Barnet and Chase Farm Hospitals NHS Trust Job Planning for Consultants and SAS Doctors

Objectives To gain a shared understanding of the Consultant Job Planning process and in particular:- The role of the consultant Steps in the process Who is involved Key elements of a good Job Plan

Context Medical staff are professional members of staff, highly trained and committed to patient care Economic environment Consultants have greatest control over Trust activity, productivity and commit most resources Nationally agreed process

What is a Job Plan? “A consultant job plan should be a prospective agreement that sets out a consultant’s duties, responsibilities and objectives for the coming year.” “...consultant job plans should set out agreed personal objectives and their relationship with the employing organisation’s wider service objectives.” Job planning: standards of best practice, Department of Health, April 2003

Underpinning Principles The process should be: undertaken in a spirit of collaboration and cooperation reflective of the professionalism of being a doctor focused on measurable outcomes that benefit patients consistent with the objectives of the NHS, the organisation, teams and individuals clear about the supporting resources the Trust will provide to ensure that objectives can be met transparent, fair and honest flexible and responsive to changing service needs during each job plan year fully agreed and not imposed focused on enhancing outcomes for patients whilst maintaining service efficiency

Who is involved in Job Planning? Consultants Clinical Leads Clinical Directors Medical Director General Managers With support from HR

Job Planning Timetable

Steps in Job Planning Clinical Director/Clinical Lead with General Manager, form a clear view of service requirements and the activity required for the forthcoming year; Agree tariffs and matrices; Calculate the average amount of DCC work undertaken as a result of on-call activities – this will be a 1st call on DCC time Calculate the remaining DCC time (take care to take account of time not worked due to annual leave, bank holidays etc) and consider a 42 week year Consider what SPA time is required by the organisation (above the base level of 1 SPA) and agreed what outcomes will be expected from this allocation of time Agree the final job plan in conjunction with others in the same specialty (team based approach)

In the Job Planning discussion Review organisational objectives Local service development strategies National service development strategies Service pressures due to rising or decreasing demand Service pressures due to more challenging targets being set Consultant shortages Workload of existing consultant body Before starting the job planning process, clinical and general managers need to think what are the most significant pressures faced by the specialty, in which the consultant or team works. List given not necessarily comprehensive, although most likely pressures covered.

In the Job Planning discussion (2) Identify the issues Relative priority of each Can I affect through job planning? Am I dependent upon the efforts of others? Are there underlying factors I need to consider? List of pressures may be long, so need to prioritise, make sure job planning can influence and consider the potential impact of other people and factors.

In the Job Planning discussion (3) Questions to ask Are consultants working in a way that is the best way for this particular issue or service? Does the work that is currently being undertaken by consultants need to be done at all? Does all of the work that is currently being undertaken by consultants need to be done by a consultant or could some of it just as effectively be undertaken by another individual/professional? The clinical manager needs to ask him/herself six questions, 3 on this slide, 3 on next slide.

In the Job Planning discussion (4) Questions to ask 2 Does the organisation give the consultants the support they need to help them work effectively? Are there models of service provision tried elsewhere that make more effective use of consultants’ time? Have any of the consultants or other members of the clinical team suggested ways in which they could be helped to work more effectively? See previous slide

In the Job Planning discussion (5) Taking Action Prioritise the issues that have arisen Decide how job planning helps meet the objective/address the issue Identify the support the organisation needs to provide Action plan long timescales acceptable and may be essential Then job plan Action their reading prior to starting the job planning process

Objective Setting (1) Objectives Hard Soft Personal development Team

Objective Setting (2) Agreeing SMART Objectives Specific Measurable Achievable and Agreed Relevant Timed

Objective Setting (3) Tracking and Reviewing progress allows:- Problems to be tackled when small Identification of any learning or development needs Feedback Spontaneous coaching opportunities

