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BackgroundWith the introduction of the new Junior Doctor Contract (Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016), the way junior doctors are paid has changed dramatically. Pay is now made up of multiple elements, each with a unique and specific way of being calculated. These include a Basic Salary, Additional Rostered Hours, Weekend Allowance, Night Premium, Flexible Pay Premia and Less Than Full Time (LTFT) Allowance. For trainees who work LTFT each of these elements is calculated differently, adding a new layer of complexity.Within the medical profession, this has led to widespread uncertainty about how pay should be calculated. While resources are available to explain it, most LTFT junior doctors are unfamiliar with how they should be paid. This means they cannot check the accuracy of their own salary, relying on correct calculation and pay by hospital payroll departments. Anecdotally, it was recently noted that there were errors in the Weekend Allowance pay for a number of LTFT trainees in a South London DGH and therefore this study aims to categorise them further.ObjectivesA retrospective study was conducted to identify the accuracy of Weekend Allowance supplements for trainees working LTFT in South London. The long-term objective is that identification of payroll errors will allow payroll departments to correct internal pay algorithms, ensuring accurate pay and increased satisfaction levels amongst LTFT trainees.MethodsLTFT trainees working in South London were asked to volunteer their personalised work schedules and pay slips for their current training post. Their expected Weekend Allowance was calculated manually, based on their personalised work schedule. This was then compared to the value stated on their work schedule and their actual take home Weekend Allowance pay. A copy of each trainees personalised work schedule was analysed to identify where (if present) the miscalculation error was made. At the same time, a survey was done to answer whether the trainee was aware of how their Weekend Allowance should be calculated.ResultsTrainees from 5 DGHs in South London responded. Weekend Allowance pay was incorrect in 3 of the 5 hospitals. The nature of the error was different in each case and all errors led to trainee underpayment. Of the 11 trainees identified to have been affected, the mean underpayment was equivalent to £1600 gross per annum. The most significantly affected trainee was underpaid by £3531 gross per annum. Of all those surveyed, not a single trainee was aware of how their Weekend Allowance should be calculated or that an error had been made.ConclusionsThe 2016 Junior Doctor Contract has led to increased complexity in salary, especially for those working LTFT. This survey has identified a clear need for personal responsibility in understanding how trainees are paid, along with improved education for payroll departments to ensure errors are not made. To date, around £3800 among five trainees has been recouped, with more pending. One hospital’s payroll department has formally recognised the error and is taking steps to correct it.

ObjectivesThe ‘Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016’1 has substantially changed the way junior doctors are remunerated. Salaries now consist of multiple discrete elements, each with a unique method of calculation. For less-than-full-time (LTFT) doctors each element’s value is calculated differently, adding further layers of complexity. Both doctors and Human Resources (HR) struggle to understand these calculations, leading to common and often unnoticed underpayments. We outline the extent of the problem, financial impact and scale across trusts, and present our solutions to resolve these recurring issues.MethodsFrom 2020 to 2023 we have supported paediatric doctors across London to identify and rectify pay errors through informal support, roles as LTFT Trust rep, and through a recently developed Pay Clinic run through the London School of Paediatrics. With careful review of work schedules and payslips, contractually accurate salaries were compared to actual pay to identify errors. We have quantified the extent and breadth of errors encountered.ResultsErrors in pay were identified within all 12 trusts studied. 22 distinct errors are delineated, often replicated across trusts, with the most substantial being an underpayment of £20,836 per year affecting three doctors. While pay errors impact all doctors, we found that LTFT doctors are disproportionately affected.The most common error was miscalculation of the LTFT weekend pay supplement, which was often found to be systematic, affecting every LTFT doctor in affected trusts. The most challenging errors to identify pertain to ‘Prospective Cover’ calculations, a poorly understood but vital element of calculating accurate pay. Its misuse can cause pay errors upwards of £7,500 per year and has caused rotas in some trusts to illegally breach the European Working Time Directive.To date, this work has supported trainees to reclaim over £100,000 gross, with additional advice and supporting letters provided to numerous others. Formal intervention by NHS Employers was required for one trust that consistently refused to pay its workforce according to the national terms and conditions.ConclusionsThis work reveals the alarming extent of inaccurate remuneration and the disproportionate impact on LTFT doctors. Providing accurate pay is crucial to improve morale and wellbeing in the current challenging NHS climate. There is a vital need for education and support for all parties, including training for HR departments to mitigate these errors from the source, and education for doctors to improve recognition and resolution of these errors.Referencehttps://www.nhsemployers.org/publications/doctors-and-dentists-training-terms-and-conditions-england-2016

