Consultant and Speciality and Associate Specialists (SAS) Doctor Job Planning Procedure

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1 SH HR 70 Consultant and Speciality and Associate Specialists (SAS) Doctor Job Planning Procedure Summary: Keywords (minimum of 5): (To assist policy search engine) Target Audience: This document outlines the Southern Health NHS Foundation Trust s approach to job planning for its Consultant and SAS doctor workforce. Job planning, Speciality and Associate Specialists (SAS), Direct Clinical Care (DCC), Supporting Professional Activity (SPA), time shifting. Consultants, SAS doctors, managers who manage doctors. Next Review Date: September 2018 Approved & Ratified by: Local Negotiating Committee Date of meeting: 3 rd March 2015 Date issued: April 2015 Author: Sponsor: Lorna Mills, Senior HR Manager Employee Resourcing Martin Diaper, Medical Director for Quality April 2015 Page 1 of 15

2 Version Control Change Record Date Author Version Page Reason for Change 26/1/17 1 Review date extended from Jan to April /3/17 1 Review date extended to May /5/17 1 Review date extended to October /10/17 1 Review date extended to April /4/18 1 Review date extended to June /5/18 1 Review date extended to Sept 2018 Reviewers/contributors Name Position Version Reviewed & Date April 2015 Page 2 of 15

3 CONTENTS 1. Introduction 4 2. Scope 4 3. Overview of job planning 4 4. Objective setting 5 5. The job planning process - The job planning meeting 5 6. Monitoring compliance 7 7. Procedure review 7 8. Associated documents 7 9. Supporting references 7 Page Appendices A1 Job planning components 8 A2 Equality Impact Assessment 14 April 2015 Page 3 of 15

4 Consultant and Speciality and Associate Specialists (SAS) Doctor Job Planning Procedure 1. Introduction 1.1. Organisational and individual responsibilities in relation to job planning are detailed in Consultant Contract and associated Terms and Conditions and Speciality and Associate Specialists (SAS) doctors contract and associated terms and conditions This document sets out Southern Health NHS Foundation Trust s (SHFT) approach to job planning for its Consultant and SAS doctor workforce. 2. Scope 2.1. This procedure applies to all directly employed Consultants and SAS Doctors working within SHFT. 3. Overview of Job Planning 3.1. A Job Plan can be described as a prospective professional agreement that sets out the duties, responsibilities, accountabilities and objectives of the Consultant / SAS doctor and the support and resources provided by the employer for the coming year. In order to achieve measurable and sustained improvements in quality, an effective Job Plan needs to be more than a high level timetable which sets out in general terms the range of a Consultants activity. It is important that it describes accurately the relationship between the organisation and the Consultant / SAS doctor and the desired impact on patient care. The key to achieving this is through objective setting. In order to achieve this, there needs to be an alignment of the objectives of the Consultants / SAS doctors own team with their service/divisional and Trust objectives. It is clear that we are not going to achieve the delivery of safe, responsive, efficient and high quality care if the Consultants /SAS doctors objectives do not fit with those of their individual team or the Trust. However the Job Plan should also provide opportunities for Consultants / SAS doctors to develop both personally and professionally to help improve quality Revalidation has led to greater transparency because Consultants / SAS doctors have to demonstrate that they remain fit to practice. It also changes the focus on professional development and the need to demonstrate improved outcomes for patients All Consultants / SAS doctors work as part of a medical team and therefore a team based approach to Job Planning is to be supported This document is based on the publication from the British Medical Association and NHS Employers (A Guide to Consultant Job Planning, July 2011). April 2015 Page 4 of 15

