Job planning in the new NHS

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. Contestability Changed Training Practice based commisioning Payment by results Market forces Our health our care our say competition Patient Choice 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 www.bma.org.uk/ • 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 www.wise.nhs.uk/ • 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

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. Direct clinical care Work relating to prevention, Dx or Rx Emergency work (includingon-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 Programmed Activities Typically 7.5 : 2.5 balance (you should not accept less without careful consideration) also External Duties Royal College / Spec. Soc HMG / Trades Union etc Additional NHS responsibilities Lead clinician College tutor 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 focused tightly on service delivery • Job Plans written by service managers • Objectives subordinated to targets • Organisation has no coherent plan for service delivery • Consultants make up their own job plans • Focus entirely on schedule of fixed commitments 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 personalobjectives 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. 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 What you are prepared and able to do Determine what resources you need Time Finances Equipment Managerial Personnel Know and build in what you familyandpersonal time require of you Before job planning

22. 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? Preparation for meetingcollect, reflect and share

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 • 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.)

25. 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 Getting started 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. What are your goals? Your bottom line Be clear Realistic Bold Honest with yourself • Cyclical process • Meet again next year • Big wins now - later losses • Rome not built in a day Strategy • Win-win • Partnership approach 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

28. Many advantages Team Individuals Organisation Need “buy-in” 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 Team Approach

29. 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 The job plan review meeting

30. Objectives • What are they? • 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

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. Additional responsibilities e.g. teaching, research Team objectives Service requirements Include corporate objectives, LDP, local service developments Personal development plan From appraisal Clinical governance and quality issues Objective setting discussion Agreed process for review of objectives Agreed objectives Including agreed and supported PDP Agreed support requirements

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

34. 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 Examples of objectives

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

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

37. Summary • Prepare • and survive • Opportunity • 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 • http://tinyurl.com/kz5a3

39. Any questions or points?

40. Documentation links • Consultant job planning diary www.consultantscommittee.info • 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