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Applying the breaks

25 March 2011

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Simon Carvell

GP Partner

Simon qualified from Birmingham University in 1994 and has been a member of the Royal College of GPs since 1999. He is currently a GP partner working in the West Midlands, an honorary lecturer at the University of Birmingham and an editorial adviser to Management in Practice

Fifty-two weeks, nine partners, at least eight salaried partners and plenty of bank holidays, with each doctor having up to seven weeks’ holiday entitlement… it sounds like advanced algebra. Once you’ve factored in the rule that doctors with school-age children have priority at school holiday times, practice managers can be left not only with a migraine, but also a cluster headache and the potential of assassination from the doctors who don’t get their preferred holidays.

Our holiday rota is a nightmare. It had been suggested by our now-retired senior partner that we reduce our holiday entitlement. This was met with protests unrivalled in the southwest Midlands. I hasten to add that the partner in question didn’t retire immediately after this ‘flawed’ proposal.

Plan early
The key to success in establishing a successful holiday rota is to plan well in advance. In recent years, we’ve let things drift. Organising next year’s holiday in September is likely to fail, or so it seems in our experience. Start early!

Rules are often broken. However, we have two rules: no more than three staff members off during any normal week (this includes salaried doctors and partners) and no more than four off in one week during the school holidays. These rules are a great aspiration. However, aspiration, expectation and realisation are poor bedfellows when it comes to holidays. Furthermore, the numbers don’t fit so these rules are flawed from the start, even if the philosophy is sound.

Our annual leave entitlement period runs from 1 Jan to 31 December. There’s a fundamental problem with this. December turns into a disaster as the doctors realise they still have holiday remaining. It would help if December were 64 days long.

We’re toying with the idea of running 1 April to 31 March in terms of our holiday entitlement. This makes sense: December is always pressured, with higher levels of patient demand. The surgery is then forced to accommodate that last day owing to the ’12 doctors who forgot’. It all becomes a nightmare.

If the holiday year ended on 31 March, at least those who hadn’t planned their leave wouldn’t poleaxe those who had planned their leave when the days owing were finally realised. Rules are never enforced – but there’s no carrying over days to the following year. It would be easier to accommodate annual leave ending in March, which is generally a quieter month than December, when there is a notorious great pill panic before the bank holidays.

Another good idea would be to enforce a rule that a number of days ought to be taken each quarter. Most of us need to reboot after a certain number of weeks. This evens out leave and makes planning ahead easier. What none of this allows for, however, is that spontaneous: ‘Let’s go to Biarritz next week!’ But in an organisation where there are commitments, this is a sacrifice that must be made.

Are you the gatekeeper?
Who controls the leave? Herein lies a problem. The Gatekeeper (Controller of the Leave) has to be empowered to say ‘no’, or pass to a referral panel in the most deserving of cases. The gatekeeper must not be intimidated, capable of taking a bribe or abused.

In the case of our practice, the referral panel is made of the partners, who it must be said usually mull over their own requests and those of the salaried doctors in the fifth hour of the monthly practice meeting – not always the best time to do this. The partners are generally fatigued by definitive decision-making; the requests are passed and only in the cold light of day does the realisation hit home that no one will be in on 4 July!

The holiday rota is posted on our intranet. It cannot be altered by anyone other than the gatekeeper. However, this comment could be naïve: as access is not encrypted the rota is probably open to corruption. It lists all doctors and also includes our GP registrars. (The registrars are not, however, included in our leave rules, as they are ‘supernumerary’, although we try to encourage them to avoid taking the same weeks off as each other.) So the lesson here is to ensure you have a system where you (or the designated gatekeeper) alone can alter the holiday rota.

Pairing up
When doctors are away we operate a ‘buddy system’. This means all correspondence addressed to the doctor on annual leave is forwarded to a doctor buddy. The buddies usually share a similar working profile, ie, part-time (six sessions), salaried or registrar. Buddies remain the same unless both doctor and buddy are away at the same time; then it gets complicated. In this case, the work, including viewing blood results and signing repeat prescriptions, is disseminated among the other doctors (whom I shall refer to as ‘grumbling buddies’ if this situation arises).

Bank holiday bonuses
Then there are those incidentals: bank holidays, weddings and maternity/paternity leave. Our practice rule is that you can’t get married or conceive a child that could be born during school holidays, as this wrecks everything. Of course this is patently untrue, but such situations do complicate matters.

Many (myself included) congratulate Prince William and Kate Middleton on their intended nuptials. But couldn’t they have married on a Wednesday in mid-October just before our annual flu campaign? The extra bank holiday, running so close to Easter and then May Day, will cause chaos. If your holiday entitlement runs over a bank holiday, you can claim that bank holiday day back. So booking all of your annual leave around bank holidays is a cunning plan, in my view.

Perhaps our now-retired senior partner had a point; perhaps our holiday entitlement is too generous. He was all for slashing it by one to two weeks (before we all felt like slashing him). But this would have made everything so much simpler: the gatekeeper would not be surrounded by burly minders, we wouldn’t need to spend late nights mulling over whether just two doctors covering those December days would actually suffice (this was never the case and never will be).

Rest assured, I won’t be offering annual leave reduction as a solution to our holiday hell. Annual leave is too dangerous a subject to tackle: our last gatekeeper was replaced in a bloodless coup. On a positive note, our new gatekeeper seems happy – for the meantime.