Consultant Job Description Checklist

					                        Consultant Job Description Checklist
                            Advice for Regional Advisers
This advice is intended for Regional Advisers, CSAC Chairs, Scottish National
Panellists and those acting as College representatives on AACs. However,
consultants drawing up job descriptions may also find it useful. It has been prepared
specifically regarding consultant grade job descriptions but the principles it contains
are valid for Specialty Grade and other middle grade posts taking the specifics of the
relevant national or local terms and conditions of service into account.
The role of the Regional Adviser in signing off consultant job descriptions:
In line with the NHS (Appointment of Consultants) Regulations: Good Practice
Guidance – January 2005 – the RCPCH delegates authority for giving final College
sign off for any career grade job description to College Regional Advisers. Regional
Advisers may seek advice from the Chair of the relevant CSAC, Intercollegiate Group
or Specialty Group, Local Neonatal Network Lead, Regional BACCH Representative
and/or relevant College Officer (e.g. Officer for Child Protection) as they see fit for
any post and should always do so for posts with >40% subspecialty duties.
In commenting on job descriptions the central concern of the Regional Adviser
should be the professional content of the post in relation to clinical, teaching and
research work. The governance of the Trust is the responsibility of the Chief
Executive. However, it is the role of the Regional Adviser to ensure that the
conditions of the post will enable the appointee to work to safe clinical standards set
by the College and other relevant bodies, without exposing him / her to professional
risk in the discharge of his / her duties. Regional Advisers should look at the
proposed job description in relation to other posts in the department, recognising that
Trusts will often be seeking consultants to take specific responsibility for certain
areas of activity (e.g. in service, teaching or subspecialty work). Early discussion with
the Trust, and particularly the appropriate clinical director, is likely to be helpful in
resolving concerns.
Foundation Trusts are not under any statutory obligation to involve the Medical Royal
Colleges in the sign off of consultant job descriptions or the appointment process.
However, in August 2005 the Foundation Trust Network - now Monitor, which
represents NHS foundation trusts, signed a concordat with the Academy of Medical
Royal Colleges to enable the two organisations to work together on the appointment
of consultant medical staff.
A list of sources for this guidance is given at the end of this document. Where
relevant, our advice has been benchmarked against guidance released by other
Medical Royal Colleges to ensure consistency of approach. However, Regional
Advisers should not sign off posts or job plans that do not meet the standards set out
in A Charter for Paediatricians or in the Guidance on the Role of the Consultant
Paediatrician which represent the specific principles of practice agreed by the
RCPCH.
Sign Off process
Regional Advisers are required to respond to requests for feedback and sign off on
job descriptions in a timely manner (i.e. within 3 weeks). If awaiting advice from a
specialist colleague, it is good practice to keep the Trust informed of progress. In all
circumstances where additional advice is sought, the decision of the Regional
Adviser is final.



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For speed of communication, it is recommended Regional Advisers handle the initial
advice and recommendations by email. However, once the job description has been
finalised, the Regional Adviser should send a letter signing off the job description on
behalf of the College to the Clinical Director and HR department of the Trust. A copy
of the letter and the final job description should be sent to John Pettitt at the RCPCH.
Where a Regional Adviser is concerned that an employer has chosen not to accept
their advice they may wish to raise the issue with the College Registrar. This will not,
however, prevent an employer advertising the post.
An employer is at liberty to not seek or not take advice from the College Regional
Adviser and they may take a lack of response within 3 weeks as sign off from the
College.
Conflict of interest
If the post is based at the Regional Adviser‟s Trust, he/she should delegate approval
to the deputy Regional Adviser or a Regional Adviser from a neighbouring region.
If the post is based at the CSAC Chair‟s Trust, he/she should delegate approval to
one of the CSAC training advisers.
The Post:
The job title should clearly define the post, and should specify the number of
programmed activities (PAs). There should be a brief summary of the purpose and
context of the post, which should guide subsequent action. It is useful, but not
essential, to have an indication of whether this is a replacement or a newly
established post.
Question Action
Is this an NHS Consultant post? Standard procedure
Is this a Senior Lecturer post? See section on Academic Posts, and consult
Academic CSAC Chair
Is this a specialist post* or one with significant subspecialty aspects requiring
subspecialist advice? Send to chair of relevant CSAC for advice OR if no CSAC to
relevant speciality or inter-collegiate group
Is this a community post? Send to Regional BACCH representative for advice
Is this a neonatal post? Send to local neonatal network lead (for Level 2 & 3 posts),
as well as to CSAC chair for full speciality posts
* Defined as >40% of time spent in the stated subspecialty
The Department:
The job description should contain a description of the department, including relevant
information about medical and multi-disciplinary team members, clinical activity,
workload, training activity, and administrative infrastructure. This should enable the
Regional Adviser to judge whether the departmental arrangements are such that an
appointee would be able to meet clinical obligations within the framework outlined in
Duties of a Paediatrician and the document Guidance on the Role of the Consultant
Paediatrician (see A Charter for Paediatricians; Section 6 „The duties of a
paediatrician‟ and also Section 19 „Facilities for Paediatricians). For example:
    • Are colleagues listed by title and named?
    • Are the junior staff posts recognised by the College / PMETB?
    • Is there evidence of collaboration by other relevant departments (e.g.
         obstetrics)?



