SCTS Consultant Job Planning

Regional Representative Meeting

RCSEng: 10th Nov 2010 Graham Venn

Chairman of Job Planning Cardiothoracic Surgery

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

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.

Problems

• Problems with the primary JD structure

• Problems with the primary JD approval

• Problems with the secondary approval process

• Problems constituting the AAC

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

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

Problems with Secondary Approval

• President usually too busy for detailed review

• Introduces further variable and unhelpful delay

• JD usually nodded through

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

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

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

Provide Consistent Template

• A modified BMA template serves well

Daily Work Plan

Day Time Location Work CategoryNo. of

DCC PAsNo. of

SPA PAs

Wednesday 0800 to 1200

City Hospital

OPD (Inc review, clinic and letters)

DCC 1.00 embedded teaching

1200 to 1400

County Hospital(alternate weeks + travel)

Aortic Surgery MDM

DCC 0.25

1400 to 1700

City Hospital

Ward Round

DCC 0.75 embedded teaching

Thursday 0800 to 1800

City Hospital

Operating DCC 2.5

Weekend Work

Day Time Location Work CategoryNo. of DCC

PAsNo. of SPA

PAs

Saturday 0900 to 1200

City Hospital(1 in 4)

On Call Ward Round (includes travel)

DCC 0.25

1200 to 1500

City Hospital(alternate weeks)

Waiting List Initiative

DCC 0.5

Sunday

Predictable On Call Work(Saturday)

1200 to 1800(1 in 4)

City Hospital

Post Take Surgery + WRs

0.5

Annualised Activity?

Work Location Weekly Hours

Category Weekly DCC PAs

Weekly SPA PAs

Teaching Students

City Hospital

2 SPA 0.5

Audit City Hospital

2 SPA 0.5

Service Lead

City Hospital

4 SPA 1.0

Post G Super

City Hospital

2 SPA 0.5

CPD and Research

City Hospital

2 SPA 0.5

Patient Admin

Variable 6 DCC 1.5

Total 1.5 3.0

SPA Activity

• Training: CS, AES etc. S1• CPD S2• Teaching S3

• Postgraduate• Undergraduate• External

• Audit and Clinical Governance S4• Job Planning / Appraisal S5• Research (negotiable with Trust) S6• Clinical Management - Service Lead etc S7

On Call

On Call Allocation

Availability Category Immediate ‘A’ – 8%Delayed ‘B’ – 5%

8%

On Call Rota 1 in 4

Unpredictable On Call Work

4 hours 1 PA

Clear Summary

Programmed Activities Number

Direct CareOptional and Funded

7.5 2.0

Supporting Activities 2.5

Total PAs 12.0(9.5 + 2.5)

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

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

Next Steps -

• Provide concise advice to RSPAs and DPAs• Provide advice to specialty membership

• Advice Document

• Coordinate advice nationally – small core group – be consistent

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