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NHS Direct nurses fight plans to make them work more weekends

Nurses working for NHS Direct have lodged a collective grievance after being told they will have to work more weekends in a bid to improve the organisation’s performance.

About 80, mostly band 6, nurses who work for the triage service on a part time basis are affected by the rota changes, Nursing Times understands.

They will require part time staff to work five weekends out of eight, the same number as full time staff. Currently the number of weekends worked by part time staff is worked out on a pro rata basis.

NHS Direct chief nurse Tricia Hamilton said the rota changes were needed to cope with an increase in demand at weekends.

She said: “We appreciate that this may not be a welcome change for some of our staff and we are doing everything we can to support them and answer any questions they may have.”

The service has recently been fined £1.1m and issued with a warning for persistently failing to meet all of the key performance indicators (KPIs) set out in its contract. At the end of March, it was failing to meet 17 of its 30 performance indicators, including time to clinical assessment for less urgent and non-urgent calls.

NHS Direct chief executive Nick Chapman told a recent board meeting that high demand at the weekends was a factor in failing to meet these indicators.

But Royal College of Nursing employment relations officer Gary Kirwan said the imposed rota changes were “damaging morale”.

He said: “Because NHS Direct are facing problems with meeting their KPIs… what they have proposed is that all part time staff will work the same weekend arrangements as full time staff.

“Many of these part time staff have got care arrangements where they would find it very difficult,” he told Nursing Times.

The dispute has gone to stage three of the grievance process, meaning members of the NHS Direct board will hold a hearing to listen to nurses concerns and recommendations.

Mr Kirwin added: “What we want to happen is instead of saying ‘we will do this’, they actually engage with staff.

Readers' comments (21)

  • Adrian Bolt

    F***king-helski! Everyone else has to work weekends and weekends are when NHS (re) direct are going to be the most busy. Some people just don’t know when they are onto a good thing, band 6 pay for reading from a typed pro-forma, well if they don’t like it they can always get a job back in the real world.

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  • @Edwin
    The nurses know that weekends are an expected part of the working rota. It is the way in which this change has been imposed that has caused so much distress, and is a symptom of the way in which NHSD treats its staff. The reason most of the nurses are band 6 is because they *do not* read from a script, they are having use their experience and training to assess patients without being able to see them. I defy any nurse to take a random call from any area of nursing; adult, paediatric, mental health, midwifery and be able to assess the caller as well as they do. The decision support software is a way of recording the thinking and decision of the nurse, it does not do the thinking or make the decisions. It is a very, very hard job indeed. Relentless, call after call, every call recorded and scrutinised, a constant battle between a nurses' natural (and professional duty) to give each caller the time they need and the outcome that is best for them and the demands of a call centre environment with targets that are sometimes directly at odds with that. Getting time for accurate and contemporaneous documentation is a battle. You never know what happens next, there is no follow up, so precious little reward. There is no down time, no quiet time, it is constantly busy from the minute you log on till the end of your shift, never knowing whether the next call is going to be a routine bread and butter call or someone about to jump off a bridge. The majority of the shifts are antisocial, with some 'day' shifts ending at 2am.
    I left the service for a much lower paid post because of effect the stress and the hours were having on my health. In the end the band 6 was not worth that for me and I was lucky enough to get a job back in the 'real world'. I have huge respect for any nurse who survives longer than a year at NHSD - they deserve better than to be treated like this.
    However much you are paid for a job you deserve to be treated fairly, especially if you are caring for others.

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  • It is obvious that the busier times are going to be the unsocial hours and having chosen a nursing profession that negates working unsocial hours, the nurses must expect that the larger portion of their work will fall at night and weekends. You chose the job. If you dont want to work unsocial hours, find a job in a clinic

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  • After over a years service now I'm still here and still working unsociable hours and I will back what was said before in the anon comment, working at NHS Direct is very chalenging. You have to be constantly on the ball and using your critical thinking skills, with the constant worry of making a mistake or something going wrong. Working long shifts call after call, dealing with a range of subjects and some very difficult and emotional situations, it is very very stressful and with no face to face contact it takes a lot of skill to complete telephone triage. BUT I also agree, you don't go in to nursing as a career for the money or to get weekends off, you ought to know what you are getting yourself in to when you first start Uni :)

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  • In case people forgot .... Stress takes its toll on NHS Direct nurses
    30 March, 2011 | By David Williams

    Stress is by far the most common cause of long-term absence among staff at NHS Direct.