5 4. Objective Setting 4.1. The principles that are described in the BMA and NHS Employers Document A Guide to Consultant Job Planning regarding objective setting were agreed. These include that: Objectives should be set for most of the activities the Consultant / SAS doctor has in their job plan. They should set out a mutual understanding of what the Trust and Consultant / SAS doctor will be seeking to achieve over the year and how this will contribute to team, service and organisational objectives Objectives may relate to quantifiable achievements or they may be more descriptive about how someone goes about their job Objectives should be written as SMART i.e. Specific Measurable Achievable & Agreed Realistic Timed and Tracked Objectives should cover most aspects of a Consultants / SAS doctor s role, Direct Clinical Care (DCC), Supporting Professional Activities (SPAs) including Personal Development and those which are more professionally orientated and academic sessions where appropriate. However all objectives should ultimately focus on the benefits to patients, although in some instances for example education and training, the impact may be less direct or immediate. Objectives need to be personalised to the specific Consultant / SAS doctor and in this way meaningful progress can be made and measured Clinical Managers should take their Service/Directorate/Trust objectives and translate them into meaningful objectives for Consultant / SAS doctor colleagues Objectives should remain focused on key strategic and service aims. General contractual requirements such as the need to retain professional registration or participate in mandatory training do not need to be included as separate objectives as these are expectations of being an employee and covered by employment law and guidance Objectives must be appropriate, identified and agreed. Consultants / SAS doctors should make reasonable efforts to achieve the agreed objectives. This is not only a general expectation in the contract but is laid out in two of the 7 criteria for pay progression. It is the norm for Consultants to achieve pay progression, but progression is not automatic. Consultants should not be penalised for failing to meet objectives for reasons beyond their control, such as illness, whether this was due to a lack of agreed supporting resources or another reason. However, both employers and Consultants have a responsibility to identify potential problems with achieving objectives as they emerge rather than waiting for an annual job plan review meeting. 5. The Job Planning Process - The Job Planning Meeting 5.1. As noted earlier, it has been suggested that prior to the individual Consultants / SAS doctors Job Planning Meeting, that a meeting of the Consultants and SAS doctors within the service/area should take place to agree some April 2015 Page 5 of 15

6 elements of each Consultants / SAS doctors timetable and objectives. This could include specific roles that need to be undertaken by at least one Consultant / SAS doctor within the service/area and in this way these roles can rotate between different individuals The Job Planning meeting will take place between the Consultant / SAS doctors and their Clinical Manager. For most Consultants/SAS doctors this will be their Clinical Service Director. Consultants/SAS doctors whose line managers are not doctors will have input from a doctor for the job planning process, with the involvement of their non-medical line manager The relevant manager will join attend the Job Planning Meeting. This is to ensure that team/service/divisional objectives are taken account of in agreeing the Consultant s / SAS doctors own objectives. The manager may not be present for the entirety of the meeting, but will be in attendance for the majority of the discussions about service, DCC and SPA time discussions. Practicalities such as where the meeting will be held and that all parties will be free from other commitments and interruptions as far as possible will be avoided, should all be agreed in advance It is generally accepted that it is most useful to review the Consultant s / SAS doctors objectives from the previous Job Planning round. If any of the objectives have not been achieved then the reasons for this should be discussed. If it is envisaged that there will be a significant change in the Consultant s / SAS doctors Job Plan in the coming year then it is most useful if it is discussed at this point. It may well be that some of the objectives are ones that are carried over from the previous year but it is also the case that to have a completely unchanged set of objectives suggest that these have not been well chosen An essential part of agreeing the objectives will include the resources required to achieve them. Once that has been done, the timetable required to delivery those objectives can be agreed. There should also be consideration of whether any external duties will be undertaken and ensuring that these will have a minimal impact on the delivery of their agreed Job Plan outcomes. Any private practice undertaken by the Consultant/SAS doctor should be detailed in the Job Plan to ensure compliance with the Code of Conduct on private practice Rarely there may be disagreement over some elements of the Job Plan. If this happens then it is always better for both parties to consider whether they can meet half way or an alternative would be to try a trial of a particular Job Plan and schedule a review within a shorter timescale such as 6 months. Whilst there is an agreed process for mediation and appeal in these circumstances, it is always best if the Consultant / SAS doctor and their Clinical Manager can arrive at an agreed Job Plan themselves Finally, the agreement reached at the Job Planning meeting should be put in writing but would not be put into effect until it has been reviewed and signed by all parties. There should be agreement as to when the Job Plan will be reviewed and this is not necessarily only annually. There is considerable merit in some circumstances to having more frequent Job Plan reviews between the Consultant/SAS Doctor and the Clinical Manager. For instance, should a Consultant/SAS doctor take on additional responsibilities or roles April 2015 Page 6 of 15

