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

Patient Choice Market forces ISTCs Payment by results Contestability Changed Training Practice based commisioning Payment by results Our health our care our say Market forces Patient Choice competition ISTCs New 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 This slide summarises what the job plan is. Discuss DH views on role of non-clinical manager, their training programme and typical attendance breakdown of CCIT roll-out events. “2-way street” of agreement on resources

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 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) This is a reminder of the components – different types of work. External duties remind of supporting statement from DH also Additional NHS responsibilities Lead clinician College tutor etc External Duties Royal College / Spec. Soc HMG / 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

Clinical academic job plan 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 Organisation focused tightly on service delivery Job Plans written by service managers Objectives subordinated to targets Partnership Missed opportunities

“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 Appraisal meeting Local Delivery Plan Annual pay progression Job plan review meeting Business planning and service development Agreement of service objectives (team or individual)

Before job planning Appraisal meeting 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

Preparation for meeting collect, 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? This slides provides a list of the issues that now need including in the actual job plan review meeting ( & job plan review forms) It highlights the increased detail that job plans will contain in the future – in comparison to a timetable which was the format of many previous job plans under the old contract.

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

Data in job planning What you do What you & team 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.) Diary exercise – next slide shows diary card, come back to diaries 1st year of job planning regarded as “non-robust”. Second round to be better informed with data. Good data is hard to come by. Most reliable is data you collect your self. BUT YOU SHOULD NOT HAVE TO. Managers should help. Collect what ever data possible about, e.g. out-patient visits, DNAs, lists, FCEs. Demand – e.g. waiting lists and times, WLIs. Capacity – potential and actual ? Gap between capacity and demand? Staffing/workforce Juniors’ working patterns, WTD, leave DON’T PANIC – Rome not built in day, iterative process, build up over time.

Getting started Clinical director Consultant 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

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 Who are the players? Where are they coming from? What must they achieve? What could they give What can’t they give What are your goals? Your bottom line Be clear Realistic Bold Honest with yourself Defensible extreme as starting position 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 Need “buy-in” Team Individuals 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” Vital to get consultants working together in teams This is the real future way to progress

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? What are they for? Who are they for? 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 Personal objectives will be brought from appraisal. ?Link between appraisal and job planning. ? Same person ? Same meeting

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)

Objective setting discussion Additional responsibilities e.g. teaching, research Team objectives Service requirements Include corporate objectives, LDP, local service developments Clinical governance and quality issues Personal development plan From appraisal Objective setting discussion Agreed process for review of objectives Agreed objectives Including agreed and supported PDP Agreed support requirements

SMART Objectives should be… Specific Measurable Achievable and Agreed Quantified or descriptive Achievable and Agreed Relevant and Resourced Timed and tracked SMART

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 Mediation worked very well on coming onto the contract Expecting ~20% problems, so far 4 appeals All 4 won by the consultants with BMA input

Summary Prepare Opportunity New healthcare environment and survive 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