A stronger voice for junior doctors
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6019 (Published 01 December 2016) Cite this as: BMJ 2016;355:i6019
- James Constable, core surgical trainee and JDF chair,
- Neil Patel, medical registrar and previous JDF chair,
- Sarah Barlow, foundation doctor and JDF vice chair,
- Adrian Blundell, consultant geriatrician and director of postgraduate medical education
- james.constable{at}nhs.net
Abstract
Restructuring the junior doctors’ forum means it now better represents trainees, say James Constable and colleagues
About 18 months ago we noticed that our trust’s Junior Doctors’ Forum (JDF) was suffering from a vicious cycle of low attendance, low levels of participation and poor engagement. However, the recent junior doctors’ contract dispute, low morale, and heightened interest from employing trusts had given our JDF—and others around the country—added relevance. This prompted us to review our JDF and to improve its efficacy.
Problems with the model
Our original model comprised one committee representing all junior grades in all specialties. It was made up of routine committee positions (such as chairperson), trainee representatives, medical education leads, and human resources leads. Committee members were appointed after the start of each new training year, and the committee met once a month for an hour.
Our review focus groups identified problems with this model: the meeting duration and frequency were inadequate for identifying, discussing, and actioning items of concern relating to around 900 junior doctors; meeting attendance was variable; new committee members were appointed relatively late, which disrupted continuity of both the meetings and their agenda; and communication between committee members and juniors was poor. Meetings were often cancelled for not achieving quorum, and feedback from representatives was often absent.
As a consequence of this review, we significantly changed our JDF (fig 1⇓).
Fig 1 Overview of new Nottingham University Hospitals Junior Doctors Forum Network
We now have a JDF Network, which retains the old committee as a central forum and meets once a month for an hour. However, we also have “sub-forums” representing groups of junior doctors depending on grade or specialty (see fig 1⇑).
These sub-forums have their own individual committees that also meet once a month for an hour. The sub-forum chairs then disseminate their minutes among the JDF Network, and attend the central JDF monthly meetings. Members of the trust’s senior management team and relevant directors now consistently attend the JDF Network’s meetings.
A positive effect
These changes have had a positive effect. For example, the total discussion time across all forums within the network has increased from one to six hours a month. Furthermore, the sub-forums have increased discussion time for grade or specialty-specific issues from five minutes to one hour each month. They have also created many leadership roles for junior doctors and we now recruit new JDF committee members before the start of the training year in August.
Senior management and college or training director involvement has been key to several successful initiatives, such as contract discussion events, training projects, and this year’s General Medical Council visit. Not a single meeting within the JDF Network has been cancelled since its full introduction in April.
Communication between committee members has been improved by employing a trust storage drive for documents, which all members can access. This drive is then linked to our new intranet webpage, which is accessible by all junior doctors. We can also use the trust’s video conferencing facility for members who cannot attend meetings in person.
Communication between the JDF and junior doctors has also improved, with committee introductions at induction events, an intranet webpage, newsletter, trust JDF email accounts, and Facebook groups (with around 300 members) for each of the network forums. Finally, in order to improve all channels of communication related to the JDF and junior doctors, the trust has introduced a new role—the junior doctor liaison officer.
Confidence and satisfaction
Reviewing and changing our JDF has been a 12 month process. The changes to communication came through focus groups, and were relatively quick and straightforward to implement. The structural changes within the network were driven by descriptions of “distributive leadership.”123
The sub-forums were more of a challenge to introduce, as they were entirely new. Our JDF has also enjoyed the enthusiasm and experience of the senior management team and college and training directors during this transition process.
Our new JDF network works well because it caters for our numerous doctors, at an individual level. Training programmes can vary enormously, and the issues raised by one junior doctor may be completely irrelevant to a doctor in a different training programme.
One single committee that represents 900 junior doctors and meets for an hour a week is unlikely to be fit for purpose. Our sub-forums facilitate focused, in depth discussion of issues relevant to that sub-forum’s delegation. This combined with better communication has led to higher levels of both JDF productivity and junior doctors’ confidence and satisfaction in our new JDF network.