Rota Design for 2009 - North Western Deanery

Approval to change band/work pattern (NHS North West)Trust:Hospital:Specialty(ies):Numbers of Doctors in Working Arrangement by GradePRHO: SHO: SpR: OtherWorking Pattern:Current Banding: Proposed Banding: Effective Date:Stage 1 Evidence Required Documentation Confirmed Y/N1a.Consult post holders onproposed changes andobtain agreement of themajority participating inthe working arrangements.1b.Submit details of the newworking arrangements tothe action team forinformation and invitedcomment.Approval of majority ofcurrent/incoming postholdersFull details of proposedworking arrangements and/orrota summary (eg fromND2000 software)Template signed by trustjunior doctor representativeconfirming agreement ofmajority of current/incomingpost holdersLetter signed by action teamchair or delegated authorityconfirming theoreticalcompliance of workingarrangements (see below)I confirm that the proposed working arrangements submitted to the action team are theoretically compliantwith the New Deal (To be completed by the action team)Name……………………………………………………………..Signature………………………………………………Designation…………………………………………………………………………………...Date ………………………1c. Obtain agreement fromclinical tutor foreducation purposes.Full details of proposedworking arrangementscomments of action teamLetter signed by dean ordelegated authority confirmingeducational acceptability ofworking arrangementsStage 1 Evidence Required Documentation Confirmed Y/N3. Monitoring of workingpattern and confirmation ofbandingCompleted monitoring returnsfrom 75% of doctors on rotaover full two week periodSummary of monitoring resultsThis signed templateThis Action Team Authorisation at Stage 3 is based on the information supplied by the Trust. Any innacuracies inthe data provided including analysis / interpretation of monitoring data may render this rebanding invalid.Previous banding: Verified New Banding: Effective Date:Trust Signatory(Designation)Rota Signatory(Designation)Action Team Signatory(Designation)Date:Date:Date:22