Job planning in the new NHS CCSC / 27 November 2006
Job planning in the new NHS
Dr Mark Porter FRCA
Consultant anaesthetist, University Hospital Coventry
Deputy chairman, BMA consultants committee
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Changed TrainingChanged Training
Payment by
results
Practice based
commisioning
Patient ChoicePatient Choice
Market forcesMarket forces
ISTCscompetitioncompetition
Contestability
New SAS
contractNew SAS
contract
Job planning in the new NHS CCSC / 27 November 2006
Where do we go now?• New contract• New Context
• New NHS?– Multi-provider environment– Portfolio careers
Job planning in the new NHS CCSC / 27 November 2006
2003 contract
• Professional• Time limited• Increased
clarity• Balances
objectives and supporting resources
‘Something for Something’
• ‘Productivity’• ‘Benefits realisation’• Adapt the resource
to the need
Job planning in the new NHS CCSC / 27 November 2006
A forty-minute seminar…
• Can’t cover everything
• Much advice in the public domain• Most of it is good advice
Job planning in the new NHS CCSC / 27 November 2006
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’
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Job plan – other agreements
• Other comments and agreements– Category 2– Flexibility of location
• Additional programmed activities and private practice
• A dotted line
Job planning in the new NHS CCSC / 27 November 2006
Programmed ActivitiesDirect clinical careWork relating to prevention, Dx or Rx• Emergency work (including on-call)• Operating, ward rounds, clinics,
treatment sessions, MDM, public health, etc
• Admin. related to the above
Supporting PAsWork underpinning Clinical Care. • Training, education, teaching• CPD, Audit & Research• Job planning / Appraisal• Service Management• Local clinical governance
Typically 7.5 : 2.5 balance
(you should not accept less without careful consideration)
also
Additional NHS responsibilities
Lead clinicianCollege tutoretc
External Duties
Royal College / Spec. SocHMG / Trades Union etc
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Two models of job planning• Organisation has no
coherent plan for service delivery
• Consultants make up their own job plans
• Focus entirely on schedule of fixed commitments
Missed opportunities
• Organisation focused tightly on service delivery
• Job Plans written by service managers
• Objectives subordinated to targets
Job planning in the new NHS CCSC / 27 November 2006
• “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 personal objectives and their relationship with the employing organisation’s wider service objectives”
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Job planning and appraisal cycle
Agreement of personal objectives
Job plan review
meeting
Appraisal meeting
Business planning and
service development
Agreement of service objectives (team or
individual)
Annual pay progression
Local Delivery
Plan
Job planning in the new NHS CCSC / 27 November 2006
Before job planning
• 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 family and personal time require of you
Job planning in the new NHS CCSC / 27 November 2006
Preparation for meetingcollect, reflect and share
• 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?
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
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.)
Job planning in the new NHS CCSC / 27 November 2006
Getting started
• Consider issues such as:– Review corporate
objectives– Review Local Delivery
Plan– Identify service
development priorities– ‘Payment by results’
Clinical director Consultant
• Consider issues such as– Identify service
development priorities– Identify PDP priorities– Identify resource issues
• “something for something” approach
Job planning in the new NHS CCSC / 27 November 2006
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.
Job planning in the new NHS CCSC / 27 November 2006
Simple negotiating tactics
What are your goals?• Your bottom line
– Be clear– Realistic– Bold– Honest with yourself
Who are the players?– Where are they coming
from?– What must they achieve?– What could they give– What can’t they give
Cyclical process– Meet again next year– Big wins now - later losses– Rome not built in a day
Strategy– Win-win– Partnership approach
Job planning in the new NHS CCSC / 27 November 2006
Team Approach
• 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
Job planning in the new NHS CCSC / 27 November 2006
The job plan review meeting
• 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
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Where & How do Objectives fit in?
Agreement of personal objectives
Job plan review
meeting
Appraisal meeting
Business planning and
service development
Agreement of service objectives (team or
individual)
Annual pay progression
Job planning in the new NHS CCSC / 27 November 2006
Objective setting discussion
Clinical governance and quality
issues
Team objectives
Additional responsibilities
e.g. teaching, research
Service requirementsInclude corporate
objectives, LDP, local service developments
Personal development
planFrom appraisal
Agreed support
requirements
Agreed objectives
Including agreed and supported PDP
Agreed process for review of objectives
Job planning in the new NHS CCSC / 27 November 2006
• Specific• Measurable
• Quantified or descriptive
• Achievable and Agreed• Relevant and Resourced• Timed and trackedSMART
Objectives should be…
Job planning in the new NHS CCSC / 27 November 2006
Examples of objectives
• 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
Job planning in the new NHS CCSC / 27 November 2006
Recording objectives
• Objective• Actions to achieve
objective• Success criteria and
measures• Agreed review
process and timetable• Support required
(including removal of organisational barriers)
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Summary
• Prepare– and survive
• Opportunity – to drive and to lead change– take control!
• New healthcare environment– embrace, use and change
Job planning in the new NHS CCSC / 27 November 2006
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
Job planning in the new NHS CCSC / 27 November 2006
Any questions or points?
Job planning in the new NHS CCSC / 27 November 2006
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
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