AimsBackgroundThe involvement of trainees in research in paediatrics is dependent on individual enthusiasm and access to appropriate opportunities and support. These are affected by the frequency of rotations, the demands of busy paediatric training jobs and a lack of guidance on how to get involved. The relatively new RCPCH academic tool-kit goes some way to providing support and guidance and the college’s Trainee Research Network initiative aims to support existing trainee research networks and facilitate collaborative working regionally and nationally. Trainee ownership and leadership of collaborative multi-centre governance and research projects provides trainees with research skills mandated by the RCPCH Progress curriculum and as well as opportunities for peer networking and steering of research priorities.Whilst over the past 5 years several trainee-led research networks have been set up, there are gaps across the country. Arguably, the most successful are those focussing on sub-specialty projects with General Paediatrics falling behind.ObjectivesWe set out to establish a pan-London, trainee-led network that exists to support the conception and coordination of multi-centre research, audit and service evaluation projects to answer relevant general paediatric clinical questions. Additionally, this initiative provides opportunities for trainees to develop research competencies.MethodsFounding trainees sought experiences of existing trainee network organisations active in research and clinical governance. Subsequently, a working group was assembled by promotion on social media and through the regional trainee network. A group of 16 interested trainees from ST1 through to ST8 was formed and initial meetings were held monthly in May-Dec 2021.The working group divided in to 3 key smaller subgroups;1. Guidance documents & first project development2. IT & communications3. Trust network set-upThe group was overseen by a set of co-chairs ranging from ST4-ST8 and senior consultant support.ResultsThe working group set to work on the 3 main workstreams and developed an initial set of resources which included;1. Guidance documents & first project development:- Constitution- Project proposal form- Standard operating procedure guidance for projects2. IT & communications:- Branding including network name and logo- Social media presence- Website1 and dedicated email addressNewsletter outline and mailing list template3. Trust network set-up:- Review of regions and hospitals with collation of potential local stakeholders and consultants leads- Plan for recruitment of interested trust leadsIn parallel the working group conducted successive brainstorming exercises of potential first projects, taking into account the outputs of other trainee networks, feasibility and current views on research priorities. Additionally, in recognition of the need to hear parent and patient as well as pan-region trainee voices, links to patient and public involvement (PPI) organisations are being established and a priority setting exercise is planned for 2023. A central committee was formed in December 2022.ConclusionThe London REACH – Research, Evaluation and Audit for Child Health – network collaborative established its central committee, core guidance documents and communication infrastructure. A first regional trainee-led multi-site project will be conducted in 2022.Referencewww.reachnetworkldn.com

ObjectivesThe RCPCH Progress+ curriculum mandates research and audit skills for all paediatric trainees. The London REACH (Research, Evaluation and Audit for Child Health) network1 aims to support trainees in gaining those valuable skills. We gathered cross-sectional data on London School of Paediatrics (LSP) trainees’ (1) existing experience of and (2) perceived access to research and multi-centre quality improvement projects.MethodsThe PEAR survey was designed by a subgroup of the REACH central committee and disseminated by NHSmail by local leads. All paediatric trainees in London were included including those OOP. Descriptive quantitative analysis of anonymised data was conducted via R and Excel. A qualitative thematic analysis was undertaken by three reviewers to identify shared themes throughout the open-ended questions.Results142 responses were received and categorised by demographic (age, gender, ethnicity, non-UK primary medical qualification) and training data (integrated academic training, subspecialty training, less than full time). 