Gmc Extended Service Contract - PowerPoint

							Medical Staffing
Contracting to Compliance
A Whistle Stop Tour for 2010
   Consultant and SAS Contracts - Objectives:

• To ensure that the work of individual doctors is fully aligned to the
  objectives of their employing organisations

• To deliver a system of review and re-validation, where senior
  doctors maintain required clinical and professional standards for
  high quality patient care

• Through job planning and annual appraisal, to provide employers
  with greater scope for redesign of clinical services, plus the ability
  to manage clinical time in ways that best meet local service
  needs and priorities.

• To provide greater clarity for mutual objectives through
  implementing effective systems for engaging doctors in joint
  action to improve performance and modernise patient care.
1. Consultant Contract 2003 – History

 Framework set out in 2002

 Old = fixed and flexible sessions 3.5 hours x 11 = full time

 New = Programmed Activities (PAs) 4 hours x 10 = full time

 PAs separated into:
         Direct Clinical Care (DCC)
         Supporting Professional Activities (SPA)

 Additional responsibilities/other duties (e.g Clinical Tutor) can
 be substituted for other work or paid separately, with
 agreement by the employer


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 Consultant Contract – continued
Guidelines suggest:
         7.5 PAs for Direct Clinical Care (DCC)
         2.5 PAs for Supporting Professional Activities (SPA)
         Extra PAs above 40 hours – subject to WTD 48 hr max

 • Actual allocations are based on annual job planning

 • Contract can be ‘annualised’ with PAs allocated differently
   across the year

 • Pay progression dependant upon meeting time and service
   commitments in job plans

 • Working towards changes identified in previous job plans

 • Supporting achievement of the organisation’s service objectives

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  Consultant Contract - Incentives and Changes

• Pay and structure – provided a substantial increase to average
  earnings, plus intention to improve recruitment/retention and
  provide sustained incentive for high quality performance over the
  course of the consultant’s career

• OH work - up to 2 PAs per week, plus new availability supplements
  inc payment for work undertaken 2200 and 0800 hours M-F, and
  between 1300 and 0900 at weekends

• Private practice – not outlawed, but consultants expected to make
  greater time available to the NHS

• Clinical Excellence Award Scheme replaced discretionary points
  etc

• New national disciplinary framework (ultimately MHPS)
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   2. SAS Contracts 2008


• Staff Grade docs viewed as an ‘overlooked’ medical staff group

• SAS grades undertook significant senior service provision, but
  with limited rewards or development opportunities

• Intention - to ensure that all Specialty Doctors are:

    – employed in the spirit of the new national contract
    – legitimate participants within their profession
    – supported in taking on management, leadership, training and
      research roles
    – seen as an integral part of the clinical team


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  2008 SAS Contract Objectives:


• To increase pay to reflect SAS doctor seniority and competence,
  and to recognise their often significant commitment to OH cover
• To ensure protected time for CME, professional and career
  development
• To reward SAS doctors committed to developing knowledge and
  skills in the role, while providing consistent and high quality
  services for patients.
• Alignment with the new consultant contract, to facilitate service
  delivery through job planning
• Improved morale and motivation among these grades


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    Changes and Assimilation

•    Associate Specialists given the opportunity to retain old, or
     move to new contract, prior to closure of the grade in April 2009

•    New grade of Specialty Doctor replaced Staff Grade and other
     NCCG roles

•    New contracts offered improved pay progression linked to job
     planning and appraisal (typical pay increases were between 6%
     - 13%)

•    Supporting Professional Activities (SPA) now formally
     recognised

•    No clinical excellence awards for new contract holders

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    Local Freedoms

•    Every Trust should have completed the process for all docs
     who wished to transfer.

•    There are still some Trusts which have not yet implemented
     the new contract, and assimilation still needs to take place.

•    Associate Specialist, Staff Grade, Hospital Practitioner,
     Clinical Assistant – became closed to new applicants with
     effect from 31 March 2008

•    There is still evidence that locally designed middle grade
     roles are being implemented, born out by the fact that AS
     grade roles are still being advertised nationally.



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    SAS Contracts - Key Points

•   Base contract similar in many ways to the consultant contract
•   Full time contract = 40 hours
•   10 x Programmed Activities (PAs) of 4 hours
•   9 PAs for Direct Clinical Care (DCC) and other duties
•   Minimum 1 PA awarded for Supporting Professional Activities
    (SPA)
•   Contracts based on job planning, and annual appraisal
•   Individual objectives aligned with organisational priorities for
    patient care
•   Portfolio development to support progression
•   Flexibility can be effected through annualised agreements

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 SAS - On call and Premium Time
On call availability supplement:
• Paid to doctors who participate in (non-resident) on call rotas
   based on frequency of rota commitment
     - more frequent than or equal to 1 in 4 = 6% of salary
     - less frequent than 1 in 4 or equal to 1 in 8 = 4%
     - less frequent than 1 in 8 = 2%
Premium Time
 • Covers all actual work outside 7am-7pm M-F, and any time at
   weekends or on public holidays
 • This entitles doctors to either:
      - 3 hrs of scheduled work = 1 PA, or
      - 4 hours of scheduled work paid at time and a third
 • (For Associate Specialists only, non-emergency work at these
   times was introduced only by agreement)