7 after a job plan has been agreed, then a job plan review would take place to ensure that the job plan accurately reflects the workload. 6. Monitoring Compliance 6.1. It is the responsibility of the Clinical Service Directors to ensure all Job Plans are completed in accordance with this procedure. Compliance with this policy will be monitored by the Senior HR Advisor Medical Workforce through an annual audit of Job Plans 7. Procedure Review 7.1 The procedure will be in place for two years following approval of a review and amendments. An earlier review can take place should exceptional circumstances arise resulting from this procedure; in whole or in part, being insufficient for the purpose and/or if there are legislative changes. 8. Associated Documents All documents associated with job planning are available on the Trust website A Guide to Consultant Job Planning (British Medical Association and NHS Employers) Good Medical Practice Guide (General Medical Council) Maintaining High Professional Standards in the Modern NHS (Department of Health) A Code of Conduct for Private Practice (can be found on the following link: dh_ pdf) 9. Supporting References bma.org.uk the British Medical Association is the trade union and professional association for doctors. nhsemployers.org NHS Employers is part of the NHS Confederation, and provides guidance on workforce issues in the NHS. April 2015 Page 7 of 15

8 Appendix 1 - Job Plan Components Job Plan Timetable The expectation of SHFT is that Consultants / SAS doctors will work a maximum of 10PAs per week. Some Consultants may work up to 11PAs where they are undertaking specific additional roles that require an additional PA to complete them. Examples include ECT Lead role, Child Protection Lead Consultant and Clinical Leadership roles such as Director of Medical Education, Clinical Service Director etc. The expectation is that the 10PAs will be worked over 5 working days. Mutual agreement between the Clinical Manager and the Consultant/SAS Doctor will be required before a consultant will work more than 2PAs per day. This will only be happen if it can be demonstrated that by working in this way, there is a clear benefit to patients. The timetable will be divided into the following categories where these are applicable Direct Clinical Care Supporting Professional Activities Additional NHS Responsibilities External Duties Academic Activities Direct Clinical Care Direct Clinical Care is work that relates to the prevention, diagnosis or treatment of illness that forms part of the services provided by the employing organisation under Section 3(1) or Section 5(1)(b) of the National Health Service Act This includes: Emergency Duty (including emergency work carried out or arising from on call) Outpatient/Community Activities Clinical Diagnostic Work Other Patient Treatment Multi-Disciplinary Meetings about Direct Patient Care (including CPA/Care Planning) Administration directly relating to the above (including but not limited to referrals and notes) Supervision/Consultation with other Clinicians across the whole Care Pathway Supporting Professional Activities These are activities that underpin Direct Clinical Care. SHFT expects that Consultants on 10 PA contracts will have 2.5 SPAs allocated within the job plan. Consultants on part-time contracts will have a reduced number of SPAs. The Academy of Medical Royal Colleges estimates that SPAs per week is the minimum required for a Consultant to meet the needs for CPD for Revalidation purposes. Southern Health has agreed 1.5 PA for CPD for both full and part time Consultants. SAS doctors are entitled to a minimum of 1 PA for SPA. If they have taken on additional responsibilities as listed below additional SPA may be agreed. Therefore the Trust expects that the remaining 1 SPA, for Consultants on 10 PA contracts, should be allocated to specific roles with specific objectives for these roles. A number of roles are suggested that could be included within SPA time and these April 2015 Page 8 of 15

