Rotas, work schedules and recognition of additional roles
The FICM encourages open dialogue between ACCPs and the unit clinical lead, consultant ACCP supervisor and where applicable lead ACCP, for ACCPs to agree their working patterns within the unit. Where a team of trained ACCPs exist, the lead (or most senior) ACCP should assume responsibility for writing the ACCP rota, which should allow for a degree of self-rostering. This rota should dovetail with the medical rota. Rostering in this way recognises the permanent nature of the ACCP commitment to the critical care rota and supports sustainability through recognition of the value that permanent staff bring to the medical rota.
The intention is to generate a working pattern which meets the clinical and non-clinical needs of the unit and fosters a sustainable and fulfilling pattern of work for ACCPs. The rota should be agreed and published with sufficient notice to allow plans for work/life balance to be made; a minimum notice period would be 6 weeks, but ideally 3 months. The rota must allow sufficient time for rest and recovery.
The FICM suggest a working pattern based on Agenda for Change. For full-time practitioners this represents 37.5 hrs a week, or 150 hours a month. Newly qualified ACCPs require a period of time on the medical rota where they are fully clinical, to continue building experience, confidence and capability. With advancing seniority, an ACCP will usually take on roles relating to audit, research, teaching or quality improvement, following discussion with the clinical lead, consultant ACCP supervisor or lead ACCP.
These roles should be formally recognised with a recommended 80/20 split between clinical care and SPA. This would therefore equate to 7.5 hours a week of SPA or equivalent prorate, to undertake unit specific roles agreed by the unit clinical lead, consultant ACCP supervisor or lead ACCP. The SPA roles should appear on the ACCPs roster to ensure the entire clinical team recognise this time as SPA and to avoid the ACCP being drawn into clinical work. Ultimately the FICM encourage flexibility in working patterns, and collaboration between staff, such that where clinical need arises and the SPA time is surrendered for clinical care, then the ACCP is ‘refunded’ the SPA time on another date.
As experienced ACCPs take on increasingly senior roles within the unit, the organisation, and the healthcare system, it is important that they maintain a predominantly clinical commitment for the retention of skills, knowledge and capability. The FICM suggest that ACCPs clinical commitment should be no lower than 70% of whole-time activity.
ACCPs may be asked to undertake additional, extracontractual work to fill gaps in a medical rota. Additional work must have patient safety as its primary focus, balancing the need for staffing cover with appropriate time for staff rest between shifts. The FICM encourage an open dialogue between ACCPs and the unit clinical lead and consultant ACCP supervisor to agree appropriate remuneration for extracontractual work. It is possible through local arrangement, that remuneration for the ACCP aligns with the medical locum payments which would normally be offered to doctors working on the rota in question.
It is recognised that the onerous nature of regular night time shift work has a greater impact on individuals with advancing age3. The appeal therefore of regular night time working by ACCPs with advancing age is likely to wane. However, it must also be recognised that critical care is a 24 hour per day, 7 day per week specialty and critical care units are faced with the challenge of supplying appropriately skilled individuals across the 24-hour period. In order to deliver a sustainable career for ACCPs whilst also delivering an appropriate skill-mix, we encourage open dialogue between unit clinical leads, consultant ACCP supervisors or lead ACCPs and ACCPs aged over 55 on what constitutes an appropriate working pattern with advancing age4
This must be tailored to the physical and psychological needs of the ACCP, however units must ensure consistency and fairness to all ACCPs who work within their unit.