I have worked as a pharmacist in various different sized hospital trusts over the past 10 years, all with different on-call arrangements. The big teaching hospitals appear to have the advantage in that they are so busy with calls overnight that they can justify paying a pharmacist to work a night shift, who receives the associated pay enhancement. Unfortunately for smaller hospitals, pharmacists are stuck with systems that mean they could be called and required to attend work in the middle of the night, and then still be required to be at work for 9 am.
I have been in a situation before where I had to go to work between 3 am and 5 am to sort out a broken pharmacy fridge and I then had to negotiate with senior managers to leave work early that day to get some rest. I’m not sure how I managed to get through even half a day without making a mistake. Time off in recognition of being called out was an informal arrangement and only ever allowed if there was sufficient staff available to cover. Some hospitals might let you start a bit later, but those one or two hours extra you may get to rest don’t always help you get over a broken night’s sleep.
The working time directive stipulates that you should have an 11-hour rest break between one shift and the next, however, hospitals can utilise a loophole that means they do not need to adhere to this as they need to ensure continuity of service. The GPhC standards for pharmacy professionals (Standard 5) also states that we must only practice when fit to do so. This can be difficult to uphold when your employer is expecting you to work without sufficient rest. Appropriate rotas should be devised to ensure staff have a day off after an on-call shift which some hospitals do have in place. However, as each trust can devise their own system, most do not. You also need to ensure you work an extra day at another time, to make up for the hours lost.
Some hospitals are fortunate enough to have older remuneration policies in place, which might compensate pharmacists fairly well. However, many pharmacists believe the newer agenda for change on-call renumeration does not compensate them adequately for sacrificing their night. A flat rate at just over £1 per hour to be available is just not good enough. As much as you can be told that you are free to do what you want in your own time until you get called, this is not really the case. For instance, I enjoy going to a gym class in an evening. I can’t be mid-way through body combat taking a call from a doctor and firing up the on-call laptop to look something up. If my life is going to be put on hold for the night, then I would much rather pick up a locum shift and be paid properly.
Lastly, those of us with dependents are expected to manage on-call around our other personal duties. For example, in my situation, there is no taking your child to swimming lessons, as you may need to leave to go to work. Or you have to swap shifts due to partners’ working patterns and childcare issues. In a department where most staff undertake on-call duties as it is in our contract, I had to repeatedly request not to take part in the on-call rota due to childcare needs. This is under continual review, and I have to constantly have the same conversations justifying why I am the exception and why on-call does not work around my childcare responsibilities. More focus is placed on maintaining the service than staff wellbeing.
The NHS Staff Council undertook a review of on-call arrangements across many trusts in 2010 and found varying practices regarding payment, contractual obligation, and frequency of on-call, not only between trusts but also between different departments of the same trust. It did not look at compensatory rest. So, whilst each hospital pharmacy department is allowed to determine their own rules either formally or informally, it is difficult for us to raise these issues within our workplace or nationally. There is no gold standard to aim for and until there is we will continue deal with poor working conditions and the knock-on impact on our work/life balance and our health and wellbeing.
Example of an on-call arrangement
Whilst Agenda for Change sets out that there is a need for compensatory rest, many trusts appear to have failed to acknowledge this in their on-call policy or find work arounds. For example, one trust has given this example as acceptable arrangement:
“’B’ worked Tuesday 9 am – 5 pm, was on call Tuesday night 5 pm to 8 am and due back on duty at 9 am Wednesday. ‘B’ was called in at 9 pm until 4 am. Rest period (in two parts) is a total of 9 hours (4 + 5), which is less than the 11 hours required so ‘B’ is due 2 hours’ compensatory rest. Compensatory rest should ideally be taken before the beginning of the next duty period, so ‘B’ could start duty on Wednesday 2 hours later (at 11 am) or, if taking the break at the start of the next duty period would cause unacceptable disruption to services, the rest should ideally be taken at another time during the same duty period, so ‘B’ could finish 2 hours earlier at 3 pm
But in either case ‘B’ will still owe the employer 2 hours’ working time.
Alternatively, ‘B’ is not on call again Wednesday night, so ‘B’s’ next rest period is a total of 15 hours, which is the 11 hours rest period required and 2 hours of the ‘balance’ can count as the compensatory rest required.”
Essentially this is stating you could be up until 4 am and either do a full day’s work or, only get 2 hours rest period back at a time to suit your employer. While this is technically in the rules, it doesn’t afford the employee sufficient rest in order to be safe.
For now, individuals who have specific circumstances which affects their ability to take part in on-call duties, can look into flexible working policies and formally agree a scenario with their employer which works better for themselves. The PDA Member Support Centre can be contacted for advice regarding poor working conditions surrounding an on-call service. PDA members can work together to raise issues collectively with the support of the PDA and individuals are encouraged to raise issues with their local PDA Regional Committee member which can be fed into the National Executive Committee meeting to build a better overall picture of the situation. Together we can work towards creating that gold standard.
By Louise Hemmings, PDA Regional Committee member and hospital pharmacist
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