Planning for Progress

1
Specialty Doctor and Associate Specialist (2008)

• Planning for Progress
• A General Introduction to the New Contracts

2
Specialty Doctor and Associate Specialist (2008)

• Part 1
• The contracts

3
Choice and Opportunity

• This new contract continues the progress started
  by Choice and Opportunity.
• It is designed to support the establishment of
  career grade opportunities that provide
  attractive career options and that will support
  doctors in their professional development.
• This will reward trained doctors who are
  committed to developing knowledge and skills in
  the role, while providing consistent and high
  quality services for patients.

4
Background to the New Contract

• Last group to have their contract reviewed
• Driven by Choice and Opportunity of July 2003
• Negotiations started in May 2005
• Proposals to 4 Health Departments in late 2006
• Approval by PSPC in December 2007
• Implementation from April 2008 (England)

5
In Short

• New grade of Specialty Doctor
• Open to all NCCG doctors except Associate
  Specialists
• Improved pay progression linked to job planning
  and appraisal
• Provision for support of professional activities
• Associate Specialist grade to close by April 2009

6
Out

• The Associate Specialist (old grade)
• Staff Grade
• Hospital Practitioner
• Clinical Assistant (part time medical officer and
  part time general dental practitioner)
• These grades are closed to new applicants with
  effect from 31 March 2008
• (The SCMO and CMO grades are already closed)

7
In

• Specialty Doctor Grade
• - replaces all NCCG grades for new posts from
  2008
• Associate Specialist (2008 terms)
• - No new posts to be created doctors in post
  can apply to be re-graded until March 31 2009

8
Key Points and Benefits

• Basic full time now 40 hours (10 PAs) for all
• Minimum of 1 PA for Supporting Professional
  Activities
• Contracts based on job planning, and annual
  appraisal
• Individual objectives better aligned with
  organisational priorities for patient care
• Portfolio development to support progression
• Better links to training

9
Benefits for Patients, Trusts and Doctors

• The new contract will enable trusts to provide or
  redesign services to more easily meet patients
  needs.
• Strengthened job planning makes it possible to
  ensure that the work of individual doctors is
  fully aligned to the objectives of the
  organisation to ensure improvements for patients.
• Job planning and appraisal facilitates the
  production of personal development portfolios to
  facilitate access to training and to support
  Article 14 applications.

10
Benefits for Patients, Trusts and Doctors

• Better alignment with the new consultant contract
  gives employers the opportunity to integrate
  doctors more within multi-disciplinary teams and
  bring Specialty Doctors and Associate Specialists
  into line with reward systems operating for other
  senior doctors.
• We believe this consistency will facilitate
  service delivery and lead to improved morale and
  motivation among these grades.

11
Key Differences from Consultant Contract

• No external appeals mechanism
• Two explicit thresholds in pay scales
• On-call availability supplement has only one
  determining parameter

12
Pay
Specialty Doctor range 35,904 to
66,954 - typical pay increase 9 - 12
Associate Specialist range 50,339 to
82,863 - typical pay increase (for 40 hr wk) 6
- 13 Plus - Extra pay increment on
assimilation (in 2 stages) - Additional pay for
on-call and out-of-hours
13
On call - availability supplement

• An availability supplement is paid to doctors who
  participate in on call rotas
• based on frequency of rota commitment
• between 2 and 6 of basic salary
• more frequent than or equal to 1 in 4 6
• less frequent than 1 in 4 or equal to 1 in 8 4
• less frequent than 1 in 8 2

14
Out of hours work

• This is work outside 7am to 7pm Monday to Friday
  and any time at weekends or on public holidays
• This entitles doctors to either
• - 3 hrs of scheduled work 1 PA, or
• - 4 hours of scheduled work paid at time and a
  third
• (For Associate Specialists only, non-emergency
  work at these times only by agreement)

15
Pay progression

• The scale is made up of 11 pay points (0 to 10)
• There will be annual progression up to point 4 of
  the scale.
• To move from point 4 to point 5, doctors will
  need to pass through Threshold 1.
• Movement between points 5 and 7 at 2-yearly
  intervals
• To move from point 7 to point 8, doctors will
  need to pass through Threshold 2
• Progression between points 8 and 10 at 3-yearly
  intervals

16
Threshold 1

• To move through Threshold 1, the doctor must
  have
• participated in job planning
• met their Job Plan and participated in the
  annual review
• met their personal objectives in the Job Plan
• addressed changes identified in the last Job
  Plan review
• participated in the appraisal process
• undertaken 360 degree appraisal/feedback and
• met specific requirements if undertaking
  private practice.

