1. Job planning in the new NHS
Dr Mark Porter FRCA
Consultant anaesthetist, University Hospital Coventry
Deputy chairman, BMA consultants committee

2. 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

3. 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

4. Where do we go now? New contract New Context New NHS?
Multi-provider environment
Portfolio careers

5. 2003 contract Professional Time limited Increased clarity
Balances objectives and supporting resources
‘Something for Something’
• ‘Productivity’
• ‘Benefits realisation’
• Adapt the resource to the need

6. A forty-minute seminar…
Can’t cover everything
Much advice in the public domain
Most of it is good advice

7. Sources of advice - BMA
The British Medical Association published advice in September 2004
Available for download at
Follow
Consultants
2003 consultant contract
Job planning
Sample job plans are available
Also read the ‘Consultant Handbook May 2005’

8. Sources of advice - CCIT
The NHS published advice in January 2005
Available for download at
Follow
Workforce themes
Retaining and developing staff
Pay and Reward
Implementing the consultant contract
Concise guide for consultants

9. 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

10. 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

11. 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

12. 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

13. Job plan – other agreements
Other comments and agreements
Category 2
Flexibility of location
Additional programmed activities and private practice
A dotted line

14. 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

15. 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

16. 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

17. 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

18. “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”

19. 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

20. 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)

21. 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

22. 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.

23. 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

24. 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.

25. 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

26. 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.

27. 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

28. 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

29. 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

30. 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

31. 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)

32. 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

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

34. 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

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

36. 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

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

38. 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

39. Any questions or points?

40. Documentation links
Consultant job planning diary
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