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   • Is there evidence of support from paediatric specialties such as radiology?
   • Are the facilities described? e.g. bed numbers, ambulatory unit, intensive care
       support etc.
   • Is the range of specialist clinics described?
   • Does the job description suggest an active audit and CPD programme within the
       department?

The list is not intended to be exhaustive, but to give some indicators which would
suggest an active and appropriately functioning department.
Duties of the Post:
The main duties of the post should be described in detail. Particular attention should
be paid to the following:
   • If this is a subspecialty post, will the post-holder be expected to undertake
        any general paediatric duties or on call?
       If there is a general on call requirement, the job plan must include sufficient
       time to allow a post-take ward round. There must also be sufficient CPD time
       to maintain both specialist and generalist skills.
   • If this is a general post, is a clinical ‘special interest’ (more correctly
        described as a ‘special responsibility’) defined?
       Applicants have been disadvantaged because the department has
       undeclared preferences for one specialty over another. Departments should
       have some idea of what they need and can accommodate, and present this
       transparently in the job description and job plan.
   • Are other specific responsibilities specified in the job description? For
       example, designated doctor for child protection, leadership in
       developing an ambulatory unit, or specific educational roles such as
       College Tutor.
       In these circumstances, sufficient support professional activities (SPAs) must
       be allocated in the job plan to undertake these roles (see section on the Job
       Plan).

The Job Plan:
Full job plan guidance is beyond the scope of this document, but is set out in the
2003 Consultant Contract (England), and relevant supporting documents. Within a
full-time framework of 10 PAs, it has been agreed that a consultant will normally
devote an average of 7½ PAs to direct clinical care (DCC) and 2½ PAs to supporting
professional activities (SPA) see Guidance on the Role of the Consultant
Paediatrician.
   • Does the job plan specify a requirement in excess of 10 programmed
      activities (PAs)?
       New consultant job descriptions should not specify a requirement in excess of
       10 programmed activities (PAs) including on call work. Any work in excess of
       10PAs will be by subsequent negotiation once in post, and should be paid at
       the appropriate rate.




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   • Are there enough direct clinical care (DCC) PAs to manage the clinical
       workload?
       It is recognised that paediatrics involves a heavy workload in clinical
       administrative duties; for example, office-based clinical administration, as well
       as non-clinic based meetings with parents, and with multi-disciplinary and
       multi-agency colleagues. Sufficient time must be allowed for this within the
       DCC allocation of the post (i.e. a minimum of 1½, and often 2½ of the 7½
       direct clinical care PAs).
       All predictable out-of-hours work (e.g. weekend or evening ward rounds)
       should be included within the DCC allocation of the job plan. For work
       performed outside 7am to 7pm Monday to Friday, a programmed activity
       equates to 3 rather than 4 hours. Unpredictable out of hours work also needs
       to be factored into the job plan (see section on Emergency On-Call Work)
       Travel time to outreach clinics should also be included in the DCC
       component.
   • Are there enough supporting professional activities (SPAs) to cover both
       specific responsibilities set out in the ‘duties of the post’ and the
       generic requirements for all paediatricians
       Sufficient SPAs must be allocated to cover any specific educational or
       management roles defined within the job description, as outlined above.
       For all consultants, the processes for revalidation recommended in the
       Donaldson report (2006) will strengthen the stated need for adequate SPAs to
       be devoted to continuing professional development, audit and governance-
       related activities.
       Routine educational supervision also requires an explicit commitment and
       should be properly reflected in supporting professional activities. This
       requirement will increase with the advent of competency-based training and
       its assessment.
   • Has a weekly timetable been provided, and does it match the stated
       number of PAs?
       Where there is a mix of attending and non-attending weeks or an annualised
       programme, this will need to be calculated over the cycle-length of the rota.

