Job planning in the new NHSCCSC / 27 November 2006 Job planning in the new NHS Dr Mark Porter FRCA Consultant anaesthetist, University Hospital Coventry

Job planning in the new NHS CCSC / 27 November 2006

Job planning in the new NHS

Dr Mark Porter FRCA

Consultant anaesthetist, University Hospital Coventry

Deputy chairman, BMA consultants committee


Aims

By the end of the seminar, we should understand:

• How to job plan• Key skills for realising benefits• Data for job plans• Understanding and using objectives in job plans

• The context - a changing NHS, a changing environment


Changed TrainingChanged Training

Payment by

results

Practice based

commisioning

Patient ChoicePatient Choice

Market forcesMarket forces

ISTCscompetitioncompetition

Contestability

New SAS

contractNew SAS

contract


Where do we go now?• New contract• New Context

• New NHS?– Multi-provider environment– Portfolio careers


2003 contract

• Professional• Time limited• Increased

clarity• Balances

objectives and supporting resources

‘Something for Something’

• ‘Productivity’• ‘Benefits realisation’• Adapt the resource

to the need


A forty-minute seminar…

• Can’t cover everything

• Much advice in the public domain• Most of it is good advice


Sources of advice - BMA• The British Medical

Association published advice in September 2004

• Available for download at www.bma.org.uk/

• Follow Consultants 2003 consultant contract Job planning

• Sample job plans are available

• Also read the ‘Consultant Handbook May 2005’


Sources of advice - CCIT

• The NHS published advice in January 2005

• Available for download at www.wise.nhs.uk/

• Follow Workforce themes Retaining and

developing staff Pay and Reward Implementing the

consultant contract Concise guide for

consultants


Opportunity

• Need to engage and take trusts in the right direction

• New skills needed– Negotiating skills– Data

• Key role of job planning– More than just a timetable


The job plan (Schedule 3 TCS, Standards of Best Practice)

• An agreement with clinical manager (? Role for non-clinical manager)

– Description of duties– Time-table– Agreed objectives– Agreed resources

• Annual process– Interim review– Continuous process of

evolution and development

• Also part of the old contract


Job plan – job content

• Job content – where and when– Direct clinical care

• Including predictable and unpredictable emergency work

• Including patient-related administration

– Supporting professional activities– Additional NHS responsibilities– External duties– Travel time

• Accountability for contracted time


Job plan: objectives and resources

• Availability supplement– rota and category

• Objectives and how they will be met– Personal objectives (appraisal)– Service objectives

• Supporting resources– Everything you need

• Additional NHS responsibilities• External duties


Job plan – other agreements

• Other comments and agreements– Category 2– Flexibility of location

• Additional programmed activities and private practice

• A dotted line


Programmed ActivitiesDirect clinical careWork relating to prevention, Dx or Rx• Emergency work (including on-call)• Operating, ward rounds, clinics,

treatment sessions, MDM, public health, etc

• Admin. related to the above

Supporting PAsWork underpinning Clinical Care. • Training, education, teaching• CPD, Audit & Research• Job planning / Appraisal• Service Management• Local clinical governance

Typically 7.5 : 2.5 balance

(you should not accept less without careful consideration)

also

Additional NHS responsibilities

Lead clinicianCollege tutoretc

External Duties

Royal College / Spec. SocHMG / Trades Union etc


Clinical academic job plan

• Applies to honorary consultant contract holders

• On call – same rules apply as to NHS consultants

• University component is based on work diary and needs of the job

• Can contract for additional PAs as NHS or University depending on the needs of the job



• NHS PAs ratio of direct to supporting professional activities of 3:1

• External duties will be important because of wider work for the NHS

• NHS-based teaching and research activity should be recognised in the NHS SPA component

• Flexible over a year e.g. term time teaching


Two models of job planning• Organisation has no

coherent plan for service delivery

• Consultants make up their own job plans

• Focus entirely on schedule of fixed commitments

Missed opportunities

• Organisation focused tightly on service delivery

• Job Plans written by service managers

• Objectives subordinated to targets


• “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”


Medical manager’s approach

• Should be fair to consultants

• Should respect the protections of the contracts

• Should endeavour to deliver the needs of the service, with the available resources

• Should not let consultants get away with everything and anything

• Should not allow ‘ignorant’ managers to set the pace


Job planning and appraisal cycle

Agreement of personal objectives

Job plan review

meeting

Appraisal meeting

Business planning and

service development

Agreement of service objectives (team or

individual)

Annual pay progression

Local Delivery

Plan


Before job planning

• Appraisal meeting– Personal development plan– Personal objectives

• Understand & define what is expected of you– Balance of activities– What your contract requires

of you– What your profession requires

of you• CPD, Audit, Appraisal,

revalidation

• What you are prepared and able to do

• Determine what resources you need– Time– Finances– Equipment– Managerial– Personnel

• Know and build in what you family and personal time require of you


Preparation for meetingcollect, reflect and share

• What has affected the job plan?

