“It’s a game-changer for everyone”: Flexible working on A&E wards

Talia Barry, an A&E consultant, tells us how highly flexible rotas can help medics to balance work and family, as well as preventing burnout in a high-stress career.

Talia Barry


Around 12 years ago, Talia Barry went to her husband in tears and said: “I can’t manage this anymore, I can’t do these ridiculous shifts.” 

Barry, who at that time was a junior doctor training in emergency medicine, was struggling to make her rigid shifts fit with family life. She had some flexibility, in that junior doctors can complete their training hours on a part-time basis. But she had little control over the shifts she was given. She often had to do a stretch of long days followed by days off.

“I had quite a lot going on at the time – my son was having problems at school and I was working in an extremely stressful environment, a really busy A&E,” she says. “It was so soul-destroying leaving the house [for work] at 6.30am and then coming back at 6pm or 7pm, and doing that for seven days in a row, never having time with your family.”

Barry, who is now an A&E consultant at North Middlesex Hospital, is one of many doctors who have benefitted from the rise of highly flexible rota systems in the NHS. Her team has an “annualised hours” set-up, where staff are contracted to work a total number of hours across the whole year, rather than per week or month. They can choose when they work and commit to different hours in different weeks.

“It’s a game-changer for everyone”

Many NHS services are turning to “self-rostering” systems, whereby staff say what shifts they can do and a rota is then woven together. Workingmums.co.uk has also spoken to NHS staff in Sussex and Milton Keynes, where hospitals are using or trialling these set-ups. A third of A&E departments now use Health Rota, a specialised flexible rota software, while others use their own tech or spreadsheets.

“It’s really a game-changer for everyone. It means that you could take three weeks off…because your mum’s sick or you want to go on holiday or something else, and then do three more compressed weeks afterwards,” Barry says. “As long as you’ve got a whole team that’s on board with it, and you discuss how you rota things fairly, then it works.”

In a typical week, Barry might do three day shifts and one evening shift on the wards. She will also spend some hours working on her teaching role at UCL. She always has Fridays off for family time – she has four children, aged between 11 and 24. She finds self-rostering particularly useful for taking time off during school holidays.

Her team plans rotas in four-month chunks so gaps are covered well in advance. They also work together to divide shifts fairly and avoid major gaps – successful self-rostering requires collaboration, rather than each person only ever doing what works for them.

Keeping hold of talented medics

Barry says self-rostering has had huge benefits for her colleagues – and not just those with children. It helps A&E doctors to look after their mental health by having regular time away from work. It also allows them to pursue other professional projects, as she has done with her UCL role, thereby gaining skills that they bring back to the wards.

“It’s been really great for working parents and it’s also saved the mental health of [medics], because it means they don’t have to be in this high-intensity environment all the time,” says Barry, who adds that doing 50-hour weeks on an A&E ward simply isn’t sustainable. 

Barry says it has been relatively easy to avoid periods when too many people want to be away. She acknowledges that it’s useful if a team has a mix of people who do and don’t have children, so that not everyone is tied to school holiday schedules. In fact, people who are child-free often prefer to go on holiday outside of peak times.

At a time when the NHS is facing severe staff shortages, anything that can foster more balanced and sustainable careers is hugely welcome. Being flexible has kept Barry in a job that she loves. “I could never have done emergency medicine if we hadn’t flexibly rostered – never ever,” she says.

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