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Job Planning for a New Consultant

Updated on: 14 Jun 2022   First published on 14 Feb 2022

Introduction

This is a short guide I have written on job planning and development for the BSG’s website. As previous chair of RCP London’s new Consultants committee and the individual responsible for developing and aligning our departmental job plans, I am well placed to do this and have presented on this topic to colleagues before.

For reasons that are not fully clear to me, there is a taboo around discussing job planning and remuneration openly. This is ultimately not helpful and can cause inconsistencies in job planning between colleagues which may lead to ill feeling and moral distress. In this article, I talk about the key principles of job planning for a new Consultant Gastroenterologist, and also give advice on the benefits of negotiating job plans as a team.

Key definitions for job planning

The key definition from the British Medical Association and NHS employers online document on job planning states: “A job plan can be described in simple terms as a prospective, professional agreement that sets out the duties, responsibilities, accountabilities, and objectives of the consultant, and the support and resources provided by the employer for the coming year. However, in order to drive measurable and sustainable 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 consultant’s activity. It is vital that it articulates the relationship between the organisation and the consultant, and the desired impact on patient care.” 1

The key principles of job planning are shown below in figure 1. To put it simply, your job plan is a broad outlined timetable that defines your roles and responsibilities. It describes what you do and when; it correlates with what you are paid. It needs to be fair and agreed, and help to define your quality of (work) life.

Figure 1

Composition of a job plan

The building block of a job plan is programmed activities (PA)

  • One PA is defined as 4 hours of activity Monday to Friday 7 am – 7 pm (3.75 hours in Wales)
  • Out of hours (OOH) is premium time during which one PA is 3 hours of activity
  • In addition, there is a supplement payable for OOH on-call commitments
  • There may also be payments for additional NHS responsibilities & external duties

For a normal 4 hour programmed activity (time is divided pro-rata)

  • 4 hours = 1 PA
  • 2 hours = 0.5 PA
  • 1 hour = 0.25 PA
  • 30 minutes = 0.125 PA
  • 15 minutes = 0.0625 PA and smaller – avoid defining tasks using such small intervals

Programmed activity are classified either to deliver direct clinical care (DCC) or time for supporting professional activities (SPA).

Direct clinical care typically encompasses “patient facing” care such as:

  • Ward rounds
  • Out-patient clinics (new patient appointments – 30 minutes, follow up appointments – 20 minutes)
  • Endoscopy lists
  • MDT meetings
  • Patient administration – minimum of 1.5 PA for a WTE Consultant (as a guide; 1 hour per clinic / ward round / endoscopy list / MDT and time for A & G, vetting etc)
  • On-call / emergency work
  • Clinical research (was traditionally labelled SPA, but increasingly recognised as DCC)
  • Travel time to peripheral sites for DCC is also remunerated

Supporting professional activities (SPA)

  • Six hours (1.5 PAs) is mandated for revalidation, this is an absolute minimum even if working less than full time, and other SPA activities are in addition to this
  • Teaching
  • Clinical management roles
  • Continuous professional development (CPD)
  • Educational supervision of trainees (typically 0.25 PAs per trainee, capped at 0.5 PAs)

Job plans may need to be adjusted for special circumstances; such as the COVID-19 pandemic. There is additional guidance available on the BSG website. 2

On call supplements are paid in addition to the allocated PAs for the time spent on-call. It is a percentage of your basic 10 PAs salary. Return to work applies if there is a possibility you may need to attend the hospital (as per GI bleed on-call). Deal by phone means there is zero possibility you need to return to work, exclusively dealing with on-call commitment offsite (theoretically you can be anywhere in the world as long as you are contactable!).

Frequency Return to work Deal by phone
1 in 4 (or worse) 8% 3%
1 in 5 – 1 in 8 5% 2%
1 in 9 (or better) 3% 1%

Balance of a job plan

Job plans should be advertised and planned based on 10 PAs (40 hours) which is pensionable. You cannot be forced to work more than 10 PAs.