• Progress against the

agreed objectives?

• Any changes to duties

and responsibilities

needed?

• PP commitments

• Data• SPA Activities• Internal and external

commitments

• Next year’s objectives?

• Support needed from

the organisation?



Process:• Integrated joint NHS and University job plan

review meeting• Any party may propose amendment• Joint report will be submitted to the Dean of the

Medical School for pay progression copied to yourself and the Trust/s CEO

• Mediation and appeals processes are available


Data in job planning

• What you do– Diary exercise

– Hospital activity data

• What you & team do– activity data

– Peer review

• Demand and capacity

• Workforce & support issues

• Governance data (complaints, litigation, incident reports, etc.)


Getting started

• Consider issues such as:– Review corporate

objectives– Review Local Delivery

Plan– Identify service

development priorities– ‘Payment by results’

Clinical director Consultant

• Consider issues such as– Identify service

development priorities– Identify PDP priorities– Identify resource issues

• “something for something” approach


Process for clinical academics

• Any work agreed should be joint between NHS and University

• There should be adequate resources to support these agreements

• Academic targets ie for the RAE are not part of job planning-this is a time based agreement. These issues are more appropriately dealt with in appraisal but they can inform the process particularly if more time or resources are required.


Simple negotiating tactics

What are your goals?• Your bottom line

– Be clear– Realistic– Bold– Honest with yourself

Who are the players?– Where are they coming

from?– What must they achieve?– What could they give– What can’t they give

Cyclical process– Meet again next year– Big wins now - later losses– Rome not built in a day

Strategy– Win-win– Partnership approach


Team Approach

• Many advantages– Team– Individuals– Organisation

• Need “buy-in”

– Combined calculation of

scheduled commitments

– Accounting for cover for

annual leave– Decide how to share:

teaching, audit etc

– Team approach may

identify needs for extra

staff

– Cover for on-call


The job plan review meeting

• Participants– Consultant(s)– Medical Manager– (non-medical manager)

• Purpose and capacity?

• Scope– Structure of meeting

• Resources– Data etc

• Review progress against objectives

• Agree new objectives• Agree prospective work

program• Pay progression sign-off


Objectives

• What are they?– The “action points” for the coming year– Mutually agreed and resourced

• What are they for?– Quality and Improvement– Opportunity to lead change

• Who are they for?– All consultants– Part of the contract– Linked to pay progression


Where & How do Objectives fit in?

Agreement of personal objectives

Job plan review

meeting

Appraisal meeting

Business planning and

service development

Agreement of service objectives (team or

individual)

Annual pay progression


Objective setting discussion

Clinical governance and quality

issues

Team objectives

Additional responsibilities

e.g. teaching, research

Service requirementsInclude corporate

objectives, LDP, local service developments

Personal development

planFrom appraisal

Agreed support

requirements

Agreed objectives

Including agreed and supported PDP

Agreed process for review of objectives


• Specific• Measurable

• Quantified or descriptive

• Achievable and Agreed• Relevant and Resourced• Timed and trackedSMART

Objectives should be…


Examples of objectives

• Hard objectives– 4 hour wait, 17 week OPD– Choose & Book– Workload Management– Clinical Records CNST– Absence management

• Recording of leave etc

• Soft objectives– Greater involvement of

patients– Consider benchmarking– Improve communication

skills

• SPA outcomes– Complete an audit project

• Team objectives– Specify individual consultant’s

role– Plans for service development

• Performance standards– Successful cancer peer

review

• Personal development objectives– Acquire a new skill


Recording objectives

• Objective• Actions to achieve

objective• Success criteria and

measures• Agreed review

process and timetable• Support required

(including removal of organisational barriers)


Mediation and appeals

• If you fail to agree• Nationally agreed timescales• Mediation largely ‘successful’

– Medical director mediates CD : Consultant

• Small number of appeals to date– Non-exec chair– Consultant nominee– Independent member


Summary

• Prepare– and survive

• Opportunity – to drive and to lead change– take control!

• New healthcare environment– embrace, use and change


Clinical excellence awards

• A waiting list initiative is for Christmas, but a clinical excellence award is for life.

• One CEA from age 40 to age 80 is worth £92,625.

• Preparation starts on day 1.• Just like a tax return, only more lucrative.• ACCEA

– http://tinyurl.com/kz5a3


Any questions or points?


Documentation links

• Consultant job planning diary www.consultantscommittee.info

• Department of Health tinyurl.com/kyoml

• NHS Employers tinyurl.com/g7u8r

• NHS Modernisation Agency, ‘Effective job planning’ tinyurl.com/cazft

• BMA guide to consultant job planning tinyurl.com/potue

• Advisory Committee on Clinical Excellence Awards tinyurl.com/kz5a3

Documents

Job planning in the new NHSCCSC / 27 November 2006 Job planning in the new NHS Dr Mark Porter FRCA Consultant anaesthetist, University Hospital Coventry