17
Threshold 2

• To move through Threshold 2, the doctor must, in
  addition to meeting the Threshold 1 criteria
• be able to demonstrate an increasing ability to
  take decisions and carry responsibility without
  direct supervision and
• provide evidence to demonstrate their
  contributions to a wider role, for example,
  meaningful participation in or contribution to
  relevant
• - management or leadership
• - service development, modernisation and audit
• - teaching, training and innovation
• - committee and representative work

18
Fee paying services

• (Previously known as Category 2 work)
• Can be undertaken in NHS time and/or in NHS
  facilities by agreement with the employer, who
  may charge for facilities.
• In general, as in the consultants contract,
• In NHS time as part of the job plan - fee to NHS
• In NHS time if minimal disruption to NHS -
  negotiable
• In own time - keep fee
• - but see TCS.

19
Assimilation - general

• Typically, Staff Grade doctors
• will assimilate to the point in the Specialty
  Doctor transition scale next above the value of
  their pay point at 31 March 2008.
• Typically, Associate Specialists
• will have their basic pay as of 31 March 2008
  re-based to 40 hours, and move to the point in
  the Associate Specialist transition scale next
  above the value of that re-based salary.

20
Assimilation some detail points

• Doctors on points 0 to 3 of the old AS scale will
  move to the minimum of the new AS scale.
• Optional and Discretionary Points
• Doctors in either Staff or Associate Specialist
  grades who received Optional or Discretionary
  Points on 1 April 2008 may choose to assimilate
  from a date later than 1 April so as not to lose
  the benefit of the additional point.
• OPs and DPs do not form a part of the new
  contract, however doctors who do not assimilate
  and remain on the old contract will be entitled
  to consideration for such awards as in the past.

21
Assimilation from Staff Grade
22
Assimilation from Staff Grade
Staff grade doctor assimilating below Threshold
1 Staff grade incremental point 2 38,544
Current incremental date 1 August 1 April
2008 move to point 2 on the specialty doctor
scale receive half the assimilation increment
40,755 1 August 2008 (incremental date) move to
point 3 on the specialty doctor pay scale
43,145 1 April 2009 receive the second half of
the assimilation increment. Pay increases to
45,104 (2008/09 Rates)
23
Assimilation from Staff Grade
Staff grade assimilating between Thresholds 1
2 Staff grade incremental point 5
46,935 Current incremental date 1 October 1
April 2008 move to point 5 on the specialty
doctor scale receive half the assimilation
increment 49,095 1 October 2008 (incremental
date) do not move up the incremental scale 1
April 2009 receive the second half of the
assimilation increment. Pay increases to
51,256 1 October 2009 move up to point 6 of the
specialty doctor pay scale 54,395 (2008/09
Rates)
24
Assimilation from Staff Grade
Staff grade doctor assimilating above Threshold
2 Staff grade optional point 9 57,028 Current
incremental date 1 May 1 April 2008 move to
point 9 on the specialty doctor scale receive
half the assimilation increment 60,677 1 May
2008 (incremental date) do not move up the
incremental scale 1 April 2009 receive the
second half of the assimilation increment. Pay
increases to 63,814 1 May 2010 move up to point
10 of the specialty doctor pay scale
66,954 (2008/09 rates)
25
Full-time Senior Clinical Medical Officer
Full-time Senior Clinical Medical Officer
assimilation Full-Time Senior Clinical Medical
Officer point 4 55,991 Current incremental
date 1 May 1 April 2008 salary rebased to 40
hours (40 x 55,991 / 37) 60,531 1 April 2008
move to the next highest pay point on the
specialty doctor scale Point 9 60,677 1 May
2008 (incremental date) do not move up the
incremental scale 1 April 2009 receive half of
the assimilation increment. Pay increases to
63,814 1 May 2010 move up to point 10 of the
specialty doctor pay scale 66,954 (2008/09
rates)
26
Assimilation Associate Specialist
27
Assimilation from Associate Specialist
Associate Specialist assimilating between
Thresholds 1 and 2 Associate specialist
discretionary point 8 67,690 Current
incremental date 1 June 1 April 2008 salary
rebased to 40 hours 70,327 1 April 2008 move
to point 6 on the associate specialist (2008) pay
scale receive half the assimilation increment
71,580 1 June 2008 (incremental date) do not
move up the incremental scale 1 April 2009
receive the second half of the assimilation
increment. Pay increases to 72,833 1 June 2009
move up to point 7 of the associate specialist
(2008) pay scale 75,340 (2008/09 rates)
28
Assimilation from Associate Specialist
Associate Specialist awarded a discretionary
point from 1 April 2008 Associate specialist
discretionary point 8 67,690 Current
incremental date 1 June 1 April 2008 awarded a
discretionary point 70,103 2 April 2008
salary rebased to 40 hours 72,834 Move to point
7 on the associate specialist (2008) pay scale
receive half the assimilation increment
74,087 1 June 2008 (incremental date) do not
move up the incremental scale 1 April 2009
receive the second half of the assimilation
increment. Pay increases to 75,340 1 June 2009
the doctor will need to meet the criteria given
in the TCS to pass through Threshold 2 (2008/09
rates)
29
Assimilation flowchart
30
Employing and supporting specialty doctors