    Papers for the trust’s latest board meeting show that stress and anxiety accounted for 19 of the trust’s 85 recorded long-term sickness cases as of 28 February.

    The second most prevalent cause was musculo-skeletal conditions, with nine cases, and the third was surgery, with eight.

    However, the total of 85 was a reduction on January’s figure of 100, and the 122 cases recorded in December 2010.

    “The churn of long-term sickness cases remains high”, the board papers note.

    The documents add that 39 cases of long-term sickness absence were resolved during February. Of these, seven “resigned or were dismissed,” and 32 returned to work. However, 26 new cases were reported last month.

    A key performance indicator for the trust is to reduce the long-term sickness rate to under 50 by 31 March

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  • as a full-time member of staff - I have agreed to work as per contract - 5 shifts out of 8 weekends, every 4 weeks. The situation that has now arisen is that all staff irrespective of hours worked will now do the same. EG someone working 3/7 days per week, ie 12 shifts every 4 weeks; will now work 5 of those shifts on the week end. This does not take into consideration any other unsocial hours that the person works during the week ie after 2000hrs. so technically the person can do all unsocial hours not through choice nor flexibility.

    No one disputes the difference in jobs and the issues that arise from each role a nurse has to play in some ones life - but respecting that diffferent roles bring different types of stress and politics to the individual should be observed

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  • as a full-time member of staff - I have agreed to work as per contract - 5 shifts out of 8 weekends, every 4 weeks. The situation that has now arisen is that all staff irrespective of hours worked will now do the same. EG someone working 3/7 days per week, ie 12 shifts every 4 weeks; will now work 5 of those shifts on the week end. This does not take into consideration any other unsocial hours that the person works during the week ie after 2000hrs. so technically the person can do all unsocial hours not through choice nor flexibility.

    No one disputes the difference in jobs and the issues that arise from each role a nurse has to play in some ones life - but respecting that diffferent roles bring different types of stress and politics to the individual should be observed

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  • Adrian Bolt

    @Anonymous | 12-May-2011 1:33 am

    Fair enough but GP's don't work at Weekends so it seems logical that NHS Direct's busiest time will be at the weekend so that is when the bulk of the staff are needed. There are compensations to having time off during the week.

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  • Anonymous | 12-May-2011 1:33 am
    Well said.
    Edwin you're spouting hot air, again.

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  • Edwin - How disrespectful and rude of you to level foul language to people you do not know, and about someone you clearly do not understand! I am a nurse at NHS Direct, and I work here due to a disability that prevents me from 'working in the real world'as you put it. I work 30 hours per week all my shifts start after 4pm, I take one call after another, and I can tell you, the work is very stressful. You never know what type of call you are going to get, and sometimes I have to made life or death decisions, I do not earn as much as a doctor, and I am constantly scrutinised and always fearful of making the wrong decision on the spur of the moment in case someone listens to my call, who has the benefit of hindsite, and pulls your call to pieces.

    Only last year I was forced to sign a new contract [otherwise I would be terminating my contract] I have worked with my new contract. And, because wrong decisions were made, and too many people work office hours during the week [In other words whoever decided on the new rosters got it wrong] Now I, who remember does all my shifts when the service is busiest, are having to give up more of my home life time, because as a nurse at NHSD you are seemingly, not entitled to a private life! I do not object to working my fair share of weekends. What I do object to is working more than my fair share, and what is particularly annoying is because someone got it wrong. There was no discussion, they just changed our shifts, giving very little notice or consideration to those of us affected. I hope those responsible at NHSD are reading this. Because this is no way to treat staff. It is no wonder that there are high levels of sickness due to stress related illness!

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  • Adrian Bolt

    @ Anonymous | 13-May-2011 2:49 pm
    “How disrespectful and rude of you to level foul language to people you do not know,”

    Excuse me, foul language? If you are referring to the “F***king-helski!” comment that wasn’t being leveled at any one in particular except perhaps the author of the piece who seems to think it odd that an organisiation offering a service to the public mainly out of hours, i.e. Weekends, evenings and at night, should expect its workforce to work predominantly at those times.

