G515(P) ‘In spite of the gaps’ – a multifaceted approach to staffing a children’s hospital

The RCPCH UK workforce census made recommendations to ensure sufficient paediatric staffing in the future. Our Children’s Hospital has embraced this model and taken a new approach to staffing that enables the provision of high quality, safe paediatric care, with a focus on paediatric training. We have experienced significant gaps in the trainee medical workforce in recent years. Gaps are spread equitably across the region, however a 20% gap is usual. Trainees and consultants alike have felt the impact, resulting in concerns about morale, retention and burnout. The effect of receiving yet another email asking for locum cover, or informing you of out of hour’s gaps, should not be underestimated. We adopted a new approach to forecasting and managing the rota gaps. This involves the management team, rota coordinators, college tutors, trainees and medical deployment. A monthly strategic workforce meeting is held, alongside a biweekly meeting to manage day-to-day issues and on-going recruitment. Recruitment looks 6–12 months ahead - essential when recruiting overseas doctors. We have recruited to 1–2 year posts through NHS jobs, MTI schemes and a trust-wide international recruitment programme. There is bespoke induction and a supernumerary period before starting in ST1–3 rotas. Trainees then move into ST4–8 rotas after 6 months. We support those applying for paediatric training, with anticipated longer-term gains for the regional workforce. An innovative FY3 post with 20% QI time has been popular, with their on-call reducing locum spend. Expansion of the non-medical workforce has begun with 5 permanent Physicians Assistants in paediatric specialties. There is expansion of The Advanced Clinical Practioner team into general paediatrics and surgery. These roles increase patient continuity and enable trainees to access educational opportunities. Locum spend has significantly reduced with a 60% reduction in locum shifts. This has been achieved with strong day-to-day leadership of the rotas, alongside a management team committed to improving staffing and working lives. Dedicated staff are essential for this strategy to be sustainable. Challenges include significant ongoing time commitment, increased educational supervision and unpredictability of international recruitment. We suggest that this model can be used by other UK Children’s Hospitals and form an important part of a regional workforce strategy.