A defining feature of the RCP chief registrar scheme is its flexibility: no two chief registrar roles are the same. Differences occur in training status, role structure, and tasks and priorities. Despite the differences, all chief registrars work towards the goal of ensuring safe, high-quality and patient-centred care, and address challenges around engagement and morale, education and training, and workforce issues that can impact the delivery of care.
Here, Dr Zoe Burton provides an insight into what a typical week looks like for her as a chief registrar and anaesthetics trainee at Portsmouth Hospitals NHS Trust.
Since starting as an RCP chief registrar in December 2017, one of the most common questions I am asked by colleagues is 'so, what do you actually do?'. Whilst every week presents new challenges, I hope this example may provide an insight to the role. I currently spend 50% of my time as a chief registrar, and work 50% clinically, with a 100% on-call commitment. I am lucky to have a ‘partner in crime’, Dr Helena Edwards (nephrology trainee), as co-chief registrar.
Monday was an allocated chief registrar day. At 8am I controlled my constantly overflowing email inbox before my first meeting. This was with the resuscitation team and their junior doctor representative. We discussed several projects including introducing a daily resuscitation team brief and multidisciplinary in-situ simulation training.
Every month we produce the ‘chief’s brief’, a newsletter for all junior doctors, so my next task was to finish and disseminate the current edition. I then met with Helena to discuss our progress with moving each of our ‘high-impact actions’ forward. NHS Improvement produced the Eight high impact actions to improve the working environment for junior doctors report, which we have adopted as a loose structure for our chief registrar projects.
In the afternoon I worked on a project involving colour-coded lanyards for different grades of doctor across the trust. I also met with the patient experience team and arranged to meet the patient collaborative to hear patient viewpoints.
My final meeting of the day was with our director of nursing to discuss introducing the 'Hungry, Angry, Late, Tired' (HALT) campaign and to arrange a joint nursing and junior doctor forum. This will be the first multidisciplinary monthly forum, which has so far been limited to junior doctors. I left the hospital at 6.45pm after a long but productive day.
Tuesday and Wednesday were clinical on-call days, but I also worked on a global patient safety initiative encouraging writing staff names and roles on theatre hats to improve communication in crisis scenarios. Since starting my chief registrar role I have realised the power of social media and have attempted to embrace Twitter. I tweeted a photo of my newly labelled theatre hat under #theatrecapchallenge and collected audit data regarding staff recall of team members’ names following the World Health Organization team brief.
At 9.30am I interviewed a Google employee, trying to discover what we can learn from Google in terms of making the NHS a better place for junior doctors to work.
On Thursday I attended the 8am 'hospital at night' handover. I talked to junior doctors about handover issues and asked how the resuscitation team brief might fit in. At 9.30am I interviewed a Google employee, trying to discover what we can learn from Google in terms of making the NHS a better place for junior doctors to work. At 11am I had a meeting with the wellbeing lead regarding organising the HALT campaign, and at lunchtime I swung by the canteen to support one of the occupational health team who was promoting ‘Time to Talk’ day, encouraging staff to discuss mental health.
Sharing experiences and troubleshooting issues
By 1pm I was on the M27 driving to Health Education Wessex for a monthly meeting with the associate dean and my fellow Wessex chief registrars. Ten chief registrars (including non-physicians) were appointed across Wessex and these meetings provide an opportunity to share experiences and troubleshoot issues. Discussion focused on introducing positive event reporting and provision of post on-call rooms for rest before driving home.
I began Friday at 7.30am, assessing patients preoperatively for a trauma list. At 8.30am I attended the monthly clinical directors’ forum held by the medical director. I was party to in-depth discussions regarding essential financial savings to be made before the year end, and had an opportunity to share my vision to make hospital guidelines accessible in an app format. This was positively received and I achieved buy-in from several clinical directors. I also raised concerns expressed to me by many juniors in light of the recent Bawa-Garba case. By late afternoon, the medical director had sent an email stating his recognition of the vulnerability felt by junior doctors and expressing assurance that consultants should be fully supportive.
I finished my trauma list at 4.45pm and gathered more audit data prior to starting my evening on-call. At 8pm I gratefully handed my bleep to a consultant covering the night shift due to sickness. A message from the chief executive confirmed I could shadow him in 2 weeks’ time. He also requested to shadow me for a day in return, showing clear support for another chief registrar initiative involving trust board members shadowing clinical staff across all grades and specialties.
All in all, an exhausting but rewarding week!
Dr Zoë Burton is part of a regional pilot of non-physician RCP chief registrar posts in Wessex