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

2. 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

3. 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

4. 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

5. 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

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

7. Job Planning Timetable

8. 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)

9. 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.

10. 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.

11. 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.

12. 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

13. 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

14. Objective Setting (1)
Objectives
Hard
Soft
Personal development
Team

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

16. 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

17. 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)

18. 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)

19. 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

20. 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

21. 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

22. 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.

23. On-Call

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

25. 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.

26. 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

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. 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’

34. Any Remaining Questions/Discussion