61.3% of trainees felt they had no capacity for research, whilst 35% found it difficult to identify research opportunities and supervisors. Whilst 98% of trainees demonstrated involvement in local quality improvement projects, only 33% had multi-site experience. Trainees reported conducting only 16% of research activity during paid time and 89% wanted more access to research during their training.Multiple trainee subgroups showed variable research involvement. Integrated academic trainees were more likely to have additional qualifications (100% vs 64%), oral presentations (100% vs 46%) and publications (90% vs 61%); and felt more able to identify research opportunities (80% vs 38%). Less than full time trainees were also more likely to have publications (75% vs 57%), despite fewer being able to identify research opportunities., Trainees with non-UK primary medical qualifications were less likely to have additional qualifications (47% vs 72%) or involvement in poster presentations (76% vs 90%).Qualitative analysis identified three key themes: recognising the importance of paediatric research, barriers to research within training, and wanting integrated research during training. Notable barriers included variable research culture and limitations in time and commitment.ConclusionsOverall, trainees desired greater involvement in research related activities, yet demonstrated difficulty in accessing opportunities. There was variability between subgroups in experiences and access. Subgroups with more protected research time, such as integrated academic trainees, were more likely to have greater academic attainment. Therefore, the provision of equitable access to research will require expansion of protected time for all trainees.Referencewww.reachnetworkldn.com

Why did you do this work?The Working Lives Subgroup of the London School of Paediatrics (LSP) Trainees’ Committee aims to empower trainees with the knowledge and resources to help them navigate issues that they may encounter throughout their training. Through our work with educational seminars, open forums, one to one support, and the creation of user-friendly guidance, we identified a need for further awareness, guidance and support for trainees regarding their working lives matters. We therefore designed and hosted a ‘Working Lives Study Day’ (WLSD).What did you do?The online WLSD was designed for paediatric trainees, and was also open to colleagues involved in the organisation of paediatric training including rota coordinators and consultants. The day consisted of presentations, Q&A sessions, and interactive workshops. We focused content on four key areas: payslips and salary calculations; pregnancy, maternity/paternity leave and pay; rota design and implementation; and less-than-full-time (LTFT) training. These topics are in line with NHS England’s Chief Executive Amanda Pritchard’s agenda for ‘Improving the working lives of doctors in training’, as set out in a letter to all NHS trusts in April 2024.1 Pre and post course surveys were sent to all attendees, asking them to rank their confidence level from 1–10 (1 being least confident, 10 being most confident) in the four areas, as well as encouraging open space questions and feedback.What did you find?The WLSD was attended by 45 paediatric trainees from across London. Our data demonstrates improvement in confidence levels of attendees across all four topics. Attendees’ confidence in calculating their pay and checking their payslips scored a mean of 3.5 prior to the course, which increased to 7 in the post course feedback. The mean score for understanding rights during pregnancy and parental leave before the course was 3; this improved to 7.5 following the course. Attendees ranked their confidence tackling rota related issues such as rostering and leave at a mean of 6 before the course, which improved to 8 after the course. Attendees’ confidence navigating LTFT training scored a mean of 4.5 before the course, which increased to 7.8 after the course (figure 1).Abstract 8253 Figure 1Results comparing attendee mean pre survey confidence to post attendance confidence, for four topics covered during the study day[Image Omitted. See PDF.]Most queries from the pre-course survey centred around rota and leave. The post course feedback was overwhelmingly positive: trainees expressed highlights from all the sessions, particularly with regards to understanding pay.What does it mean?The WLSD achieved an improvement in trainees’ confidence managing issues with their pay, rotas, LTFT training and parental leave. This supports the continuing need to disseminate this information through further study days to help trainees find solutions to these common issues. We feel encouraged by the success of this work, and plan to open future sessions to a national audience. Ultimately, doctors who are happy and empowered in their working lives provide better patient care.2 ReferencesPritchard A, Powis S, Evans N. Improving the working lives of doctors in training [Internet]. NHS England: United Kingdom; 25th April 2024 [Accessed 27th September 2024]. Available from: https://www.england.nhs.uk/long-read/improving-the-working-lives-of-doctors-in-training/Department of Health. NHS Health & Well-being Improvement Framework [Internet]. Department of Health: United Kingdom; 29th July 2011 [Accessed 30th September 2024]. Available from: https://assets.publishing.service.gov.uk/media/5a7c0296e5274a7318b907ab/dh_128813.pdf

