Sussex Partnership NHS Foundation Trust (SPFT) and HEE working across Kent, Surrey & Sussex (HEE KSS) introduced a novel role of the Agenda for Change (AfC) band 3 Doctors’ Assistant (DA) into mental health settings within the NHS determining the effect of the DA role both on trainee doctors’ and the wider workforce’s workload. It has been identified that trainee doctors, especially junior trainees, spend 40-70% of their time on administrative tasks and the proportion of paperwork has increased, thus reducing their time for training opportunities.
SPFT and HEE KSS implemented the DA role in 2018 which aimed to:
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Give individual's an opportunity to gain a wider experience and encouraged to work at SPFT before they complete their higher education qualifications
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Reduce trainee doctors time on clinical admin tasks
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Increase trainee doctors time for research and training
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Improve morale of medical teams
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Streamline communication between medical and clinical teams, MDTs, carers and other key partner agencies
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Support wider medical team and their secretaries with admin tasks to improve service efficiency and patient flow
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Support medical education with trainee training and induction set up, to enhance trainee’s experience with the trust
Four DAs were recruited from local colleges and implemented across four mental health sites in East and West Sussex, including inpatient and community. Their roles were mainly admin based and included:
Documentation of ward rounds
Sitting in clinic appointments, making notes and then writing the
clinic letters to be checked by the junior doctor prior to be
sending to GP
Collating clinical information from historical notes for discharge summaries, tribunal reports
Chasing historical notes from other psychiatric units or other
areas of the country
Managing the patient list for the junior doctors on the inpatient
wards
Undertaking physical monitoring in community and inpatient
settings – including doing basic physical observations and ECGs
with the Rhythm Pads
Carrying out physical health monitoring audit, ensuring all patients have had the relevant physical health monitoring both on the wards and in the community
Retrieving investigation results such as blood results and ECGs
Preparing discharge summaries for trainees to complete and
sign off
Liaising with other medical specialities
Preparing referrals to be sent for medical, psychological or social interventions
Collecting and updating audit data
Writing letters on behalf on the administrative team Managing junior doctor diaries – arranging appointments
Calling patients to remind them of upcoming appointments and chasing patients who have not attended appointments
Checking if discharge summaries had been completed, and if
not, chasing junior doctors to complete them
Ensuring Mental Health Act (MHA) documents were complete,
correct and up to date
Taking minutes of meetings
Assisting organising induction events for junior doctors
A qualitative study was undertaken with focus groups with those who worked with the DAs. Audio recorded interviews were transcribed and a thematic analysis conducted. Feedback received on the role was generally positive. As a result of the DA role, Doctors experienced a reduction in their overall workload, allowing them more time to spend with patients, leave work on time, improved clinical consistency (GP received clinic letters within a shorter lead team) and generally enhanced their training experience and overall morale.
In addition, the DAs felt they gained valuable skills and understanding of working in a healthcare setting. After the DAs completed their one- year contract they were all accepted into their preferred university to study Psychology or Medicine and joined the trust on the bank to work as administrators or support workers in between university terms.
HEE KSS and SPFT found that implementing a novel role of a DA into mental health within the NHS is an effective, inexpensive and speedy solution to increased junior doctor workload and low morale. Increasing doctor’s time with patients and improved interprofessional communication contributes to a positive impact on patient care.
The DA role could be considered across all psychiatric teams and the wider medical workforce.