{
  "abstract": "Introduction Excessive on-call intensity within medical rotas is increasingly recognised as a modifiable system-level contributor to clinician fatigue, reduced specialty engagement, and workforce attrition. In gastroenterology, where service pressures and workforce shortages persist, rota design represents a critical but underexplored lever for improving staff wellbeing and specialty-facing clinical exposure without compromising service delivery.Methods We undertook a service redesign evaluation comparing a baseline gastroenterology specialty doctor rota (Rota 1; 10-week cycle) with a redesigned rota (Rota 2; 24-week cycle). Shifts were categorised as on-call (long days 09:00–21:30 and nights 21:00–09:30; 12.5 hours each) or non-on-call gastroenterology daytime shifts (8 hours). Outcomes included frequency of long days, night shifts, total on-call shifts, proportion of total working hours delivered as on-call commitments, number of specialty-facing gastroenterology day shifts, and average weekly working hours. All outcomes were normalised to per-week values to enable robust comparison.Results Following rota redesign, long day frequency reduced from 0.70 to 0.29 per week (58.3% reduction) and night shift frequency reduced from 0.70 to 0.29 per week (58.3% reduction). Combined on-call shifts decreased from 1.40 to 0.58 per week, with on-call hours reducing from 17.5 to 7.29 hours per week. The proportion of total working hours delivered as on-call commitments fell from 39.1% to 20.5%, representing an absolute reduction of 18.6 percentage points. Concurrently, specialty-facing gastroenterology daytime exposure increased, with normal gastroenterology day shifts rising from 3.40 to 3.54 per week (+4.2%), and the proportion of all shifts delivered as non-on-call gastroenterology specialty work increasing from 70.8% to 85.9%. Importantly, redistribution off on-call commitments enabled the Introduction of dedicated out-of-hours upper gastrointestinal bleeding on-call exposure, increasing from no scheduled weekend exposure in baseline 10-week Rota to six GI bleed on-call weekends across the redesigned 24-week Rota, aligning Rota structure with current UK Gastroenterology curriculum requirements.Conclusions A structured, data-driven redesign of the gastroenterology specialty doctor rota substantially reduced on-call burden while enhancing specialty-specific daytime clinical exposure. By reframing rota design as a quality improvement intervention aligned with workforce sustainability and patient safety, this low-cost, scalable approach offers applicability across other medical specialties facing similar workforce and service challenges.Key References (for future manuscript development) West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. Lancet. 2018;388:2272–2281.General Medical Council. National Training Survey: Results and trends. GMC, UK.NHS England. NHS People Plan: We are the NHS – People Plan 2020/21.BMJ. Fatigue, shift work and patient safety. BMJ. 2019;364:l477.Health Education England. Enhancing doctor wellbeing through rota design and job planning.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay NHS Foundation Trust UK, Preston, United Kingdom"
      ],
      "name": "Waqas Gaba"
    }
  ],
  "title": "P280 Reducing on-call burden while increasing specialty exposure: impact of a redesigned gastroenterology specialty doctor rota",
  "uid": "b32b05fd-e074-55c4-9a21-d9d168c96848"
}