9 are listed below. Where these roles have to be undertaken by Consultants within each service/area, then a meeting prior to Job Planning is a useful way to allocate them fairly. However this is not an exclusive list and other specific roles with identified objectives and accountabilities, in line with service objectives may also be agreed between the Clinical Manager and the Consultant. Lead Educational Supervisor - The Deanery is moving to change the provision and role of Educational Supervisors so that there will be an Educational Supervisor supporting 3-4 Trainees. The expectation would be that the Educational Supervisor would support the Trainees in Core Training for the first 2 years, giving improved continuity. There would be expectations as to training and support provided and they would take part as a facilitator in the MRCPsych course. This would include attending relevant Educational Supervisor meetings. A suggested allocation could be 1 SPA per 3-4 trainees. Appraisers - Appraisers for the new strengthened Appraisal for Revalidation would use 1 of their PAs from the SPA allocation to undertake up to 8 Consultant Appraisals. These would take place over a whole year so a greater spread of Appraisal activity would take place than is currently the case. This would also include attending relevant Appraiser meetings. Complaint, Critical Incident, Case Reviews and Other Investigations Consultants have a valuable contribution to make in bringing their skills and experience to this part of the Clinical Governance work of the Trust. This ensures that services learn and improve as a response to complaints and incidents. Time taken to complete each investigation varies, but in general, Consultants would use one SPA to complete up to 4-6 investigations each year Mentorship, Leadership Development & Coaching Consultants who undertake the role of mentor for Consultants who are new to the role would receive ½ SPA for mentoring up to 3 Consultants and delivering the New Consultant Development Programme. Consultants who have received training in coaching could use up to ½ SPA to undertake coaching activities for up to 3 people per year. Peer Review for Quality Improvement supporting activities to improve quality of our services for patients; this may include a range of different activities, such as Mock CQC inspections. Teaching including regular commitments to Undergraduate Medical Teaching Research regular commitment to undertaking research in line with the Trust Research Strategy Undertaking of other specific work e.g. Policy Development/Review, Clinical Pathway Lead, NICE Lead Representative Roles on Trust Committees e.g. Medicines Management, Chair of LNC, Chair of Trust Consultants Committee As with Direct Clinical Care, all SPAs should be based on SMART objectives and measurable outcomes. There should be clarity on the core content and expectations around activity such as audit, CPD or Revalidation. CPD activities will encompass clinical, personal, professional and academic activities. Additional NHS Responsibilities In addition to Direct Clinical Care and Supporting Professional Activities, Consultants / SAS doctors often undertake extra responsibilities. These are agreed between a Consultant / SAS doctor and SHFT and cannot be absorbed within the time that April 2015 Page 9 of 15

10 would normally be set aside for Supporting Professional Activities. Examples within SHFT include: Medical Director Clinical Director Clinical Service Director Director of Education (including DME) Other Lead Consultant roles including Lead Consultant for Child Protection, Lead Consultant for ECT Research & Outcomes Director NICE lead Safeguarding Lead All of these roles have specific PAs allocated to them which are intended to be used to provide backfill for the Consultant. The additional PAs are not expected to be paid in addition to the Consultants / SAS doctors normal 10 PA contract except where the role only attracts 1 PA. A number of the clinical leadership roles listed above also attract a responsibility allowance payable under Section 16 Paragraph 15 of the Terms and Conditions. External Duties External duties are those duties not included within the definition of fee paying services or private professional services but undertaken as part of the job plan by agreement between the Consultant / SAS doctor and the SHFT. Examples include: Trade Union duties Acting as an external member on Advisory Appointments Committees Reasonable quantities of work for the Royal Colleges in the interests of the wider NHS Reasonable quantities of work for a Government Department Specific work for the General Medical Council Undertaking assessments for the National Clinical Assessment Authority Work for NICE, e.g. fellowship Although SHFT accepts that undertaking external duties such as these brings benefits to the wider NHS, it is important to minimise the impact of them on the delivery of services and the ability of Consultants / SAS doctor to deliver their agreed job plan outcomes. Where a Consultant wishes to take on a substantive role within the Royal College or other national body, such as President, Faculty Chair, Dean etc. This should be agreed with the Clinical Manager before agreeing to take it on. In some cases external bodies reimburse individuals or Trusts for such work. However even where this is the case, before this work can be agreed, SHFT and the Consultant would need to consider the potential effect on workload for the wider team. On Call The Consultant job plan will clearly set out the on call commitment for each Consultant. Under the 2003 contract it is recognised in 3 ways: An availability supplement based on the commitment to the rota. There is no prospective cover allowance here April 2015 Page 10 of 15

