthcare Practitioners that can be accessed by other Trusts.
Trusts, through their education supervisors and with the involvement of Deaneries and College visitors, will also need to ensure that the learning objectives of doctors in training are met within the new working patterns.
EWTD compliance is also one of the requirements for Trusts to achieve IWL accreditation.
Primary Care Trusts
PCTs need to be aware that implementation of the EWTD will have implications for both staffing and service delivery models. NHS Trusts should be discussing with their commissioners the impact that EWTD compliance will have on individual departments and specialties well in advance of August 2004. In addition to their role as commissioners ofservices, PCTs must also ensure that, as service providers, their own staff (for example in mental health or community health services) comply with the EWTD. Discussions on changes that need to be implemented to prepare for compliance should form part of the planning round for the financial year 2003/ 4.
Workforce Development Confederations and Deaneries
In addition to supporting the StHAs in the workforce element of the LDP, WDCs will also need to address the training implications of the EWTD. Many of the solutions rely on the development of extended non-medical roles, and recruitment and training of these staff will need to start well in advance of August 2004. Since many of these posts are likely to be filled by staff already within Trusts, staffing plans should also address back-filling the consequential vacancies.
WDCs will be responsible for the local management of the EWTD pilots and for using these to help to facilitate the changes required to achieve compliance. WDCs will also need to ensure they make the best use of available resources, including the training budgets they hold, to support EWTD implementation.
The changes in working patterns of doctors in training will have a significant impact on their training. Deaneries need to be working with Trusts to ensure that satisfactory training arrangements are in place when the changes are introduced. Further guidance on training arrangements under EWTD is contained in the document Liberating Learning (see section 6 Further guidance).
Department of Health
The Department of Health will continue to work with national stakeholders including the Royal Colleges and the BMA to facilitate successful implementation of the EWTD. We will also discuss how the best practice from the EWTD pilots and work from other Trusts on EWTD compliance can best be disseminated.
