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Enhancing training opportunities by changing working patterns

In partnership with Health Education England, Leeds and York Partnership NHS Foundation Trust developed a project which aims to improve psychiatric training by combining on-call rota re-organisation, implementation of the SBAR (Situation, Background, Assessment, Recommendation) communication tool, and use of clinical simulation training, to deliver safe and effective patient care 24/7.

Related themes

  • Handover
  • Out-of-hours care (24/7)
  • Rotas and scheduling
  • Multi-professional team
  • Change and empowering employees
  • Improving training programmes and pathways
  • Mental health.


The pilot was set up to support improvements to psychiatry core training and progression to higher training. Evidence suggested that one way this could be achieved was through enhanced training to trainees in key areas.

In addition, a 12 week survey of trainee activity in the Trust found that trainee doctors were missing out on training experiences as a result of reduced hours under the European Working Time Directive and due to the way that their out-of-hours rotas were set up.

How they did it

Following a review and redesign of how out-of-hours care was provided, the trust was able to bring more trainees into daytime hours. Not only did this mean that they provided more direct patient care, as most patients prefer their assessments and therapies during the daytime, they also benefitted from greater supervision and support.
With more time to train, the trust also delivered additional training in key areas such as communication.
For those trainees who were required to work out-of-hours to support the service and gain necessary emergency experience, measures were put into place so that workplace based assessments could be carried out by the multi-professional team and every last drop of learning could be extracted from the out-of-hours work that they do.

Examples include

  • A programme to assess and develop communication skills throughout core training. This included multi-professional clinical simulation training on how to recognise a medical problem in a psychiatric setting, and revised training materials for both trainers and trainees.
  • A comprehensive training package for staff to use the ‘Situation Background Assessment Recommendation’ (SBAR) communication tool, which was rolled out in psychiatric inpatient settings. This followed a review of incident forms completed out-of-hours showing a high percentage of poor communication between on-call doctors and ward staff.
  • A handy user guide to support all members in the multi-professional team to understand medical training grade posts and their expected competencies. This was put together with input from doctors, nurses and other members of the team.

Who was involved

The project team included: a project lead, project manager; project administrator, the Chair of the trainee doctors’ committee, a clinical operations manager, three workstream leads, a medical education manager and an academic partner.


  • A positive impact on communication, behaviours and commitment, patient contact time and trainee/trainer time
  • All trainees felt more confident
  • An increase in productivity for weekday evenings by 38% and weekends by 29.1%. Night-time activity also increased by 2.1%
  • An improvement of management skills important for higher training such as time management, delegating and utilising the mix of skills within the working group
  • More opportunity for trainees to undertake workplace based assessments
  • Facilitated identification of areas for development in communication skills
  • More supervision opportunities
  • Fewer incidents reported and feedback shows strong agreement of improved clinical care
  • An improvement in multi-professional team working and improvement in behaviours and commitments in the team
  • A positive impact on the communication and relationships within multi-professional teams.

What they’ve said

“I should like to commend the team involved in this complex and multi-faceted project. It has successfully delivered real and measurable benefits and has demonstrated how, even in challenging times, professionals from all disciplines can collaborate to improve patient care while enabling trainees to have a better learning experience.”  Medical Director

“So much improved on last year with the forms and feedback, I really think we should make it mandatory next year.” College Tutor

“By changing patterns of working, we were able to maximise training opportunities in daytime hours and deliver better quality training packages. Providing high-quality care can only be achieved with a coordinated team-based approach and with effective multi-professional team working” Associate Medical Director for Doctors in Training


Please look at the toolkit materials in the documents section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects. Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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