• All Specialty Doctors should be
• employed in the spirit of the national contract
• legitimate participants within their profession
• supported in taking on management, leadership,
  training and research roles
• seen as an integral part of the clinical team

31
Employing and supporting specialty doctors

• Additionally, they should have
• systems to record and audit their clinical
  activity
• a senior clinical lead to oversee clinical
  workload and support professional development
  planning
• access to a minimum of one SPA per week (for
  full-time doctors) to support professional
  activities
• fair and reasonable access to study leave with
  appropriate funding according to terms of
  service and
• pastoral support for specific Specialty Doctor
  issues.

32
Support from NHS Employers

• Maintenance of contract and terms and conditions
• Promulgation of Pay Circulars
• Website provision of associated guidance
• E-mail based enquiry service
• Continuing dialogue with BMA and other
• stakeholders

33
Key Documents

• Contract of Employment
• Contracts for APAs
• Terms and Conditions of Service
• Model expression of interest model offer
  letters
• Job Planning - Standards of Best Practice for
  Associate Specialists and Specialty Doctors
• Job planning checklists
• Questions and Answers
• Employing and supporting specialty doctors - a
  guide to good practice
• Available at www.nhsemployers.org/sas

34
Implementation stages

• BMA Ballot result 17 March 2008
• Contracts available from 1 April 2008
• Trusts offer contracts to eligible staff
• Doctors confirm interest within 12 weeks
• Prospective job plans agreed and accepted
• Doctors move to new terms, pay backdated to
• 1 April 2008 or a later specified date.

35
Action for employers

• Develop and apply implementation plan
• Engage in organisation-wide job planning
• Write to eligible doctors offering the contract
• ensure all relevant staff briefed
• build in service objectives and strategies
• check additional support for medical managers

36
The focus on job planning

• The new contract, through putting job planning
  and annual appraisal at its core, provides
  employers with an improved ability to manage
  doctors time in ways that best meet local
  service needs and priorities.
• This, combined with greater clarity over
  objectives, will provide more effective systems
  for engaging doctors in joint action to improve
  performance and modernise patient care.

37
Job planning - overview

• Mandatory annual process, partnership approach
• Supported by and informed by, but separate from,
  appraisal and revalidation
• Focuses activity on aims and objectives of local
  health community and the organisation
• Encompasses all elements of a doctors work
• Identifies support needed to fulfil role
• Medical managers role is crucial

38
Assimilation job planning

• For those doctors assimilating to this contract
  it is expected that they will prepare an initial
  draft job plan based on their current timetable
  of activities.
• For all new posts it is expected that the
  employer will prepare the initial job plan.

39
Potential barriers to effective job planning

• Competing priorities
• Culture and attitudes
• Time - for job planning
• - to get the day job done
• Lack of robust information
• Capacity and planning expertise of medical
  managers
• Trust between the doctor and their manager
• Lack of administrative support

40
Whats in a job plan

• The doctors main duties and responsibilities
• Schedule of commitments
• Identification of necessary support
• Personal objectives (in line with wider service
  objectives)
• Good objectives will be clear and achievable,
  and the individual doctors contribution
  measurable.