PAs for Additional NHS Responsibilities and External Activities are unlikely to be
included, since these are roles and activities that the appointee is more likely to
negotiate once in post. However, should such activities be specified in the job
description, it is important to ensure that they are adequately accounted for in the job
plan.
N.B. Check that the job plan should carries a statement that it is subject to
renegotiation and review annually with the Clinical Director, any changes being
by agreement within the department.




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Variations for Wales, Scotland and Northern Ireland:
Advice relating to job planning is based primarily on the English consultant contract.
For Wales, Scotland and Northern Ireland, reference should be made to the
appropriate contract arrangements.
N.B. In Scotland, job descriptions are signed off by National Panellists rather than by
the Regional Adviser.
Emergency and On Call Work:
Paediatrics is recognised as a speciality with one of the highest on-call and out of
hours commitments. On call rotas should currently be no more frequent than 1 in 5,
and it is likely that consultant team sizes will need to grow further in the next few
years to fully meet EWTD and to move towards 10PA job plans. Pragmatically, a
department may be some way from achieving this ideal and it would be unhelpful to
the existing departmental staff to refuse to approve a job description on this basis.
However, the Regional Adviser should write in strong terms to the Chief Executive
advising of the need for further expansion.
   • Under EWTD provisions, consultants should have 11 hours rest in every 24.
       Although most consultants currently work for longer than this, the rota should
       allow for adequate compensatory rest to be taken in a timely manner. In high
       intensity specialties such as neonatology and intensive care, extended
                                                           nd
       weekend rotas, particularly in the absence of a 2 on call consultant
       colleague, should be discouraged.

The job plan should demonstrate that unpredictable out of hours activity, including
telephone calls for advice and recalls to hospital, has been assessed (for example,
by means of diaries) and factored into the job plan.
Further extensive advice is given in the Charter for Paediatricians (see Section 16
„Consultants on call‟ and Section 17 „Residence on call‟) and Guidance on the Role
of the Consultant Paediatrician including guidance on PA allocation for out of hours
activity, advice for sub-specialty on call and advice on facilities and conditions for
agreeing to be resident on call. Key issues regarding residence on call are that
consultants should not be „first on‟, but should always be on call with an SHO or
nurse practitioner, and that the agreement to be resident on call should normally be
for a maximum of 5 years, with annual review.
Part Time Working:
The 2005 census indicated that 52.9% of the career grade workforce and 43% of the
consultant workforce was female. 30% of female consultants were working part time,
compared to only 7.2% of men. Currently 60% of trainees are female and it is likely
that an increasing percentage may wish to work part time as consultants.
There should be a presumption that all consultant posts are suitable for those
wishing to work less than full-time (e.g. job sharers and flexible workers). If there are
specific reasons why the post is deemed inappropriate for someone wishing to work
less than full-time, this decision should be justified.
The job description should also state how the post will be adapted to meet the needs
of job sharers or flexible workers. In particular, additional PAs (for example, 2x 6PAs)
may be needed to allow adequate time for handover and CPD. The BMA
recommends a lower DCC to SPA ratio for those working less than full time. Exact
ratios will be a matter for local negotiation, but the Regional Adviser should ensure
that the SPA allocation allows sufficient time to meet CPD requirements and any
additional supporting activities expected of the post holder.