11 PA allocation for predictable emergency work arising from on call duties should also be prospectively built into timetables as Direct Clinical Care PAs PA allocation for unpredictable emergency work done whilst on call. This will be assessed retrospectively using diary evidence and included within the allocation of Direct Clinical Care PAs within the job plan. This will be reviewed at each job plan review. The proportion of on call work undertaken by a Consultant will relate to their whole number of PAs in their contract, not just to the number of Direct Clinical Care PAs. Annual Leave In calculating the annual leave entitlement, a week will be considered to constitute whatever is the Consultants/SAS Doctors normal working week. So, for example, a Consultant/SAS Doctor (whether part time or full time) who works a 3 day week, a week s leave entails 3 working days off. Leave cannot apply to a day when no work is scheduled to take place. Annual leave entitlement (days per annum) is based on the assumption that the normal working week is 5 days. Therefore, if the timetabled working week is only 3 days, the annual leave entitlement is based on the pro-rata calculation of 3/5 times annual entitlement equals the annual leave for the entitlement for that individual. Consultants/SAS Doctor should aim to take their leave to impact proportionately on their Direct Clinical Care and SPA (and external duties) activities. Each area covered by a single rota should agree the maximum number of individuals who can be on leave at any one time in order to maintain on call and service cover. It is suggested that discussing annual leave prospectively as a team would ensure openness and fairness in allocating annual leave. Annual leave for clinical academics in SHFT is approved by their substantive university employer, the University of Southampton. However it is necessary for consultation to take place with the Consultant s/sas Doctor s Clinical Manager to ensure that agreed clinical commitments can be met. Private Work The Code of Conduct on private practice established the principle that the provision of services for private patients should not prejudice the interests of NHS patients or disrupt NHS services. Other than in an emergency, NHS commitments should take priority over private work. April 2015 Page 11 of 15

12 The job plan should include details of any private work undertaken by Consultants who work within SHFT. Consultants should identify any regular private commitments and provide information on the planned location, timing and broad type of work done to ease effective planning of NHS work and any out of hours cover. Consultants should be clear about the implications of not delivering their job plan because of the impact of private practice. Other than in the circumstances described in Paragraph 5 of Schedule 8 of the Terms & Conditions, undertaking private work when on call could amount to breach of contract. Category 2 and Fee Paying Services There is a basic principle within the contract that Consultants should not be paid twice for the same work and that any extra contractual work should not conflict with and only cause minimal disruption to NHS duties. However, SHFT have agreed that Consultants can undertake Category 2 and other fee paying work with the Consultant retaining the fee if: The work causes minimal disruption to NHS work The work is undertaken in the Consultant s own time (ie on leave or out of NHS hours or by time shifting where this is appropriate, ie without cancelling or curtailing clinics) The previous agreement as reflected in Annex B of the New Consultants Contract in 2003 suggested that time shifting of a maximum of 20% of contracted work hours was acceptable. This would allow Consultants to add an additional working day to each week. SHFT feels that this could have a detrimental effect on Consultants by extending their working week. Instead, it is agreed that up to 10% of contracted hours could be time shifted. This would allow Consultants to undertake fee paying activities such as Mental Health Act Assessments, DoLS Assessments or reports for which a fee is payable, by extending the working day by the amount of time that is spent on the activity up to a maximum of 10% of working hours in total. It is accepted that this type of work sometimes needs to be done during the normal working hours hence extending the working day to complete NHS work or undertaking the additional NHS work at another agreed time would be acceptable up to a maximum of 10% of working hours. Consultants are often asked to provide reports and/or give evidence in courts/tribunals, which attract a fee in respect of patients who are known to them or live in their catchment area. If a report is required for a patient in the catchment area for which a fee is payable (e.g. court report, fitness to drive) the Consultant can retain the fee and carry this out during the normal week, as long as this is agreed in the job plan review and as long as the time required is not excessive and does not impact on their NHS duties. The previous agreement suggested that a reasonable and proportionate amount of time taken with these activities is up to 5% of the Consultants working hours. To be consistent with the agreed maximum period for time shifting, this should also be 10%. However if the Consultant is requested to act as an expert witness outside of their service catchment area, this would need to be undertaken entirely in their own time, without any time shifting. April 2015 Page 12 of 15