    You appear to acknowledge that point yourself when you admit that most people work office hours during the week (is that what you are saying it is not clear from your reply?) So how have the the people who decided the new rosters got it wrong?

    I have already acknowledged to Anon @ 12/05/11 1:33am that the job probably involves more than just reading from a prepared set of responses although the chap in our office who used to work for NHS Direct did rather did give that impression to me when I was talking to him the other day.

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  • Edwin. The article is merely reporting on what is happening, I do not see any mention of anything being odd about NHSD offering servies out of hours. However, from my observations, there appears to be an excess of nurses working during the day time when the calls are much less. And not enough during the evenings and weekends. But the rostering team put together a new set of rosters last year - they called it 'The Roster Revolution' - this should have resolved this problem, but it appeared to have only made the problem worse. The majority of callers ring during the out of hours period, so the majority of staff should be working during the OOH period. This I fully understand, but why as a part-time worker should I do more weekends than the equavalent done by a full time worker?

    As for your colleague who gave you the impression that we only read from prepared scripts, I cannot speak for him. I am sure there are nurses who perhaps do, but I don't think they will last long in this organization if they lack the skills and knowledge to think critically, but safely. Also, our calls are monitored and effectively targetted on the amount of people we give self care to, and nurses are actively encouraged to increase the amount of self care dispositions. This means lowering dispositions frequently from a 999, which would be inappropriate in most cases, to possibly a GP or self care etc. However, I still think your tone of language is inappropriate, after all we are supposed to be professionals - I'm assuming you are a registered nurse?

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  • Anonymous | 13-May-2011 5:20 pm

    Re: Edwin Harnell

    This guy's specialty is posting offensive, arrogant and ignorant comments in reply to legitimate concerns and views expressed by nurses on these forums. Probably best to ignore him. He has nothing of any value to contribute.

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  • Edwin. The article is merely reporting on what is happening, I do not see any mention of anything being odd about NHSD offering servies out of hours. However, from my observations, there appears to be an excess of nurses working during the day time when the calls are much less. And not enough during the evenings and weekends. But the rostering team put together a new set of rosters last year - they called it 'The Roster Revolution' - this should have resolved this problem, but it appeared to have only made the problem worse. The majority of callers ring during the out of hours period, so the majority of staff should be working during the OOH period. This I fully understand, but why as a part-time worker should I do more weekends than the equavalent done by a full time worker?

    As for your colleague who gave you the impression that we only read from prepared scripts, I cannot speak for him. I am sure there are nurses who perhaps do, but I don't think they will last long in this organization if they lack the skills and knowledge to think critically, but safely. Also, our calls are monitored and effectively targetted on the amount of people we give self care to, and nurses are actively encouraged to increase the amount of self care dispositions. This means lowering dispositions frequently from a 999, which would be inappropriate in most cases, to possibly a GP or self care etc. However, I still think your tone of language is inappropriate, after all we are supposed to be professionals - I'm assuming you are a registered nurse?

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  • Don't people need advice 24 hours a day other nurses have to work weekends and night shifts so what is the big fuss here. Probably from the time NHS direct was set up staff should have been told part of their job description is to work not only 9-5 but late evenings and weekends

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  • The so called 'Rostering Revolution' is a Rostering Nightmare and its not fair that Nurses should be thrown in to unsociable hours because of schedulings mistake, without adequate prior warning.

    As for the ''reading from a script'' issue, using decision aiding software does not mean reading from a script, if that was the case the patient could do it, face it there are protocols in place for clinical safety, for example when administering meds or setting up a syring driver on a ward you need to follow certain guidelines, policies and protocols it does not meant you stand with the book and read it word for word as you do your job, you use your own proffesional training and critical thinking.

    NHS Direct nurses ARE real Nurses, the majority of them with a LOT of experience and expert specialist training, using wisdom and knowledge to help patients. Most of the NHS Direct nurses have specialist A&E training, and this enables them to complete the telephone triage. The NHS Direct nurses should not be underestimated or made to look like idiots, its a total insult.