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 SAS Pay Progression

•Scale is made up of 11 pay points (0 to 10)

•Annual progression up to point 4

•Threshold 1
Gateway requirements to transfer to point 5:

   • Participation in job planning and annual appraisal review
   • Previous Job Plan objectives met or in progress
   • Any other previous requirements identified should have
     been completed
   • Undertaken 360 degree appraisal/feedback


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  SAS Pay Progression continued


Movement between points 5 and 7 at 2-yearly intervals

Threshold 2:
Gateway requirements to transfer to point 8:
• All criteria required for Threshold 1
• Demonstration of an increasing ability to take decisions and
  carry responsibility without supervision
• Evidence of contribution to wider roles, including management
  and leadership, service development, and modernisation, audit,
  teaching and training, innovation, committee and representative
  work
• Progression between points 8 to 10 at 3-yearly intervals


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 SAS Career Development - Opportunities



PMETB Article 14 – facilitates acquisition of CESR (entry onto
the Specialist Register) for those outside of ‘numbered’ training

Job planning and appraisal facilitates the production of personal
development portfolios

Intention is to evidence career development and progression
which will support SAS doctors in making Article 14 applications

Significant additional funding has been awarded to Trusts to
facilitate development of education and opportunities for SAS
doctors


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 Employer Responsibilities for NCCGs

Employers should ensure that SAS doctors have:

• systems to record / audit their clinical activity

• a senior clinical lead to oversee clinical workload and support
  professional development planning

• access to a minimum of one SPA per week (for full-time
  doctors) to support professional activities

• fair and reasonable access to study leave with appropriate
  funding according to terms of service

• pastoral support for specific Specialty Doctor issues.


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    3. Job Planning for Consultants and SAS

•   Mandatory annual process, requires partnership approach
•   Supported and informed by, but separate from, appraisal and
    revalidation
•   Focuses activity on aims and objectives of local health
    community and the organisation
•   Encompasses all elements of a doctors’ work including main
    duties and responsibilities and a schedule of commitments
•   Identifies support needed to fulfil role
•   Results in good objectives which will be clear and achievable,
    and the individual doctor’s contribution measurable


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    Job planning - types of work

Direct Clinical Care (DCC) includes

•     emergency duties (including on-call)
•     operating sessions inc. pre- and post-operative care
•     ward rounds and outpatient activities
•     clinical diagnostic work
•     public health duties
•     multi-disciplinary meetings about direct patient care
•     patient related administration linked to clinical work



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    Job planning - types of work

Supporting Professional Activities (SPA) includes:

•     audit
•     continuing professional development
•     local clinical governance activities
•     training and formal teaching
•     appraisal
•     job planning
•     research


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  Job planning – types of work

Additional NHS Responsibilities:
• Responsibilities not undertaken by the generality of doctors,
   which cannot be absorbed in the time set aside for SPAs
e.g.
• clinical manager, clinical audit lead, clinical governance lead

External duties:
• Still a grey area and interpretation/implementation can vary
   from Trust to Trust – local position required
• Duties not included in the definitions of DCC, SPA and
   Additional NHS Responsibilities, and not fee paying work or
   private practice
• Agreed in job planning discussions
e.g.
• Royal College or Government work in the interests of the
   wider NHS
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 Job Planning - Appeals Mechanism

   • Appropriate mechanisms are required, particularly as
     sign off can influence pay

National suggestions for process
•   a chair (Non-Executive Director of the appellant’s
    employing organisation)
•   a second panel member nominated by the appellant
    doctor, preferably from within the same grade
•   an Executive Director from the appellant’s employing
    organisation.
•   No legal representative, but the doctor may be aided by a
    friend or advisor.
•   The decision will be binding on both sides.


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 GMC Revalidation
• November 2009 – GMC registration extended to include Licence
  to Practise – the 1st step towards revalidation
• New contracts, job planning and appraisal processes will
  ultimately support this
• Based on publication Good Medical Practice, which defines
  principles and values which the medical profession should uphold
• National pilots for a framework for revalidation are currently
  underway
• For future, all GMC registered doctors will have to revalidate on a
  regular basis
• Organisations will have to ensure support so that clinicians can
  keep practice up to date
• Patient and public feedback on care standards will inform the
  process
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Maintaining High Professional Standards
(MHPS) - 2005

 • Provides a framework and recommendations for handling
   the investigation of concerns about conduct and
   performance of medical and dental employees

 • Deals with restriction of practice and exclusion

 • All Trusts required to implement procedures based on
   MHPS – compulsory for non Foundation Trusts and
   recommended for FTs

 • All Trusts should have local policies in place which meet
   the full requirements of MHPS


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Everything is Linked

Contracts

Job planning and appraisal

Revalidation

MHPS

 • All of the above should ensure that doctors are working
   safely and that their clinical practice is up to date
 • Ultimately, patients should be guaranteed high standards
   of clinical care




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Key Documents




  Contracts of Employment, Terms and Conditions of Service,
  Job Planning - Standards of Best Practice for Associate
     Specialists and Specialty Doctors
  Job planning checklists
  Employing and supporting specialty doctors - a guide to
    goodpractice - www.nhsemployers.org/sas
   • Good Medical Practice and guides to Revalidation -
     www.gmc-uk.org
   • Maintaining High Professional Standards in the NHS –
     www.dh.gov.uk




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