41
Job planning - working week

• The new contract creates transparency
• 10 Programmed Activities (PAs) full time, e.g.
• 9 PAs for Direct Clinical Care and other duties
• 1 PA (minimum) for supporting professional
  activities
• Flexibility can be effected through annualised
  agreements

42
Out of hours work

• This is work outside 7am to 7pm Monday to Friday
  and any time at weekends or on public holidays
• This entitles doctors to either
• - 3 hrs of scheduled work 1 PA, or
• - 4 hours of scheduled work paid at time and a
  third.
• (For Associate Specialists only, non-emergency
  work at these times only by agreement)

43
Additional programmed activities

• Full-time doctors will contract in the first
  place for a basic contract of 10 PAs
• They can in addition contract separately for
  additional PAs up to the WTD maximum (12 PAs per
  week, more if the doctor signs a waiver to WTD
  limits, but this cannot be required of them)
• Arrangements for doctors wishing to undertaking
  private practice are similar to those for
  consultants.

44
Job planning - types of work

• Direct Clinical Care, such as
• emergency duties (including on-call)
• operating sessions inc. pre- and post-operative
  care
• ward rounds and outpatient activities
• clinical diagnostic work
• public health duties
• multi-disciplinary meetings about direct
  patient care
• patient related administration linked to
  clinical work

45
Job planning - types of work

• Supporting Professional Activities, such as
• audit
• continuing professional development
• local clinical governance activities
• training and formal teaching
• appraisal
• job planning
• research.

46
Job planning types of work

• Additional NHS Responsibilities
• Special responsibilities in the organisation not
  undertaken by the generality of doctors which
  cannot be absorbed in the time set aside for SPAs
• e.g.
• clinical manager,
• clinical audit lead,
• clinical governance lead

47
Job planning types of work

• External duties
• Duties not included in the definitions of DCC,
  SPA and Additional NHS Responsibilities, and not
  fee paying work or private practice
• Agreed in job planning discussions
• E.g. trade union duties, work for the Royal
  Colleges or Government Departments in the
  interests of the wider NHS

48
On call work

• Predictable emergency work e.g. post-take ward
  rounds should be scheduled into working week as
  part of PAs.
• Weekly level of PAs within annual total can be
  varied.
• If the work is less predictable then it may be
  managed and assessed through a diary exercise and
  on call rota.

49
How to prepare

• In forming the job plan, the doctors manager
  will need to be aware of
• Directorate targets
• Any clinical audit/governance issues
• Necessary changes to service delivery or
  capacity
• Available resources
• Wider trust issues that might affect the plan

50
How to prepare

• The doctor could helpfully provide
• Any previous job plan, or
• A list of existing clinical responsibilities
• Any previously agreed additional duties
• Proposals for SPA activity
• Details of proposed external activities
• Details of private practice
• Any clinical audit/governance issues
• Their PDP, and ideas for improving the service

51
Appeals on job plans and pay progression

• Three member panel
• a chair, being a Non-Executive Director of the
  appellants employing organisation
• a second panel member nominated by the
  appellant doctor, preferably from within the same
  grade and
• an Executive Director from the appellants
  employing organisation.
• No legal representative, but the doctor may be
  aided by a friend or advisor.
• The decision will be binding on both sides.

52
Job planning timetable
From 1 April 08 Employers write to doctors
seeking expressions of interest in taking up the
new contract Doctors have 12 weeks to register
formal interest, to receive back pay April 08
onwards Employers and interested doctors meet to
discuss job planning There is a general
expectation that the job planning process should
take no more than 3 months from an expression of
interest.
53
Back pay
Once a job plan has been agreed and accepted, the
doctor will transfer to the new terms. The new
contract is deemed to have been implemented from
1 April 2008 (or a later agreed date) and back
pay is payable for the agreed work done between
that date and the date of transfer, under the
terms of the new contract.
54
Back pay
To be eligible to receive back pay, a doctor must
express a formal interest in moving to the new
contract within 12 weeks of the employer making
an offer in writing, and must accept the offered
job plan and salary package within 21 days of its
offer, or must formally appeal.
55
Roles and responsibilities

• Trusts
• aim to agree job plans within 3 months
• set and agree objectives
• assess need for additional PAs
• service redesign and modernisation
• Specialty Doctors / Associate Specialists
• Use best endeavours to agree job plan in 3 months
• agree service and personal objectives

56
Action for employers - reminder

• Develop and apply implementation plan
• Engage in organisation-wide job planning
• Write to eligible doctors offering the contract
• ensure all relevant staff briefed
• build in service objectives and strategies
• check additional support for medical managers