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  • Get a grip, we are all expected to change with the times no matter what area of the NHS you are in. Management never get it right when they are making changes because some staff don't like changes.
    At least you have a job that is increasing your pay, you get time off during the week, ok may not work too well if child care an issue but that can be negotiated at an individual level as for NHSD work hard and have a challenging job! Hoe demeaning you sound, does that mean nurses in other areas don't have challenging roles and don't get stressed. You chose the area of nursing for that exact reason. nurses do a good job with the tools they are given, all you are asked to do is work a few more weekends, not increase your hours! The NHS has to provide a service for the people it serves not for the people it employs.

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  • Anonymous | 14-May-2011 8:57 am

    Are you advocating that all nurses should meekly accept poor terms and conditions regardless of where in the NHS we work? Because we are nurses, what else should we expect and allow to happen? Why is there such a negative reaction to colleagues who are actually doing something about a situation that they find intolerable? Good on them! Perhaps, it could set a precedent for nurses to stop putting up with dangerous changes that are causing great harm to our ability to safeguard the way we care for people.


    I do not, nor would I wish to, work in NHS Direct. I work in a busy A&E Unit and I do not think that my job is any more or less difficult, challenging , stressful or important than any of my colleagues working in other areas. From what I can see from the previous posts, the objections are about the unfair impact these changes appear to have, in particular, on part time workers; inept rota management and the way it has been imposed.

    "The NHS has to provide a service for the people it serves not for the people it employs."
    I couldn't disagree more with the second part of this statement. If the NHS does not carry out it's duty to look after and value it's staff, then it will not be fit or able to provide a decent service for our patients. Good luck to the NHS Direct staff.

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  • I work at NHS Direct. Let me tell you something about the "Rostering Revolution". This was mooted as the answer to all our problems, an overhaul of the centralised rostering system that had previously been a disaster and had been cited as the main reason for the numbers of nurses leaving ... no work life balance, leading to stress.

    In came the overhaul, where nurses could choose a shift pattern from a variety on offer. So far so good. I chose to work every weekend, as this is the best option for my work/life balance at present, but this was a personal choice. It was proposed that NHSD would continue to recruit but into those unpopular OOH shifts; however the commissioners told them to stop recruiting. Nurses who had been offered jobs had these offers withdrawn. There was no recruitment for a good 6 months but, due to falling staff numbers and the appalling service given to the public over Christmas, and the huge financial penalties that were imposed by our commissioners, recruitment started up again, the job downgraded to a band 5 for new starters. With still not enough staff in place in the OOH periods, as had been promised initially, NHSD unilaterally decided to force every part time worker to work extra weekends, no consultation, nothing. There is now a collective grievance lodged by the RCN.

    The fault lies squarely at the feet of the management - the staff work very hard, we know the problems and are keen to help but having changed forced upon us is not the way forward. The organisation is REACTIVE, not PROACTIVE and it getting worse. Interestingly, none of the people making the weekend working decisions work weekends. Wonderful.

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  • Adrian Bolt

    Anonymous | 13-May-2011 7:05 pm

    “but why as a part-time worker should I do more weekends than the equavalent done by a full time worker?”

    What the article actually says is that part time workers are being asked to work the SAME number of weekends as their full time colleagues. So you are not doing more weekends in absolute terms, but I accept on a pro rata basis you are, (the article could have made this point clearer and explained that this was the nub of the dispute).

    However I think you have answered your own question as to why this needs be so, OOH is when the majority of people want to access your service. I suppose a “fairer” way of introducing the change would be to increase the number of weekends worked by the permanent staff to 6 out of every 8 and then increase the number of W/E worked by the part time staff on a pro rata basis. That would have at least distributed the misery more evenly.

    Although why we need NHS Direct AND an OOH GP service when it would appear that they perform much the same service is beyond me. (Note to self: better keep quiet about the shift changes lest the powers that be decide to close down NHS Direct altogether and direct the resources at the OOH GP service instead)

    As for Anon @5:40hrs don’t worry about him, despite his MSc he just sore because he can’t string an argument together. That is you isn’t it Mr A, (it is so hard to tell with all these anonymous posters round here)?

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