Psychiatric Bulletin (2005) 29: 385-386. doi: 10.1192/pb.29.10.385
© 2005 The Royal College of Psychiatrists
Psychiatric Bulletin (2005) 29: 385-386
© 2005 The Royal College of Psychiatrists
How to make job planning work
M. E. Jan Wise, Consultant Psychiatrist
13-15 Brondesbury Road, London NW2 2AU; e-mail:
jan.wise{at}nhs.net
Declaration of interest
M.E.J.W. is a representative on the British Medical Association’s
Central Consultant’s Committee and is secretary of the Central &
North West London Mental Health NHS Trust Local Negotiating Committee.
See p. 387, this
issue. 
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Introduction
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New contracts were recently accepted across the devolved nations of the UK
as the basis for all future consultant employment in the National Health
Service (NHS). All existing consultants have the choice of transferring to the
Terms and Conditions of Service 2003
(Department of Health, 2003) or
remaining on their existing contract.
The new contract’s basis is that consultants perform ten programmed
activities (PAs) a week, typically each of 4 h duration. The European Working
Time Directive (EWTD) requires employees working more than 48 h a week to
opt-out, in writing, of statutory protection. As PAs performed in premium time
(19.00-07.00 h) are of 3 h duration, an EWTD-adherent job plan can comprise
more than 12 PAs without requiring the use of the opt-out.
The job plan is an agreement between the employer and employee over what
activities will take place, for how long and where, and agreement is made
annually. Guidance exists as to how many PAs should be allocated to different
types of work and these are defined in the terms and conditions: direct
clinical care, supporting professional activities, additional
responsibilities, other duties and external duties. The terms and conditions
specify that typically consultants should have 2.5 supporting professional
activities, and up to 7.5 direct clinical case activities.
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Effective job planning
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To job plan successfully, consultants will need to keep a diary of all
their activities (NHS Modernisation Agency,
2003). Ideally, this should be compiled over a period long enough
to be representative. Thus, where bimonthly clinics occur then 2 months is
required; if every week were the same, then 1 week would be sufficient. Where
there are irregular obligations, such as College work, interview panels or
other duties, it is possible to annualise them, and then break them down into
weekly fractions of a programmed activity. For example, 3 days as an examiner
for one of the Colleges should be recorded as the number of PAs spent
examining, including the travel time, premium work and related administration.
Thus, ten PAs, or more, might be involved per year.
Of the 52 weeks in the year, 10 weeks are lost to annual/study leave and
public holidays. For the job plan, these ten PAs occur over a 42-week period,
equal to 0.24 (10/42) of a PA per week, and similar arithmetic can be applied
to all responsibilities. Unfortunately, the failure of employers to adequately
recognise the time involved in College activities, for example, is commonplace
(Chaudhray, 2004; Walker,
2004).
In some trusts, directorate-wide agreements on aspects of job planning have
been reached. Examples include agreements that supporting professional
activities may be conducted off-site or flexibly (e.g. continuing professional
development performed at weekends or in the evening, or that direct clinical
care may be cancelled to lecture at local courses). Producing College
guidelines can be persuasive; the Senate of Surgery (personal communication)
has written to the Director, Human Resources, Department of Health, that all
on-call surgeons must be available to return to work immediately (band A),
because of the needs of trainees and
patients.
When a disagreement is about other duties, consultants could point out that
the Director of Human Resources for the NHS Executive stated in his letter (EL
(95)93): ‘I would like to encourage employers, as part of their
obligations as part of the NHS, to release consultants for a range of duties
such as advising the DoH, participating in college duties or examining. These
are examples of work necessary for the broader benefit of the NHS but which
involve consultants being away from their employment base’. The
Modernisation Agency’s Consultant Contract Implementation Team made the
same points (NHS Modernisation Agency,
2004a).
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Difficulties in reaching mutual understanding
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Some trusts are reluctant to implement the job plan supplied. Management
may identify inappropriate work patterns or activities; however PAs in excess
of ten may legitimately be necessary for a wider service. Where an impasse is
reached and both parties cannot agree on which PAs can and should be removed
from the job plan, such as a clinic, emergency cover, etc., a request for
mediation can be made. This should be made in writing to the medical director,
with an explanation of what the areas of disagreement are and why the proposed
job plan is unreasonable. If the medical director had been directly involved
in the decision not to implement the proposed job plan then it would be
inappropriate for them to mediate. Where practitioners have access to an
employment advisor or union representative their advice and support is best
sought at an early stage.
Mediation can be valuable; examples include clarification of a mismatch
between non-clinical managerial expectations and those of clinical directors;
clarity over time commitments expected of the consultant or flexibility in
clinical work that had not been previously agreed between the parties.
If agreement cannot be reached at mediation there remains formal appeal
(NHS Modernisation Agency,
2004b). The appeals process involves a chairperson nominated by
the employer, not previously involved in the dispute, a representative
nominated by the consultant and a third member from a list agreed between the
Strategic Health Authority and the British Medical Association. This panel
will consider written and oral evidence and make a written recommendation to
the employing organisation. Where there is significant disagreement within a
directorate about job planning the prospect of multiple appeals could be
daunting to management.
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Conclusion
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Job planning is a time-consuming and intensive experience, but proper
preparation and commitment to delivering quality care can produce a better
understanding of the time involved for both trusts and consultants. This
becomes the foundation for a mutually acceptable solution. Persistence in
explaining the necessary commitments can produce results that profit all
parties.
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References
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CHAUDHARY, A. K. (2004) Examiners for the new OSCEs.
Psychiatric Bulletin,
28, 67.[Free Full Text]
DEPARTMENT OF HEALTH (2003) Terms and
Conditions of Service 2003. An Agreement between the BMA’s Central
Consultants and Specialist Committee and The Department of Health for
Consultants in England. London: Department of Health.
NHS MODERNISATION AGENCY (2003) Preparation for Job Planning -
Record of Workload and Commitments
(http://www.modern.nhs.uk/consultants/16263/diary.doc).
NHS MODERNISATION AGENCY (2004a) CCIT Update, issue 14, 30
January
(http://www.wise.nhs.uk/sites/workforce/retaininganddevelopingstaff/Consultant%20Contract%20Document%20Library/1/CCIT%20Update/CCIT%20Update%2014.pdf).
NHS MODERNISATION AGENCY (2004b) Appeals in Consultant Job
Planning and Pay Progression Disputes. Model Protocol
(http://www.modern.nhs.uk/consultants/appeals.PDF).
WALKER, N. (2004) Not only examiners!
Psychiatric Bulletin,
28, 228.[Free Full Text]
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PB 2005 29: 387.
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Introduction
Effective job planning