2. Purpose of Presentation
Why are we changing how we employ doctors and dentists in training?
What are the lead employer arrangements?
Who are the lead employers?
How is this being implemented?
What is the impact?
How can I find out more?

3. Mandate from NHSS Chief Executives
In October 2015 the NHSS Chief Executives received a report from Scottish Association of Medical Directors / HR Directors on NHS Scotland Medical Workforce and the decision to fast track action to enhance the employment and training experience for DDiT was taken with the undernoted key objectives:
Provide DDiT with optimum continuity of employment and positive employment experience across NHSS.
Ensure consistent application of employment policies for DDiT across NHSS.
Minimise duplication or unnecessary processes in “on-boarding” throughout rotations for clinical placements.
Promote continuity and consistency in Payroll arrangements.
Ensure access to appropriate and high quality training experiences.
Effective information sharing and engagement between NHS Boards and NES in the management of performance and training of DDiT.
A Core Steering Group was established to progress fast tracking of action in support of the Chief Executive’s decision.

4. Main Aims of Lead Employer Model
Simplified, standardised and shared medical staffing recruitment/ employment service/ employee relations practice improving the quality and efficiency of services to managers and other “customers” of Human Resources
Enhances the employment experience of trainees during their employment
Improves governance of medical staffing related services and activities
Enhances local efficiencies and levels of productivity and efficiency
Maximises opportunities which are available through other systems
Improves resilience and sustainability of medical staffing services
Delivers consistency of Policy application - Lead Employer policies will be followed pending development of Once for Scotland policies

5. Employer Board NES Scotland Deanery Placement Board
Single employer for duration of each programme
Regions will agree employer model for regional programmes and host a share of national programmes
All Boards will be placement Boards
NES oversees training and placements - as now
Single contracts, policies and standardised processes
Agreed information sharing
There will be 4 employing Boards across NHS Scotland
NES Scotland Deanery

7. Delivering the model: Employing Boards
What is an employing Board?
A lead employer is the NHS Board that will hold the contract of employment and deliver the payroll function for a trainee for the duration of the programme of training. The trainee may be on placement in a different placement Board but the contract of employment and payroll will remain with the employing Board.
4 employing Boards:
NHS Grampian
NHS Greater Glasgow and Clyde
NHS Lothian
NHS Education for Scotland

8. NHS Grampian
Employing Board for all foundation, core and specialty trainees (excluding GPSTs):
In the North Region of Scotland, this encompasses NHS Highland, NHS Orkney, NHS Shetland, NHS Western Isles, NHS Tayside and NHS Grampian.
Also for doctors in training on the following national programmes:
Child and Adolescent Psychiatry
Old Age Psychiatry
Intellectual Disability Psychiatry
Medical Psychotherapy
Medical Ophthalmology
Also for those on the following East/ North regional programmes: 
Urology
ENT
East Medical Microbiology.

9. NHS Greater Glasgow and Clyde
Employing Board for all foundation, core and specialty trainees (excluding GPSTs):
In the West Region of Scotland, this encompasses NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Lanarkshire, National Waiting Times Centre and NHS Greater Glasgow and Clyde.
 Also for doctors in training on the following national programmes 
Clinical Neurophysiology (All Scotland)
Paediatric and Perinatal Pathology
Paediatric Cardiology
Neurosurgery – National
Neurology
Paediatric Surgery
Oral and Maxillo-facial Surgery
Palliative Medicine – West
Chemical, Infectious Diseases
Medical Virology
Clinical Oncology
Medical Oncology
Broad Based Training

10. NHS Lothian
Employing Board for all foundation, core and specialty trainees (excluding GPSTs):
In the East Region of Scotland, this encompasses NHS Borders, NHS Fife and NHS Lothian.
Also for doctors on training on the following national programmes:
Diagnostic Neuropathology
Plastic Surgery
Forensic Histopathology
Clinical Pharmacology and Therapeutics
Community and Sexual and Reproductive Health
Cardio-thoracic Surgery
Genito-urinary Medicine
Vascular Surgery
Rehabilitation Medicine
Forensic Psychiatry
Clinical Genetics
On the following East/ North regional programme:
Core Surgical Training

