1. SCTS Consultant Job Planning Regional Representative Meeting RCSEng: 10 th Nov 2010 Graham Venn Chairman of Job Planning Cardiothoracic Surgery

2. Consultant Job Plans Current Process Provisional job plan prepared by source Trust Trust send to College for Approval College send to Regional College Representative for approval – now ‘new’ RSPA Following approval back to source Trust who then constitute the AAC

3. Secondary Approval Three Specialities currently have a secondary centralised approval process – usually the Society President. Cardiothoracic, Neurosurgery, Transplantation SCTS present process serendipitous London RSA at the time Bruce Keogh’s proxy – increasingly busy Large number of JDs reviewed – problems apparent.

4. Problems Problems with the primary JD structure Problems with the primary JD approval Problems with the secondary approval process Problems constituting the AAC

5. Problems with JD Process Produced by junior member of HR or business staff with little experience. Few have clinician input. (Only two correct in last 65 reviewed) Old, pre 2003, contract format; half days – sessions etc No times of work specified – am or pm only On-call forgotten Travel to and from outlying hospitals forgotten Simple maths errors the norm, unable to summate PAs Remarkably little medical involvement at any time Usually try to cram 12PA job into 10PAs School-leaver level errors in most JDs

6. Problems with Primary approval Sent to Regional College Representative (RSPA) for approval Variable input and understanding from the regional reps. No homogeneity of advice. (Not surprising-Regional Reps have no training in this) Lack of consistency increases confusion back at host Trust Different rules for each job, specialty and College

7. Problems with Secondary Approval President usually too busy for detailed review Introduces further variable and unhelpful delay JD usually nodded through

8. Problems with AAC Back to Trust following central approval Trust approach College for AAC representative with tentative date for interview College struggle to find AAC rep who is free and from correct (sub)discipline Trust finally constitute appointment committee following identification of AAC representative

9. Overview Cumbersome and time consuming Inconsistent Same job countrywide- variable job descriptions Same job trustwide – variable structure and pay Difficult for a new and vulnerable Consultant to change an inappropriate job plan at inception of new post

10. SCTS Pilot SCTS form JD subcommittee Small cohort of individuals to review all new JDs Combine regional and secondary process Homogenous advice using pre-agreed BMA type JD format (usually very well received) Quick turnaround

11. Provide Consistent Template A modified BMA template serves well

12. Daily Work Plan DayTimeLocationWorkCategory No. of DCC PAs No. of SPA PAs Wednesday0800 to 1200 City Hospital OPD (Inc review, clinic and letters) DCC1.00 embedded teaching 1200 to 1400 County Hospital (alternate weeks + travel) Aortic Surgery MDM DCC0.25 1400 to 1700 City Hospital Ward Round DCC0.75 embedded teaching Thursday0800 to 1800 City Hospital OperatingDCC2.5

13. Weekend Work DayTimeLocationWorkCategory No. of DCC PAs No. of SPA PAs Saturday0900 to 1200 City Hospital (1 in 4) On Call Ward Round (includes travel) DCC0.25 1200 to 1500 City Hospital (alternate weeks) Waiting List Initiative DCC0.5 Sunday Predictable On Call Work (Saturday) 1200 to 1800 (1 in 4) City Hospital Post Take Surgery + WRs 0.5

14. Annualised Activity? WorkLocationWeekly Hours CategoryWeekly DCC PAs Weekly SPA PAs Teaching Students City Hospital 2SPA0.5 AuditCity Hospital 2SPA0.5 Service Lead City Hospital 4SPA1.0 Post G Super City Hospital 2SPA0.5 CPD and Research City Hospital 2SPA0.5 Patient Admin Variable6DCC1.5 Total1.53.0

15. SPA Activity Training: CS, AES etc.S1 CPDS2 TeachingS3 Postgraduate Undergraduate External Audit and Clinical GovernanceS4 Job Planning / AppraisalS5 Research (negotiable with Trust)S6 Clinical Management - Service Lead etcS7

16. On Call Allocation Availability CategoryImmediate ‘A’ – 8% Delayed ‘B’ – 5% 8% On Call Rota1 in 4 Unpredictable On Call Work 4 hours1 PA

17. Clear Summary Programmed ActivitiesNumber Direct Care Optional and Funded 7.5 2.0 Supporting Activities2.5 Total PAs12.0 (9.5 + 2.5)

18. Fundamental Steps Engage in constructive dialogue Provide useful and consistent proforma (BMA) Ensure that Clinical Director has signed off JD Liaise with Clinical Lead, not HR / Business staff Use annualised activity for irregular activity, particularly for SPAs Be consistent - small core group Be efficient, quick turnaround, facilitate AAC

19. Results of changes Large volume of JDs reviewed-too many for one individual All but two of last 60+ JDs substantially altered. Support offered to Trusts. BMA format JD offered to all. Increase of one to three PAs per job agreed; usually in 10 plus 1, 2 or 3PAs voluntary funded extra sessions (10 – 30% increase in remuneration)

20. How are we doing? Highly successful - but lots of work Virtually every job changed and improved Usually better remuneration Up to 3 PAs – Optional funded PAs Greater clarity and transparency and consistency Useful service for job plan reviews - staff Supporting the Surgeon in the Workplace

21. Next Steps - Provide concise advice to RSPAs and DPAs Provide advice to specialty membership Advice Document Coordinate advice nationally – small core group – be consistent

22. Summary Not Rocket Science! Current process needs to be more professional and consistent Consistency of New JDs protects new appointees – Very positive service to the membership Surprisingly well received by (most) Trusts due to inexperience of HR staff / business managers