On-call - what you need to know

Increasingly across the UK, staffing shortages have been used to drive the introduction of new forms of on-call. This is not the intended purpose of on-calls, which have traditionally been worked by community or case load/continuity teams to cover intrapartum care for the women in their care.

Any imposition of on-call systems is particularly concerning considering the extra hours worked by RCM members in England. In the 2022 NHS Staff Survey (England), 81% of midwives reported working additional unpaid hours for their organisation and an RCM survey in March 2023  which asked RCM members in England of their experience of one week in March found 88% of respondents worked additional unpaid hours with 26% working more than five additional unpaid hours that week.

Additional hours worked by staff should be rewarded fairly, with overtime paid at time-and-a-half for staff in bands 1 to 7 for hours worked above standard hours (37.5 hours a week) - work on general public holidays, is paid a double time, section 3 of the Agenda for Change Handbook covers overtime. There may also be local agreements which extend overtime payments to some Band 8 staff.

Work/life balance is fundamental to the health, safety and wellbeing of midwives and MSWs and importantly to staff retention. Burnout and work-related stress are common amongst RCM members, the RCM survey carried out in March also found that 74% of respondents often or always faced unrealistic time pressures and workloads and 64% felt burnt out or exhausted at the end of most or all of their working shifts.

The Society of Occupational Medicine (SOM) reported that midwives and nurses are at considerable risk of work-related stress, burnout and mental health problems as a result of heavy workloads, lack of support, low job satisfaction (particularly in relation to terms and conditions of employment), low satisfaction with work-life balance, and the demands of providing compassionate care.

Human factors refer to environmental, organisational and job factors, and human and individual characteristics that influence behaviour at work in a way which can affect health and safety. The Health and Safety Executive (HSE) has produced guidance on human factors including fatigue which it states needs to be managed like any other hazard and the safety risks not underestimated, changes to working hours should be risk assessed. Employers are under a legal duty to manage risks from fatigue and compliance with the Working Time Regulations alone is not sufficient to manage the risks of fatigue.

Section 33 of the Agenda for Change Handbook states that a positive work/life balance benefits both NHS employees through improved health and wellbeing, and employers because staff are more productive and satisfied at work. It asserts that employers should have a strategic response, ensuring policies which support and promote a work/life balance are agreed in partnership.

Central to achieving work/life balance is flexible working. An RCM member survey carried out in 2021 found that 67% of midwives and MSWs who had left or were considering leaving the NHS could be encouraged to return if there were greater opportunities to work flexibly. In June 2023 NHS England published its Equality, Diversity and Inclusion improvement plan which includes six high impact actions it requires trusts in England to take. One of the high impact actions is to develop and implement an improvement plan to eliminate pay gaps, as part of this trusts will also have to implement effective flexible working policies. To retain staff in maternity services NHS organisations should be looking to offer a wide variety of different shift lengths and patterns and supporting self and team rostering to enable teams to decide how to organise their working time, arrange schedules and roles while ensuring that intra-partum care is covered, not imposing on-call systems which have a detrimental impact on midwives and MSWs working lives.

The RCM has produced guidance to support RCM workplace representatives who may be faced with proposals for new on-call systems - or for existing systems to be adapted and widened beyond their intended use.

RCM reps can use our on-call negotiating guide to stop the imposition of new on-call systems that have not been agreed with staff, and negotiate any proposals on behalf of RCM members.

The guide includes:

• A breakdown of the relevant Agenda for Change provisions
• Information on other relevant arrangements, terms and conditions
• Supporting arguments and information

Not a rep? Activists and other interested members should get in touch with their reps to find out what’s happening at your workplace and feed into the negotiation process.