11. NHS Education for Scotland
Employing Board for all trainees on:
General Practice Specialty Training programmes
This includes all trainees on placements in General Practices and in hospital placements in NHS Highland, NHS Orkney, NHS Shetland, NHS Western Isles, NHS Tayside, NHS Grampian, NHS Borders, NHS Fife, NHS Lothian, NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Lanarkshire and NHS Greater Glasgow and Clyde.
 Also for doctors in training on the following national programmes:
Public Health
Occupational Medicine

12. Placement Board What is a placement Board?
A placement Board is the Party providing a training placement to the Doctor in Training (who is not their employer). Placement boards will be responsible for the day to day management of the trainees.
The placement Board retains clinical governance responsibility as the trainees are engaged in the provision of clinical care to patients of the placement Board.
NHS Education for Scotland, NHS Highland, NHS Orkney, NHS Shetland, NHS Western Isles, NHS Tayside, NHS Grampian, NHS Borders, NHS Fife, NHS Lothian, NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Lanarkshire, National Waiting Times Centre and NHS Greater Glasgow and Clyde will all be placement Boards.
Some Boards may be both an employing Board and a placement Board.

13. Impact on DDiTs
Current Doctors in Training - current doctors in training will be onboarded for August 2018 by the lead employer for their current programme of training and will remain with that lead employer for the duration of that programme of training. This will mean a reduction in repetitive on and off boarding as current trainees rotate through placements. There will be one contract of employment for the duration of the training programme, with amendments issued for each rotation to a new placement (Placement Detail letters).
Military/ Academic/ Industry employed trainees: as these trainees are not an employee of a NHS Board employment arrangements will not be impacted by the lead employer arrangements.
Out of Programme: if a trainee is out of programme and not currently under a contract of employment, on return to a training programme, the employment contract will be issued under the new arrangements.
Current trainees on long term sickness absence: if a trainee is currently off long term sick or becomes and remains sick at 1st August, they will be advised to contact the current employer to discuss the lead employer arrangements in order to ensure there is no impact on statutory or occupational payments they may be in receipt of, or entitled to and to ensure compliance with current guidance.
Current trainees on maternity leave now/ future: If a trainee is currently on Maternity leave or not currently on Maternity leave but will have commenced leave prior to 1 August 2018 they will be advised to contact the current employer to discuss the lead employer arrangements in order to ensure there is no impact on statutory or occupational payments they may be in receipt of, or entitled to and to ensure compliance with current guidance.
Current and Future Dental trainees– current dentists in training will be transitioned to the lead employer arrangements from August Further detail will be developed on how the lead employer arrangements will apply to dental trainees. Future Trainees will be employed by a lead employer for the duration of each training programme. There will be one contract of employment for the duration of the training programme, with amendments issued for each rotation to a new placement (Placement Detail letters).

14. Benefits and how we can measure them?
Evidence financial efficiency savings (reduced PVG costs, OH, administration)
Evidence improved consistency and information sharing via metrics and employee relations reporting through system.
Once for Scotland On Boarding
Monitor maternity and sickness absence for reduced complexity and therefore less administration time.
Improved monitoring of employee relations issues demonstrated through tracking on system (TURAS).
Reduction in tax code issues - monitor feedback from trainees.
Sharing Information (maternity, absence, performance, payroll)
Monitor recruitment and retention data.
Attraction
Monitor feedback through existing questionnaires (trainee surveys, exit questionnaires, iMatter).
Improved trainee employment experience

15. Turas People An application on the Turas platform
It will support implementation of the lead employer arrangements by providing an interface between existing systems (e.g. Turas TPM, e:ESS) to enable employment and trainee information to be easily shared between lead employers, placement Boards and doctors in training.
Initial functionality will support the completion of pre employment checks from April 2018 for all those moving to the lead employer arrangements from August 2018 and enable them to receive accurate payment in August.
If the trainees do not get paid properly the lead employer model will be considered a failure from the outset.

16. Timeline

17. Further Information North Region: grampian.ddit@nhs.net East region:
Contacts:
Please also see the Hub for more information on the lead employer arrangements. We will continue to update the Hub with additional information.
North Region:
East region:
West Region:
NHS Education for Scotland: