Nov 2003 Jayn Ammantoola Flexible Training, Finances, and the fresh approaches of Improving Working Lives Flexible Training, Finances, and the fresh approaches of Improving Working Lives Jayn Ammantoola Medical Personnel Specialist Barts and the London NHS Trust

Nov 2003 Jayn Ammantoola Flexible Training – what is it? All specialties, including General Practice All grades Either: in a supernumary post, (2½-4 days per week) or: a substantive post with reduced sessions (4-4½ days per week) or: job share / slot share Started in 1960’s, when a doctor shortage meant that women doctors (who previously took 15 years out of medicine to raise a family) were encouraged to stay in work, and job share. Circular PM(79)3 Equal calibre to full time trainees Not a soft option, takes twice as long, and on less pay.

Nov 2003 Jayn Ammantoola Flexible Training – why? The papers The European Union Council Directive 93/16/EEC of 5 April 1993 says that member states may permit part time training when continuing full time would be impracticable for well founded individual reasons. Improving Working Lives – HSC 2000/036 and the “Improving Working Lives Standard”. IWL relaunched Nov 2001 and April 2002 at DoH conferences. Flexible Careers Scheme for hospital doctors launched in Doctors retainer scheme (from the 1990’s) had fallen into disuse, now revamped and administered by NHS Professionals. Untapped demand – research from 1995 and onwards has shown that on any one date, 18% of doctors are not working for the NHS. 15% of those said they could be tempted back if conditions were different; particularly the hours of work. 48% of those who were not working only wanted part time work. The majority would consider job sharing.

Nov 2003 Jayn Ammantoola Flexible Training – How it’s done… months before – Consult widely Through recruitment – in open competition Transfer from full time to part time and back again at SpR grade Educational MADEL approved Approval (Deanery Training (Royal College) Funding) post

Nov 2003 Jayn Ammantoola Finances - where the money comes from – (previous) Education Levies SIFT MADEL NMET Excess costs of Teaching Medical students in clinical setting Basic salaries of trainees 100% for HOs, and SpRs 50% for SHOs Basic for flexis Public Health, Education, Study Leave, Dean’s costs Nurse education & other clinical professions Trusts

Nov 2003 Jayn Ammantoola Finance today “ A Health Service for all the Talents” A major review of workforce planning – Consistent, co-ordinated, covering the whole workforce, and all sectors DH-HRD DH-DHSC Higher Education Institutions – nursing, allied health professions, other training Trusts / PCTs: medical training, clinical placements for professional training Strategic Health Authority WDC Deanery PGME PGDE

Nov 2003 Jayn Ammantoola Finance – grab the money quickly Check the MADEL figures – in the month of April - ask your Finance Director, or the Postgraduate people check the figures that are on the 6 monthly Ministerial report for junior doctors hours. the New Deal funding – added to the baseline Clinical Fellow -> GPVTS posts – appointed by the Deanery …..If an appointment is made, expect the money streams to change SpR ceiling numbers – extra NTNs allocated by the Lead Dean? Track the funding. Summer 2003 – DoH asking the SHAs / WDCs – are the Trusts prepared for WTR? * Be aware of trousering…..

Nov 2003 Jayn Ammantoola Flexible Training – Academic Principles: The same constraints and structure as full time academic training Appointment, progress monitoring and outcomes comparable to full time training Training programmes set up in response to an individuals needs. Satisfy the academic eligibility criteria

Nov 2003 Jayn Ammantoola Flexible Training – and pay banding The thinking behind the Pay Banding Circular – AL(MD)1/01 - to pay flexible trainees who are working over a 40 hour week on the basis that 40 hours is a full time wage, and they are working full time. Para 12 – 40 hours of actual work per week or more………..treated exactly the same as a full time………”full base salary” Para 18 – no longer paid a simple pro rata equivalent of their full time colleagues……..the supplement will be paid in full………. Para 19 – non compliant flexis shall receive full pay….no pro rata reductions…… The BMA Junior doctors committee who negotiated this deal had a flexible trainee as their chief negotiator. Pensions – were based on the proportion of WTE the flexis were contracted to. After December 2000, flexis will be pensioned on any pay they receive up to 40 hours, whether it is basic or overtime (ADHs)

Nov 2003 Jayn Ammantoola Flexible Training – worries / solutions What was wrong? Trust budgets shot to pieces Inequity between full time & part time Guilt, coercion, Trust refuseniks Oxford top slice Solution? Wales – funding for all component parts England –12 March 2002 – funding for 1.00WTE (compliants only) Scotland – status quo – funding for basic 6/10 contract only

Nov 2003 Jayn Ammantoola Funding Flexible Training – choices 2003 – a crisis in funding / flexibles (amount of money / numbers wanting flexible A choice of: flexi supernumary post A flexi in a 1.00WTE funded post…..(who will do the remaining 4 sessions?) Slot share (job share) - When the doctors in the job share need to specialise in Year 4,5 of training, the job share may collapse due to different sub specialisations. - Check College recognitions for job shares (the Royal College of GPs rulings for flexis: 2 doctors each doing 0.60WTE need 40 months hospital / 20 months GP registrar training).

Nov 2003 Jayn Ammantoola Future – Improving Working Lives After flexible junior training – flexible Consultants / job share Consultants? The flexible budget is finite, demand is increasing. 22 Nov 2001 – introduction of Improving Working Lives for Doctors. –Recognition of the R & R problems; –Current shortage of doctors (hours reduction / wastage / early retirement) –Coming Working Time Directive –Work life balance Family friendly policies

Nov 2003 Jayn Ammantoola Family friendly working… where are we now? Flexible traning – some Deaneries have frozen the funding, others are allowing only certain categories of applicant NHS Professionals Flexible Careers Scheme – funded by NHS Professionals, working under 50%, not recognised for training. Childcare schemes

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