Traditionally, job plans have always been balanced to a ratio of 3 DCC to 1 SPA, such that for a typical 10 PA job plan should be constructed as 7.5 PAs DCC and 2.5 PAs SPA. In recent times, trusts have squeezed that ratio to 4 DCC to 1 SPA (i.e. 8 PAs DCC and 2 PAs SPA) or worse (see figure 2 below. However, it is worth remembering that >40% of advertised Consultant vacancies have been unappointed to in recent years, new Consultants are precious and hence able to negotiate to balance job plans appropriately.) Having adequate SPA time is critical for your work quality of life – gives you time during the week and may add some flexibility. SPA time is critical to do all the tasks expected of a Consultant.

Figure 2 – Acceptability of job plan. The minimum SPA time for revalidation is 1.5 PAs. If total job plan in 6 PAs, 1.5 SPA PAs need to be job planned for revalidation.

Value for money

If you opt to take on additional PAs above the minimum 10 (remember, this is a voluntary commitment), it is worth remembering that these are the most efficient for the NHS and are typically 30-40% cheaper than the baseline 10 PAs. These PAs are typically DCC without a pro-rata increase in SPA time. These PAs are usually non-pensionable (some management roles include pensionable payment), and are not factored in when calculating on-call supplements. Trusts frequently cap PAs to 12 in total. Ensure additional PAs are job planned and remunerated, your trust isn’t doing you a favour by paying you for this – you are actually providing value for money.

Team job planning

The ideal scenario is for colleagues within a department doing similar roles to do their job planning together as a team. This was a very positive experience when I and my colleagues did this. This exercise allows teams to do job planning uniformly and remuneration is fair across a department. Aligning job plans gives a collective bargaining power to make it more likely that Consultants are remunerated appropriately for their job plan.

Tips for job planning

  • Insist on using job planning software so that your job plan is online so it makes the rules very clear, keeps everyone honest, and makes sign off straightforward
  • Early review within 3 months of starting a Consultant post (make a point of this)
  • Annual review of job plan (may be useful to coordinate with appraisal)
  • Have a prompt ad hoc review if significant change of circumstances
  • You need adequate SPA time for balance to a job plan and your quality of life
  • Be prepared and know your rights, it is hard to negotiate if disorganised
  • A job-plan diary is helpful – especially if in dispute (available online or own record)
  • Annualised job planning may be useful for flexibility or roles with mixed activities
  • The BMA have resources online, giving advice for job planning, including job planning differences for Scotland and Wales 3

Expectations

As a Consultant, your employing trust is obliged to provide you with office space, a computer, and a secretary. You are also entitled to have an option to work from home (especially in the pandemic era). You must have access to appropriate equipment for your role and responsibilities (for example PPE). Ultimately, you can expect a fair job plan and appraisal process. In return, you must keep your mandatory training requirements up to date, act professionally and honestly, take leave fairly and honestly. It is reasonable for the trust to ask you to be flexible in working to cover emergencies (due to unforeseen absences) though this should be remedied in a timely manner. Ultimately you AND your employer are responsible for your health and wellbeing, so be prepared to inform your trust if you have a change in circumstances and seek help from your trust or others if you have health issues – whether emotional, mental, or physical in nature.


Additional Information

Author Biography

Dr Ajay M VermaDr Ajay M Verma

Ajay is a Consultant Gastroenterologist working in Kettering, Northamptonshire, appointed in 2015. He has specialist interests in IBD, early colorectal cancer, endoscopy (including ERCP), and clinical research – he is the research Director at Kettering General Hospital.

In 2019, Ajay was appointed Gastroenterology specialty lead for CRN East Midlands. He previously had an active role at the Royal College of Physicians London, as chair of the New Consultants Committee, and member of the Medical Specialties Board, Joint Specialty Committee for Gastroenterology and Hepatology, and a member of RCP council. He is also one of Kettering General Hospital’s Chief Clinical Information Officers.

Away from work, Ajay enjoys spending time with family, his wife Vini is an Interventional GI Radiologist, his son Luca is 7, his daughter Bella is 5. He is a sports fanatic – Football, Cricket, Tennis, American Football. He plays badminton to a reasonable standard (his assessment!).

Follow Ajay on twitter @UKGastroDr

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Job Planning for a New Consultant


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