Key points: Suggestions for developing sustainable rosters during the COVID-19 pandemic

The individuals involved in rota design should have experience of doing so. There needs to be a full awareness of service requirements, staffing levels, leave and contractual obligations. In addition, we suggest taking account of the following principles.
  • Meaningful consultation of affected staff.

  • Ensuring that no one grade of doctor is disproportionately burdened.

  • Considering individual circumstances, including personal, physical, and psychological needs.

  • Taking account of the fact that individual risk assessments may necessitate staff at high risk coming off on-call rosters – they can support their colleagues in other ways.

  • Building flexibility into rotas to allow for absences or overstaffing. This flexible time could be used for rest and self-care, seeking psychological support, or similar.

  • Aiming to work in teams with a clear function and structure. Stable teams may identify signs of burnout in colleagues who are unaware themselves – thus helping to manage it earlier.

  • Rotating staff between high and low intensity environments.11

  • Clearly prescribing breaks within shifts to allow for rest and refreshments, recognising that these are more important now than ever.

  • Ensuring adequate time for rest, decompression and recovery after shifts; this is critical and needs to be commensurate to the intensity of the shift worked.

  • Ensuring facilities needed for staff to work are in place (parking, refreshment, rest, changing, etc).

  • Permitting and actively encouraging leave requests, especially annual leave, and following appropriate national guidance when making changes to usual practice.9,10,12

  • Ensuring opportunities for CPD continue.

  • Being aware that those coming back from redeployment, especially from high-intensity environments, may not have been able to take leave while in those settings and thus need their leave prioritising.

  • Clearly communicating the rationale of rostering/leave decisions.