Split between DCC and SPAs Full time = 10 PAs of 4hrs each (3hrs in premium time – 7pm to 7am, Monday to Friday and all weekend cover) Each consultant will have 1 baseline SPA; the final number of SPAs allocated will depend on other roles and responsibilites and up to 2.5 SPAs (although only one is guaranteed)

DCC Direct clinical activities such as OP clinics and operating sessions etc., Includes:- Pre and post-operative assessments Ward rounds Patient correspondence Emergency work MDTs (only for core members of MDTs)

SPAs Must be evidenced and quantified Should be timetabled wherever possible Not a right or entitlement (exc. 1 baseline SPA) Should be undertaken on Trust premises (exc. 1 baseline SPA) Subject to annual review Include Governance, Audit and Research

Tariffs Allocated for specific roles – e.g. Clinical lead or Clinical Director Used to gain consistency and understanding about productivity: Admin time for clinics Number of new and follow ups Time for ward rounds

Buddying The Trust operates a ‘buddying’ system to ensure that the most clinically and financially important areas of work are covered during annual and study leave To ensure robust cover for a 5 day week this requires early discussion and co-ordinated booking of leave Directorates to publicise the maximum number of consultants permitted to be absent without impacting on service delivery

Dealing with Disagreements Where there is failure to agree between an individual Consultant and the Clinical Lead and manager there are two further stages.   1. The consultant should refer the matter to the Clinical Director and general manager for further discussion. This must be done within 2 weeks of failing to agree. Should this further review fail to resolve the issue the Trust will consider a further process involving the Medical Director or move straight to a formal appeal which will involve a senior medical leader not already involved in the case (e.g. CD or MD), a senior manager (e.g. COO) and an independent member (e.g. NED). The appeal decision will be final.

On-Call

Private Practice Regular, scheduled, private work should be shown in the Job Plan

Travel For Consultants on the new contract travel time can be allowed for traveling to and from emergencies, travel between sites but not between home and the main base unless they are undertaking an official journey in the course of the day. The main base is considered to be Barnet and Chase Farm Hospitals. Excess travel time can be claimed for travelling to one of the peripheral sites. i.e. a consultants whose normal journey to Barnet hospital is 20 minutes but travel to Potters Bar is 40 minutes may claim 20 minutes excess travel. The same principle may apply to those based at the peripheral site who have to travel to Barnet or Chase Farm hospital.

Annualised and Team Job Planning Supports consultants to work productively as a team Services delivered by a team of consultants Commissioned activity determines demand to be mapped to consultant team’s capacity DCC PAs indexed to units of activity Job plans will set annualised activity assumptions for consultants

Annualised and Team Job Planning Review of work undertaken at 6 months and 12 months Activity and KPIs require measurement and reporting See Trust guidance on team job planning

Benefits of Team Job Planning Priorities are not agreed in silos Team working towards one ‘shared’ picture Transparency in the Department

Benefits of Annualised Job Planning Equity Improved patient care – better distribution of time/ service input to demand Financial – e.g. no empty theatres Ensures adequate cover across the year

Consultants on the ‘Old’ Contract Job planning is a mandatory contractual requirement for those remaining on the ‘old’ contract 7 NHDs should be allocated to ‘DCCs’ i.e. most commonly 1 for on-call and 6 for DCC-type work (fixed NHDs) Admin time is not classed as fixed session unlike the new contract

Having ‘Difficult’ Conversations May be necessary during the job planning process Before addressing the issues, be clear about:- What the issues are What outcomes you are looking for Where appropriate, what changed behaviour is required Ensure a proper environment for the conversation – i.e.:- Confidential No interruptions

Having ‘Difficult’ Conversations (2) Start with a positive tone Lay out the issues, with objective evidence Specify outcomes required Seek the views of the individual concerned and incorporate these where possible and appropriate Agree a way forward and process of review

Further Help Help and advice is available from the Medical Staffing Projects Manager and HR Department Trust Job Planning guidance Trust FAQs BMA/NHS Employers publication ‘A guide to Consultant Job Planning’

Any Remaining Questions/Discussion