Why did you do this work?The PEAR study, conducted by the London REACH (Research, Evaluation and Audit in Child Health) Network identified lack of time as a significant barrier to trainees’ participation in research and quality improvement projects.1Supporting Professional Activity (SPA) time is essential for paediatric training, as emphasised in the RCPCH Trainee Charter.2 This recommends a minimum of 8 or 16 hours SPA time per month for ST1-3 and ST4+ trainees respectively, additional to departmental teaching and clinical administrative time.To address this, we aimed to quantify rostered SPA time for paediatric trainees in comparison to the RCPCH Trainee Charter. Additionally, we reviewed trainees’ subjective experiences of SPA provision.What did you do?We conducted a cross-sectional study utilising the London REACH network, a trainee-led research initiative spanning 28 London hospitals . Local leads at each site carried out a scoping survey to gather information on what paediatric services are present at each hospital, and the levels of trainees they accommodated (Senior House Officer (SHO) or Registrars)).Based on this initial survey, local leads identified one SHO and one Registrar trainee (where applicable) from each paediatric department. These trainees completed a survey regarding their experience with SPA provision and submitted their full-time generic work schedules.We then analysed the submitted schedules for rostered SPA time and compared them with the RCPCH recommendations.What did you find?We received scoping survey responses from 21 out of 28 (75%) London hospitals that have paediatric trainees. From this, there were a total of 110 possible work schedules that could be collated, of which we received 56 (51%). Among these, 14 (25%) had directly rostered SPA time with on average, 8.8 hours of SPA time per month for SHOs, and 11.1 hours for Registrars. Additionally, 31 (57%) rotas included shifts which were ‘occasionally’ used for SPA time. However this was not explicitly rostered for on the work schedule, and respondents reported that it was routinely not available for SPA time, and not protected. It was also reported that SPA days were often required to be taken as leave in order to take a full leave allowance.What does it mean?There is significant variation and insufficiency in the allocation of SPA time for paediatric trainees across the London area, with notable discrepancies between Registrars and SHOs, relative to the RCPCH Trainee Charter values. Moreover, only 7 (13%) work schedules aligned with RCPCH guidance on SPA time, indicating that a large cohort of trainees must use their personal time to engage in quality improvement and research activities. As research is a core competency of the RCPCH curriculum, there is a clear need for dedicated time for trainees to fulfil these important tasks.ReferencesPaediatric Trainee Experience of Multi-site Audit and Research (PEAR), a cross-sectional London REACH Network study. Dore R, D’Souza M, Ghosh N, Carr D, Loucaides E, the REACH collaborative. (2023). Retrieved from https://www.journal.londonpaediatrics.co.uk/index.php/1/article/view/75 Training Charter. RCPCH. (2024). Available at: https://www.rcpch.ac.uk/resources/training-charter [Accessed 3 Oct. 2024].

Why did you do this work?The London REACH (Research, Evaluation and Audit in Child Health) network promotes collaborative and multi-site research, audit and service evaluation opportunities for resident doctors in London. Female doctors, international medical graduate (IMG) doctors and doctors working less than full time (LTFT) are more likely to face significant barriers to research opportunities within training.1 Our EDI (Equality, Diversity and Inclusion) initiative aims to promote inclusivity within our network, reduce differential attainment in research competencies and better address the diverse needs of our patient groups.What did you do? REACH collects diversity monitoring data of its members, relating to protected characteristics as per the Equality Act 2010: age, gender, disability, ethnicity, religion and sexual orientation, as well as data on caring responsibilities, flexible working (full time vs less than full time) and country of primary medical qualification (UK vs outside of the UK). Data from central committee members and the wider network (local leads and data collectors) were first collected in March 2023, following which we published our EDI report highlighting how our organisation compares to the diversity of our workforce, nationally and locally.2Figure 1 shows our specific action points developed to champion participation of potentially underrepresented groups within the paediatric research community. We are collecting this data annually to monitor trends and examine the impact of our EDI initiative.Abstract 7832 Figure 1Development of action points to improve equality, diversity and inclusion within the REACH network[Image Omitted. See PDF.]What did you find?Table 1 shows data collected from central committee members and the wider network. The majority of members are female and aged 25–34 years, comparable to paediatric doctors in training, both nationally and in London.3 4 Most central committee members are of white ethnicity, trends within our local team recruitment shows greater diversity and increasing proportion of members from Asian, Black, Mixed and other ethnicity between successive rotations. The majority of our central committee members reported as having no religion/strongly held belief, however we have a more varied representation within our local teams.On our initial data, we had less proportion of LTFT doctors in the wider network, compared to London training data.4 Following our EDI initiative, this has increased alongside an increase in involvement of doctors with caring responsibilities. In successive rotations, we have seen a sustained increase in participation of IMG doctors within our local teams, with our volunteering roles being more accessible for locally-employed doctors.Abstract 7832 Table 1[Image Omitted. See PDF.]Demographics, protected characteristics and training status of REACH members. Data collected from memberships surveys conducted in March 2023 and March 2024. PNTS- prefer not to say, FT – full time, LTFT – less than full time, PMQ – Primary medical qualification Comparator data