Job planning in the new NHS

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Job planning in the new NHS

• Dr Mark Porter FRCA
• Consultant anaesthetist, University Hospital
  Coventry
• Deputy chairman, BMA consultants committee

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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

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Contestability
Changed Training
Practice based commisioning
Payment by results
Market forces
Our health our care our say
competition
Patient Choice
ISTCs
New SAS contract
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Where do we go now?

• New contract
• New Context
• New NHS?
• Multi-provider environment
• Portfolio careers

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2003 contract

• Professional
• Time limited
• Increased clarity
• Balances objectives and supporting resources

Something for Something Productivity Ben
efits realisation Adapt the resource to the
need
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A forty-minute seminar

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

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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

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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

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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

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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
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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

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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

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Job plan other agreements

• Other comments and agreements
• Category 2
• Flexibility of location
• Additional programmed activities and private
  practice
• A dotted line

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Programmed Activities

• Direct clinical care
• Work 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 PAs
• Work 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
External Duties Royal College / Spec. Soc HMG /
Trades Union etc
Additional NHS responsibilities Lead
clinician College tutor etc
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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

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Clinical academic job plan

• NHS PAs ratio of direct to supporting
  professional activities of 31
• 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

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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

• Organisation focused tightly on service delivery
• Job Plans written by service managers
• Objectives subordinated to targets

Partnership
Missed opportunities
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• a consultant job plan should be a prospective
  agreement that sets out a consultants duties,
  responsibilities and objectives for the coming
  year
• consultant job plans should set out agreed
  personal objectives and their relationship with
  the employing organisations wider service
  objectives

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Medical managers 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
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Job planning and appraisal cycle
Agreement of personal objectives
Appraisal meeting
Local Delivery Plan
Annual pay progression
Job plan review meeting
Business planning and service development
Agreement of service objectives (team or
individual)
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Before job planning

• 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

• 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

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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 years objectives?
• Support needed from the organisation?

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Clinical academic job plan

• 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

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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.)

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Getting started

• Consider issues such as
• Review corporate objectives
• Review Local Delivery Plan
• Identify service development priorities
• Payment by results

• Consider issues such as
• Identify service development priorities
• Identify PDP priorities
• Identify resource issues
• something for something approach

Clinical director
Consultant
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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.

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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 cant they give

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Team Approach

• 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

• Many advantages
• Team
• Individuals
• Organisation
• Need buy-in

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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

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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

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Where How do Objectives fit in?
Agreement of personal objectives
Appraisal meeting
Annual pay progression
Business planning and service development
Job plan review meeting
Agreement of service objectives (team or
individual)
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Additional responsibilities e.g. teaching,
research
Team objectives
Service requirements Include corporate
objectives, LDP, local service developments
Personal development plan From appraisal
Clinical governance and quality issues
Objective setting discussion
Agreed support requirements
Agreed objectives Including agreed and supported
PDP
Agreed process for review of objectives
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Objectives should be

• Specific
• Measurable
• Quantified or descriptive
• Achievable and Agreed
• Relevant and Resourced
• Timed and tracked

SMART
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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 consultants role
• Plans for service development
• Performance standards
• Successful cancer peer review
• Personal development objectives
• Acquire a new skill

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Recording objectives

• Objective
• Actions to achieve objective
• Success criteria and measures
• Agreed review process and timetable
• Support required (including removal of
  organisational barriers)

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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

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Summary

• Prepare
• and survive
• Opportunity
• to drive and to lead change
• take control!
• New healthcare environment
• embrace, use and change

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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

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Any questions or points?
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Documentation links

• Consultant job planning diary www.consultantscommi
  ttee.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