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We are introducing this new "Doctors Assistants" role in the Trust and have funding to do so.  We have planned the evaluation as a research project, to generate new knowledge.  We aim to ensure that data are collected rigorously so that others can assess whether the concept can be generalisable to other NHS hospitals.  We hope to publish this study, for which consideration of the ethical implications and governance is advisable.  We plan to collect quantitative and qualitative data, interviewing all grades of staff who may be affected.  For this, we need the formality of the research process.  We hope to contribute to an evidence-based debate to help other NHS organisations make workforce decisions in this under-researched area.

Junior doctors (especially Foundation doctors and core trainees) spend 40-70% of their time on admin tasks (RCS, 2016).  Junior doctors’ hours of work have reduced, but the paperwork has increased (RCS, 2008) reducing their time for training opportunities.  Morale can be low (GMC, 2014).

 

New NHS staff roles are needed (NAO, 2016).  Other bodies, including individual NHS Trusts and national bodies such as the Royal College of Physicians, are developing autonomous senior clinical roles for experienced staff (eg Nurses or Physiotherapists) or after lengthy training (eg Physician Associates). The new role we are creating is a hybrid admin and clinical role, at Band 3 on the NHS Agenda for change scale (£18,000 p.a.) equivalent to apprenticeship level.  The admin work involved is writing patient notes, keeping patient lists up to date, etc.  The clinical tasks are simple (eg screening patients for dementia or for risk of Venous Thrombo Embolism).  For seven day services, admin support adds greater efficiency to doctors’ work (AOMRC, 2013).  The tasks have been modified from successful similar projects at Southampton and Brighton with further adaptation following the Royal College of Surgeons’ work on the extended surgical team.  When the cohort are appointed, the training programme for them can be individualized to their previous experience.  These are particular tasks that do not need to be performed by a Registered Practitioner.  The training will be linked in with current Trust training programmes.  The project is being led by the Trust education department.

This project involves recruitment, induction and a training program, followed by monitoring systems as this is a new role.

 

A few other places have recently had success developing a role of this nature.  None of these other sites have started with collecting data prospectively, which reduces their ability to demonstrate to what extent this project works safely and effectively.

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“In this study, we want to evaluate the effectiveness of the new Doctors' Assistants role and of their training process”
“We hypothesize that a proportion of junior doctors’ work can be completed safely and effectively by a Doctors’ Assistant”

Quantitative data collected on diary cards and validated happiness scoring sheets:

  • Doctors’ hours and type of work before and after Doctors’ Assistants are introduced

  • Happiness scores for junior doctors before and after Doctors’ Assistants

  • Happiness scores of the Doctors’ Assistants

  • Audits of the quality of admin work done by the Doctors’ Assistants

  • Timing of aspects of work done by junior doctors and by Doctors’ Assistants (eg timing how long it takes to do a dementia screening test)

Qualitative data:

  • Group discussion and feedback from all grades of staff in different meetings or interviews

 

We plan to analyse the discussions and feedback by theme.  The number of hours and happiness scores fit a numerical model.  We plan to publish the results, to allow other sites considering adopting this workforce model, with suggestions on which aspects work and which need improving.

Data collection tools and other documents developed for this (available if needed):

  1. Participant information sheet

  2. Participant consent form (particularly noting the possibility of anonymized quotes being used in the final report)

  3. Junior doctors’ monitoring forms for hours and types of work over a one-week period (paper format, to allow easy storage of data)

  4. Suggested headings for group discussions

  5. Happiness scoring sheets

Patient and public involvement

We have decided not to include asking patients their views about this new role to avoid the complexity that this involves.  There is evidence from other sites that patients are very accepting of health professionals if their role is well defined.  During group discussions, we will ask other grades of staff how they think the patients feel.  This is a proxy measure, but some staff have been working on wards for a long time and their views about patient’s opinions will be valuable.

 

Areas of risk and their mitigation

We will ensure that all data is held anonymously and securely.  There are no financial implications and no researchers have any conflict of interest.

The Study

Methodology

The "Doctors' Assistant" is a new clinical role with diverse responsibilities
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