1. Access to less than full time working – improvements and concerns Jayn Ammantoola Chair, National Association of Medical Personnel Specialists Medical Personnel Specialist Flexis – pros ‘n’ cons…….. …Differences

2. What’s Different?  What happens now…  Dr Flexible arrives on the first day with no papers……. OR  Dr Flexible comes the Trust after having contacted the Flexible Dean, and has all the signatures and papers, working through a check list.

3. Check List ActionDate Done Dr contacts the Flexible Training Office at the Deanery to discuss eligibility Flexible form is posted to the doctor Dr discusses placement with the programme Director (SpR) and Supervising Consultant, Draw up training programme and work plan Dr gets Royal College educational approval, STC / University approval (SpR) Doctors’ Hours Team looks at the provisional timetable / pattern and calculates band The Trust may ask for further local signatures – Directorate Finance / HR Director / IWL Manager. Recruitment documents are attached to show that the recruitment was in open competition (SHO) Form is sent to the Flexible Training Office A signed copy of the form is sent back to the Dr. A copy is given to Medical Staffing for the file, Dr starts work at the Trust, signs onto payroll After 6 weeks, Dr is monitored to check the provisional band Repeat this check list – either 3 months before the next Trust, or 3 months before the year is up

4. The junior doctor…  Must collect the signatures – applications should not take longer than 3 months to process.  They will need to find out who organises the rota patterns – HR / Medical Staffing / Directorate;  - and get the papers to them in advance.  Consultant needs to talk to Dr.  Timely return to work after maternity leave…….and 6 monthly rolling rotations. …

5. The clinical tutor  …”education and service elements…..each component …allocated” ..”funded at the level contracted for educational purposes”  How to designate this?  work with the doctor to organise the timetable.

6. Sorting out the rota….  …”identifying total hours of work, which will include out of hours….”  The agreement will include an assessment of intensity banding.  So, how to do this?

7. What do the full timers do….  7 doctors doing a 1 in 7 non resident on call  Band 2B  Hybrid - Full shift and on call WeekMonTuesWedThursFriSatSun 109.00- 09.00 09.00- 14.00 09.00- 17.00 2 09.00- 09.00 09.00- 17.00 3 09.00- 09.00 09.00- 17.00 4 09.00- 09.00 09.00- 17.00 5 09.00- 09.00 609.00- 17.00 09.00- 09.00 709.00- 17.00 Average weekly hours of duty New Deal63.14Target 72.00 Average weekly hours of work New Deal50.10Target 56.00 Average total rest weekday on call11.00 Average total rest weekends on call12.00 Prospective cover included?Yes Average weekly hours EWTD48.22Target 58.00

8. Just 3 steps….  Step 1 – look at the full time pay and how much of that the flexible is doing  Step 2 – work out the supplement  Step 3 do all the sums Pay!

9. The banding flowchart http://www.nhsemployers.org/PayAndConditions/doctors_in_training_including_gp_registrars.asp

10. What do part timers do….  Part time  only does the nights when they have done the days  Band FB Average weekly hours of duty New Deal41.46Target 72.00 Average weekly hours of work New Deal32.17Target 56.00 Average total rest weekday on call11.00 Average total rest weekends on call12.00 Prospective cover included?Yes Average weekly hours EWTD30.56Target 58.00 WeekMonTuesWedThursFriSatSun 109.00- 09.00 09.00- 14.00 09.00- 17.00 2 09.00- 09.00 09.00- 17.00 3 09.00- 09.00 409.00- 17.00 5 6 09.00- 09.00 709.00- 17.00

11. Future….  Part time  does 70% of all the nights, no matter whether on for that day or not  Band FA 1 weekend in 5 Average weekly hours of duty New Deal42.37Target 72.00 Average weekly hours of work New Deal33.28Target 56.00 Average total rest weekday on call11.00 Average total rest weekends on call12.00 Prospective cover included?Yes Average weekly hours EWTD32.12Target 58.00 WeekMonTuesWedThursFriSatSun 109.00-09.0009.00-14.0009.00-17.00 2 09.00- 09.0009.00-17.00 3 09.00-09.00 409.00-17.00 09.00-09.00 509.00-17.00 09.00-09.00 609.00-17.00 09.00-09.00 709.00-17.00 8 9 1009.00-17.00

12. On full shifts -  The full time doctors average 50 hours  Part time 3 ½ days  does 70% of all the nights  Band FA 1 weekend in 4 WeekMonTuesWedThursFriSatSun 18-18 221-10 38-18 8-21 48-188-218-18 5 8-21 68-18 21-10 7 88-18 Average weekly hours of work New Deal & EWTD35 Night shift of 13 hours Day shift of 10 hours long day 13 hours Prospective cover included?Yes 70% of 50 full time hours = 35 is F8 F8 is 80% of FBP 1 in 4 full shift is a Band FA (O.5) Supplement is 50% x Basic Basic = 0.8 x FBP Supplement = 0.5 x Basic Pay 0.8 x 0.5 x FBP = 0.40 x FBP Pay = (0.8 + 0.4) x FBP = 1.2 x FBP

13. Monitoring  Currently, monitoring against the theoretical pattern for 7 doctors (1 in 7) with 2 flexis on slot share, checking 6 full timers, and the slot shares individually*.  Supernumerary – monitor against their individual pattern.  When to monitor – just after they start, one off monitoring…and again every 6 months…..  With 20% of workforce envisaged as flexible, additional analysis of monitoring ?  Software packages / PDAs etc to help  The normal monitoring mutual obligation applies.

14. Slot shares Slot shares –.  Dr Slot works 3 days per week  M, T, W. 30 hours, FB  1 in 14 weekends  Dr Share works for 3½ days a week  T,W,Th,F. 36½ hours, FB  1 in 14 weekends… W ee k MonTuesWedThFSatSun 109.00- 09.00 09.00- 14.00 09.00- 17.00 2 09.00- 09.00 09.00- 17.00 3 09.00- 09.00 409.00- 17.00 5 6 09.00- 09.00 709.00- 17.00 MTuesWedThFSatSun 109.00- 14.00 09.00- 17.00 9-13 209.00- 09.00 09.00- 17.00 9-13 309.00- 17.00 09.00- 09.00 09.00- 17.00 9-13 409.00- 17.00 09.00- 09.00 9-13 509.00- 17.00 09.00- 09.00 609.00- 17.00 9-1309.00- 09.00 709.00- 17.00 9-13 60% of 50 hours full time = 30 hours = F7 so Basic pay is 0.7 x FBP Supplement for ON call = 1 in 14 with cover = FB, so that is 40% of F7, Which is 0.4 x 0.7 = 0.28 Pay = (0.7+0.28) x FBP = 0.98 x FBP 70% of 50 hours = 35 hours = F8, so basic is 0.8 x FBP Supplement is 40% of F8 Which is 0.4 x 0.8 = 0.32 Pay = (0.8 + 0.32) x FBP = 1.12 x FBP

15. Pay protection, etc  So, what happens to the trainees who are collecting signatures now?  The initial banding, worked out before starting, is the level of pay protection for those starting after the new pay start date.  Current trainees stay at their current band if it is higher, until the end of the post or placement ….is this CCST? …or just until next year?

16. Final questions  Is it a good thing to rely on supernumerary trainees for rota compliance?  Access to flexible training is resource limited..  Numbers of flexible trainees will double in the next 3-5 years…aim to increase the numbers over 5 years to 20% of trainees within all educational contracts… a trust with 50 / 100 / 300 junior doctors….(10, 20, 60)  Last – does payroll know?