Natural Breaks survey
GMSHA
Please note that this is a survey of views from across the country. It does not constitute an official guideline or offer any advice on dealing with natural breaks.
There were twelve responses received overall, all supporting a 75% threshold for achieving natural breaks. This issue itself had only been raised in one other patch elsewhere.
The evidence highlighted in support of the 75% threshold was in HSC 1998/240, Annex B, Appendix 1. The statement underneath the table outlining New Deal work patterns and their rest requirements on page 10 states “Reasonable expectation of rest: In each of these working patterns, rest targets must be met during at least three quarters of all rostered duty periods” with natural breaks given as the minimum rest requirement for full shift working patterns within the table. The current JDC handbook refers to this HSC on page 24 when discussing the New Deal rest requirements of full shift rotas. Furthermore this reasonable expectation of rest is reiterated on page 11 of the “Junior Doctors Contract: A General Guide to the New Pay System”. I have also attached for information some guidance kindly provided by colleagues in Scotland, issued by their health department regarding natural breaks, again supporting a 75% threshold.
We met recently with our local BMA and asked them why they felt natural breaks should be achieved on 100% occasions. They referred to the fact that within HSC 1998/240 paragraph 12 it is stated that natural breaks “should not be considered part of their rest periods”. Therefore they have extrapolated from this that the reasonable expectation of rest cannot apply to natural breaks, as they cannot be classified as rest. The Terms & Conditions of service also remain silent on the percentage of natural breaks that need to be achieved on full shifts to ensure New Deal compliance.
In Mike Beattie’s response he is clear that although natural breaks cannot be counted as rest – i.e. be deducted from the working time (paid break) – they are still effectively part of the New Deal rest provision for a full shift rota, and therefore must fall within the 75% rule. He also raises a query as to the actual definition of a natural break, whether this is in fact a short break to cater for physiological need – a toilet break or chance to get a cup of tea – as opposed to the rest requirement of a full shift, which is a 30 minute break after approximately 4 hours of duty.
Several responses supported the fact that the ability to take natural breaks was a joint responsibility and that the junior doctors themselves have a significant role in this to ensure that they take their natural breaks or alert someone immediately if they are unable to take their natural breaks on a regular basis. Where junior doctors were not signing off rotas and the Regional Action Teams or their equivalents felt the reasons given for this were unreasonable, many are happy to overrule this and sign off the rota centrally recognising that juniors that remain unhappy can take these decisions to appeal. Locally we ask the junior doctors to put their concerns in writing before making this decision, and keep this information at the SHA for future reference. It was also felt that monitoring diary cards should capture the reasons why natural breaks are not achieved and junior doctors should be asked to provide this information.
Information kindly provided by Dr Yasmin Ahmed-Little, Medical Workforce Project Manager.
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