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Split Site Working:
Care should be taken in evaluating job descriptions for consultants working across
split sites as these may sometimes place excessive demands on the post holder. It is
important to ensure that adequate time is allowed to complete administrative work
and to attend essential team meetings on both sites. There should also be adequate
CPD allowance within the job plan to maintain competence for the full range of
clinical duties across both trusts. Except in the case of academic contracts, it is usual
for the primary contact to be held by the trust in which there is the greater clinical
commitment. The primary employer will usually take lead responsibility for appraisal,
revalidation, and job planning, as well as for any performance concerns, although
both trusts should obviously contribute. It is strongly recommended that there is a
statement clarifying these arrangements, and a commitment to an early job plan
review.
With the development of clinical networks, a consultant may provide out-of-hours
clinical input across more than one site, particularly for specialist services. However
he / she should not be the only available paediatric consultant across two acute sites.
Clinical Academic Contracts:
Clinical academics will vary in the split between clinical and academic
responsibilities. Typically they will be employed by a university and hold an honorary
clinical contract at an NHS Trust. However, there should be a single integrated job
plan, and a joint appraisal process (see Follett report, 2001).
The role of the Regional Adviser is to assess the clinical and relevant professional
aspects of the job description, and confirm approval to the academic department, as
well as the Trust and the College. If the post is in a defined subspecialty, it should be
referred to the CSAC chair in the usual way.
The academic component of the post is the responsibility of the academic
department but, where the Head of Department is not the Academic Regional
Adviser, he or she may wish to discuss this with the ARA, particularly if there is
concern regarding the feasibility of the balance between clinical and academic
sessions. Advice may also be sought from the Chair of the Academic CSAC. A
similar DCC to SPA ratio as for a full time NHS consultant may be applied (for
example, an academic working 5 clinical PAs might notionally have 1.25 SPAs).
However, as with those working part time, an irreducible amount of time is still
required for CPD, and hence a relatively higher SPA allocation may be necessary. In
assessing the overall job plan, the Regional Adviser should make a judgement as to
whether the appointee would have adequate time to meet the required clinical
commitments, to maintain competence in the defined areas of practice and to
undertake the necessary CPD to underpin revalidation.
Other Work Conditions:
Suboptimal work conditions can impede the ability of the paediatrician to function
effectively, and the job description should include information about the work setting
and environment. Check the following:
   • Is there adequate secretarial support?
   • Is there personal access to IT and the internet / e-mail?
   • Is there appropriate office accommodation?
Although the Trust is not obliged to respond to recommendations regarding facilities
and infrastructure, it is important to draw attention to obvious problem areas.




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The Person Specification:
   • It is essential that the applicant is either on the UK Specialist Register in
         paediatrics or is in a UK training programme within 6 months of CCT date. An
         AAC assessor will not necessarily know if there have been concerns about a
         trainee, so to aid the AAC process, it is advised that the essential person
         specification should include a clause to say “the applicant must produce
         evidence that he / she is either on the UK Specialist Register or within 6
         months of CCT date, and is expected to achieve a CCT”. In the case of UK
         trainees it will then be the responsibility of the applicant to obtain a suitable
         letter from his / her Regional Adviser to confirm this.
   • Other headings, classified as essential or desirable would include qualifications,
       experience (including on call experience), research, teaching, management,
       audit, personality and motivation (in order not to disbar those trained
       overseas it is not recommended a person specification include the MRCPCH
       examination as an essential criteria – a suggested alternative wording is
       “MRCPCH or equivalent”).
   • Job descriptions for subspecialty posts do not necessarily have to specify
       subspecialty accreditation as essential.
   • Although this is primarily a Trust, not a College function, check whether the
       specification meets equal opportunities standards. For example, “has a valid
       driving licence” discriminates against some disabled people, whereas “able to
       travel to meet the requirements of the post” is fair.
   • Has the post been designed to attract a specific individual?

Relevant supporting documents:
Charter for Paediatricians. Royal College of Paediatrics and Child Health; 2004
The NHS (Appointment of Consultants) Regulations: Good Practice Guidance.
Department of Health, 2005
The 2003 Consultant Contract (England). Department of Health; 2003*
Job Planning. Standards of Best Practice. Department of Health; April 2003
Guidance on the new consultant contract, and its implications for Job Plans
(Programmed Activities). Academy of Medical Royal Colleges; March 2004
Guidance for Regional Specialty Advisers on Approving Job Plans. Royal College of
Surgeons of England; January 2005.
Consultant Physicians Working For Patients. 2nd Edition. Royal College of
Physicians of London; 2001
Professor Sir Brian Follett and Michael Paulson-Ellis A Review of Appraisal,
Disciplinary and Reporting Arrangements for Senior NHS and University Staff with
Academic and Clinical Duties. DFES 2001.
Guidance on the Role of the Consultant Paediatrician Royal College of Paediatrics
and Child Health; 2009.
* Including supplementary academic information 2005
                                             Hilary Cass, Registrar (November 2006)
         Revised John Pettitt, AACs & Committee Administrator (February 2011)




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