13 The previous agreement on fee paying activity stated that for Mental Health Act Assessments carried out during Programmed Activities, the Consultant is not entitled to retain the fee except if the assessment was carried out in a police station. In view of the fact that Mental Health Services have undergone a significant change in their design and function over recent years, including the provision of Section 136 Suites across Hampshire, allowing consultants to retain the fee in these circumstances is no longer necessary. Therefore, consultants will not be entitled to claim fees for any MHA Assessments that are carried out in working hours. However, if carrying out a Mental Health Act Assessment during working hours requires the Consultant to extend their working hours to accommodate regular NHS work, then the provisions detailed above will apply up to a maximum of 10% of the working hours. For example, if a consultant begins a MHA Assessment at 4pm and this continues until 6pm, then the consultant is entitled to claim a fee. But, they will be required to work an additional one hour of NHS time, at some other time of the week. If a Consultant carries out more than 10 fee paying activities for which time shifting is used, such as MHA Assessment and/or reports in a 3 month period, then this should trigger a job plan review. This is to ensure that this work is not causing more than minimal disruption to their NHS work. It is the responsibility of the Consultant to make their Clinical Manager aware that this has happened. Payments for lectures and teaching would follow the same principles as outlined above. Consultants should make clear that these activities are being undertaken during working hours during their job plan review and the fees may be retained as long as the working day is extended or NHS work is undertaken at another agreed time up to a maximum of 10% of the Consultants working hours. Private Practice and Fee Paid Work by Clinical Academics In some cases fee paid work undertaken by clinical academics forms part of their work for the university with the fees remitted back to the university. The Consultant does not, therefore benefit directly from this work. April 2015 Page 13 of 15

14 Appendix 2 - Equality Impact Assessment The Equality Analysis is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by the Equality Act Stage 1: Screening Date of assessment: 14 January 2014 Name of person completing the Lorna Mills assessment: Job title: Responsible department: Human Resources Intended equality outcomes: Set out clear job planning principles for the Trust; Promote a transparent, open and fair process job planning process across the organisation; SAS doctors provide experienced, specialist care, often within a multi-disciplinary team. This includes management of complex cases and spending time and effort reflecting on and reviewing patient care activities so that quality and safety improve continuously. Who was involved in the consultation of this document? Local Negotiating Committee Please describe the positive and any potential negative impact of the policy on service users or staff. In the case of negative impact, please indicate any measures planned to mitigate against this by completing stage 2. Supporting Information can be found be following the link: Protected Characteristic Age Disability Gender reassignment Marriage & civil partnership Positive impact Southern Health provides an interpreting service and will respond to providing information in alternative formats upon request. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. Southern Health is associated with the Positive about Disability Symbol (two ticks) and will respond positively to requests for reasonable adjustments. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are Negative impact April 2015 Page 14 of 15

15 Pregnancy & maternity Race Religion Sex Sexual orientation person and patient centred. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. Southern Health provides an interpreting service and will respond to providing information in alternative formats upon request This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. This policy aims to embed a process that is open, fair and transparent so that we provide high quality safe services that are person and patient centred. Stage 2: Full impact assessment What is the impact? Mitigating actions Monitoring of actions April 2015 Page 15 of 15

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