Dr Mark Roland, Associate Medical Director from Portsmouth Hospitals NHS Trust describes how the hospital changed their general medical consultant workforce model to improve care and flow. Despite challenges, this has improved care, flow, support for junior teams and staff satisfaction.

1. www.england.nhs.uk
Seven Day Hospital
Services Webinar
July 2018
Lessons learned:
changing the consultant
workforce model in acute
medicine
Hosted by:
Sustainable Improvement
NHS England South

2. www.england.nhs.uk
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• Series of regional webinars
• Share practical examples – discuss barriers and
generate improvement solutions
• NHS E Specialist Support Team - Sustainable
Improvement
• Work in collaboration with NHS Improvement and the
UEC Programme Board for South East and South West
Region
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Objectives
This webinar will provide you with:
• An opportunity to hear the experience of how an acute
trust transformed their medical workforce model
• To learn about their challenges and opportunities for the
next stage of service development
• An opportunity to raise queries and share learning
7 Day Hospitals – Objectives
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4. www.england.nhs.uk
Our Guest Speaker today is:
Dr Mark Roland
Associate Medical Director
Portsmouth Hospitals NHS Trust
mark.roland@porthosp.nhs.uk
7 Day Hospitals – Guest Speakers
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5. QAH HospitalPortsmouth Hospitals NHS Trust
Dr Mark Roland, Associate Medical Director
July 2018
PHT – Lessons Learned from Changing the consultant
workforce model in Acute Medicine

6. QAH HospitalPortsmouth Hospitals NHS Trust
Portsmouth Hospitals NHS Trust is a large district general hospital providing
comprehensive acute and specialist services. We are the largest non-teaching hospital
trust in England, with an annual turnover of close to £550m, employing over 7,000
members of staff.
• Local community – we provide comprehensive acute services to meet the needs of
approximately 675,000 patients in our primary catchments of Portsmouth and South East
Hampshire
• Regional community – we provide some services, general and specialist, to the broader
Hampshire communities and beyond
• Military community – we are one of the largest hospitals working with the Ministry of
Defence to provide care for serving military personnel and veterans
About the Trust

7. QAH HospitalPortsmouth Hospitals NHS Trust
• Award-winning clinical research and academic partnerships integrated into
practice
• Designated Cancer Centre, part of the Central and South Coast Cancer
Network
• Cancer Beacon Status for the Head and Neck Cancer Services
• Wessex Kidney Centre
• Victory Institute for Minimal Access and Robotic Surgery (VIMARS), largest
robotic surgical training unit in the country
• Level 3 Neonatal Intensive Care Unit
Our successes
Our challenges
• CQC rating
• Financial position

8. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model - Challenging Entry point
 Chronically inadequately resourced and coordinated medical take, particularly OOH
 Emergency corridor suffering significant outflow block with 30-40 poorly differentiated medical
patients queueing for admission and very little discernible medical resource to support their safe
assessment and care
 During evenings in particular, our time of peak demand and crowding, hard to discern any resource
other than over stretched ED team trying to safely manage medical patients in particular with those
pts seemingly on a conveyor belt for admission that might see them only meet a medical decision
maker for the first time more than 24 hours after arrival
 Significant safety and efficiency challenges, high conversion rate, patients already deconditioning
or relaxed into being an inpatient before final decision about whether they needed to stay in or not
 A relatively small number of consultants on-call for GM became the focus of increasingly desperate
management attempts to plug the gap, being called in for operational challenges (as they
perceived it) almost every night during the winter and called back after long ward rounds at
weekends
 Frustrated and angry medical consultants asking whether their on-call role was operational or
clinical, often getting into very difficult conversations on the phone with duty managers and
directors, placing their professional reputations at risk
 It was clear to those consultants that the burden wasn’t being shared in a planned and equitable
manner and several of them said they would be prepared to support OOH working if equitable and
appropriately job planned

9. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model - The long and winding road…
 First presented idea of Physician of Day (POD) to a broad group of medical
consultants with MD in Feb 2014
 Worked up short 5-10pm POD pilot with extra duty payments that winter and then
extended POD pilot to support a direct admission scheme in March/April 2015
 With pressure from specialty services that they might want to run their own takes
rather than participate in a general take we ran Specialty Physician of the day (SPOD)
pilots in May-July 2015 – cardiology only service where benefit shown
 2016-2017 ran 5-10pm shifts during winter months for extra duty payments, not
always filled, palpable impact felt, on call still called in addition at times of peak
demand
 Jan-Feb 2017 – given imperative by external regulators to deliver substantive medical
model incorporating POD role
 Draft paper launched electronically and in person to CDs in mid March 2017
 Junior doctor shift reconfiguration Aug 2017
 Substantive POD rota with job planned activity commenced Sept 2017 (a 3.5 year
journey!)

10. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model – Practical details
 The medical model commenced in earnest on Sept 4th 2017
 The model supports the delivery of a 7-day per week 08.00-22.00hrs consultant led medical take
 The model has supported safer care of medical pts in ED and the emergency corridor, particularly
OOH with extended senior cover and support for the junior team
 The model was designed to be shared equitably amongst all services with G(I)M accreditation in
the organisation bringing renal, rheumatology and cardiology back into the general acute take to
join existing core specialties

11. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model – Take List
 Work is effectively identified and tracked using the AMU Take List on BedView allowing those
individuals and teams participating in the take to be able to see which patients are already being
reviewed by another team and which patients still need to be seen.
TAKE LIST Patient level data entry

12. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model – time to consultant review
 We are tracking data daily data from BedView demonstrating the percentage of pts having a
consultant review within 14 hours, with a weekly data update.
 Medical take trend line below shows sustained improvement from a mean of 69% of pts having a
consultant review within 14 hours before medical model (01.04.17-03.09.17) to a mean of 81%
now (04.09.17-17.06.18)

13. QAH HospitalPortsmouth Hospitals NHS Trust
PHT Medical Model –Next steps
From May 2018 the model was updated as follows:
- G(I)M PTWR support moved from 7/7 to weekend only
- aim of this was to free specialty teams to be able to look after day 2+ ‘stuck’
specialty pts in the AMU footprint, freeing AMU team to focus on acute take and
day 1 post take pts
- goal is for AMU to take responsibility for medically referred pts in ED (hope to
achieve during Summer Sprint), freeing ED to concentrate on reducing ED wtbs
- the multi-specialty group that have updated the model have preserved the core
POD role of 2-10pm 7 days a week shared equitably amongst all specialties
- ahead of the winter we must remove the occasional use of unreliable short term
locum fill for any shifts and ensure all services are honouring their agreed rota
commitments equitably from within their substantive workforce
- we would like to pilot a split take function before winter, having the medical take
focus on longest and shortest waits in ED to enhance early senior decision making
and further reduce the ED wtbs

14. Discussionooon
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15. Thank you to our guest speaker:
Dr Mark Roland
Associate Medical Director
Portsmouth Hospitals NHS Trust
mark.roland@porthosp.nhs.uk
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7 Day Hospitals – Advice and support
For advice and support, contact the Sustainable
Improvement Team
Sue Cottle, Programme Lead sue.cottle@nhs.net
Wendy Keating, Senior Improvement Manager wendy.keating@nhs.net
Lou James, Improvement Facilitator lou.james1@nhs.net
Thelma Daly, Improvement Manager thelma.daly@nhs.net
Suzanne Cullen, Improvement Manager suzanne.cullen@nhs.net
For general information vivrichards@nhs.net
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