specific to London resident paediatricians: ª2022 REACH PEAR study (n=142)1; b 2023 GMC data explorer specified for London region trainees (n=981)3; 2023 London School of Paediatrics Trainee Survey (n=705)4 What does this mean to you?We reflect on the difference in diversity between the central committee and the wider network, underscoring the need for more work to impact change within the senior leadership. As part of a network of professional bodies with a responsibility to tackle inequality in all its forms, we will continue to advocate for equitable access to research in child health and role of resident-doctor led networks in addressing elements of differential attainment within our diverse workforce.ReferencesDore R, D’Souza M, Ghosh N, Carr D, Loucaides E, the REACH collaborative. (2023). Paediatric Trainee Experience of Multi-site Audit and Research (PEAR), a cross-sectional London REACH Network study. London Paediatrics, 4. Retrieved from https://www.journal.londonpaediatrics.co.uk/index.php/1/article/view/75REACH Equality, Diversity and Inclusion Report 2024. Available from https://www.reachnetworkldn.com/equality-diversity-inclusionGeneral Medical Council. General Medical Council Data Explorer. 2023. Available from: https://gde.gmc-uk.org/ [Accessed 1 April 2024]London School of Paediatrics (LSP) Annual Survey 2023. Available from: https://londonpaediatrics.co.uk/trainees-committee/survey/

ObjectivesFebrile infants commonly present to the emergency department. Most will have self-limiting infections; however 10–20% will have a serious bacterial infection1 and diagnosis is challenging. In the UK, three national guidelines are in use (NICE NG51, NICE NG143, BSAC2), in addition to local clinical practice guidelines (CPGs). This holds true in London where 36% of trusts used CPGs.3 Thus, there is potential heterogeneity in the management of this patient group. As part of the FIRE (Febrile Infants Regional Evaluation) study we describe variation in management of febrile infants up to 3 months of age across London hospitals.MethodsThis retrospective, multicentre, observational study utilised 19 London hospitals within the REACH Network.4 Data was collected on infants up to 90 days of age presenting with a fever or reported fever (≥38.0°C) between 1st April 2021–31st March 2022. Pseudo-anonymised data was compiled on REDCap by local research teams. HRA ethical approval was granted (22/PR/1377) and each participating site obtained R&D approval. Descriptive statistics are reported (median of total study cohort and range for site medians).Results1880 presentations were included in the study. Across all hospitals, FBC and CRP were taken in 1383/1880 (73.6%; 54.5–96.7%) and 1387/1880 (73.8%; 53.8 -96.7%) of cases respectively. Blood cultures were taken in 1178/1880 (62.7%; 37.8–87.8%), CSF sampling was performed in 776/1880 (41.3%; 21.1–70.7%) and urinalysis/MC&S was performed in 1169/1180 (62.2%; 37.8–85.7%). NPA/throat swabs were taken in 851/1880 (45.3%; 7–82.2%) and SARS-COV-2 investigations were performed in 1162/1880 (61.8%; 26.5–91.8%). Antibiotics were started in 1123/1843 of cases (60.9%; 39.4–91.1%). 1152/1849 (62.3%; 47.3–95.1%) cases were admitted to an inpatient ward following initial presentation; a significant minority 530/1849 (28.7%; 0–46.1%) were discharged from the place of initial assessment. The remaining 9.9% of cases were either transferred to a paediatric assessment unit or equivalent, ambulated from an inpatient setting or via a hospital-at-home service, or were transferred to PICU. The median length-of-admission was 1.4 (0.46–2.6) days. Variation in practice was seen with decreasing age of infants and depending on fever being present at initial assessment (table 1).Abstract 6850 Table 1Variation in practice stratified for age <= 28 days vs. >28 days and febrile vs. afebrile at presentation*ConclusionThere is significant variation between London hospitals with respect to investigation, antimicrobial use, decision to admit and duration of stay. There is a need to standardise the approach to management of this high-risk population and limit variation in care, whilst balancing this against the burden of investigation and treatment.ReferencesWaterfield, et al, on behalf of PERUKI, Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland. Archives of Disease in Childhood. 2022;107:329–334.British Society for Antimicrobial Chemotherapy. Infant <90 days of age with fever and no source, pathway for children presenting to hospital from the community. Amended 2021.Alvarez A, et al, on behalf of the REACH collaborative. Comparing guideline recommendations for management of young febrile infants across London. Poster presented at RCPCH Conference 2023. Available from www.reachnetworkldn.comREACH Network. Available from www.reachneworkldn.com/fire.

Trainee-led Research Networks (TRNs) can mitigate against the lack of in-training academic opportunities by offering research experience, support and shared learning for paediatricians. The London Research, Evaluation and Audit for Child Health (REACH) Network, founded in 2021, has grown to involve a diverse group of 190 volunteer members at 28 London hospitals. Planning and delivery of a range of multisite projects bring not only many challenges but also a wealth of learning opportunities relating to research and quality improvement as well as leadership, management, education and fostering an accessible and equitable research culture. TRNs are an effective and valuable tool in improving the experience of trainees.