NHS HDL (2005) 21 abcdefghijklm

Transcription

1 NHS HDL (2005) 21 abcdefghijklm = eé~äíü=aéé~êíãéåí= = eìã~å=oéëçìêåéë=aáêéåíçê~íé= Dear colleague NEW DEAL FOR JUNIOR DOCTORS: SYSTEM FOR MANAGING NEW DEAL NON COMPLIANCE FOR SHO AND SpR GRADES Summary 1. This HDL sets out the system for managing non compliance for SHO and SpR grades from the New Deal Contract for junior doctors. The system was devised by a sub-group appointed by the Implementation Support Group Project Board in August 2003 and involved all three partners represented on the Project Board (Scottish Executive, BMA SJDC, Service representatives). It has been agreed by the ISG Project Board. 2. The system involves a cumulative series of breaches in relation to non-compliance and distinguishes between serious and other breaches. It provides a clear basis for dealing with non-compliance of SHO and SpR posts so that all concerned have a clear framework within which to work towards achieving compliance. ISG (or any successor arrangements to ISG) will work with Boards to operate and oversee the process. 25 th April 2005 Addresses For action Chief Executives, NHS Boards Chief Executives, Special Health Boards Chief Executive, Common Services Agency Members, HR Forum for information HR Directors, NHS Boards Medical Directors, NHS Boards Enquiries to: Joyce Edwards National Workforce Unit St Andrew s House EDINBURGH EH1 3DG Tel: Fax: Annex A details the process to be followed for the SHO/SpR non-compliance framework. 4. Annex B is a flowchart which sets out the stages in the process for managing non-compliance for SHO/SpR grades.

2 Action Implementation should take place at the start of the next training grade rotation on 3 August NHS Boards should ensure they have made all necessary preparations for the introduction of this process by that date. Yours sincerely, MICHAEL PALMER Assistant Director of Human Resources (Workforce & Pay Policy)

3 ANNEX A SYSTEM FOR MANAGING NEW DEAL NON COMPLIANCE FOR SHO AND SpR GRADES [Note: Wherever reference is made to ISG, the central team, or to the Project Board, this also includes any successor arrangements that may be put in place] Introduction This paper sets out the system for managing non compliance for SHO and SpR grades. The New Deal contract for junior doctors (as described in HDL(2000)17 and PCS (DD) 2001/3) requires that from 1 August 2003, all SHO and SpR posts should adhere to the hours limits and rest requirements contained within it. Failure to do so results in a punitive banding (Band 3) and means that these posts, being in breach of contract, should no longer remain within the training pool. However, recognising the potential effects of post withdrawal on both the service and individual trainees at this level, a system has been devised by the ISG Project Board (comprising representation from NHSScotland employers, the BMA s Scottish Junior Doctors Committee and the SEHD) for managing compliance in a way which supports employers in achieving compliance whilst recognising their contractual responsibilities. The system involves a cumulative series of breaches in relation to non-compliance and distinguishes between serious breaches and breaches. It provides a clear basis for dealing with non-compliance of SHO and SPR posts so that all concerned know what to expect. The ultimate measures available have been agreed by the ISG Project Board. The Project Board (or successor body) intends also to bring out further guidance regarding the use of provisional banding, as a result of the changes introduced by Modernising Medical Careers. Any arrangements to provisionally reband should continue to be in line with HDL 2000 (17) Annex E paragraph 3.9. It should be noted that, following a review of the arrangements for overseeing New Deal implementation, the current arrangements are due to be revised. Flowchart The attached flowchart sets out the stages in the process for managing non-compliance for these grades. This is a complex system which the chart endeavours to clarify. The key stages in the flowchart are as follows: Rota Monitored (1) Hours should normally be recorded and checked at a minimum of twice a year. Twelve monthly monitoring may be considered in cases where all parties including ISG agree, as per paragraph 20, Appendix C HDL (2000) 17. Failure to carry out this monitoring for any SHO

4 and SpR rota constitutes a serious breach under this system and the employer will be warned accordingly. For any SHO or SpR Rota - Monitoring Checked by ISG (2) The rota monitoring is checked by ISG in accordance with HDL 2000 (17) and HDL 2002 (33) to establish whether or not the rota has monitored compliant. The ISG will review the circumstances when a breach occurs. If the rota is non-compliant, ISG with the agreement of the Project Board/successor will consider the nature of the breach and issue a letter to the employer. Where either the employing authority or the practitioner rejects the opinion of ISG, there is a right of appeal as set out in HDL 2000 (17) Appendix E paragraph 3.8. Invalid monitoring will not count towards this process; likewise, it will also not count as a period of monitoring. The only exception to this would be persistent failure to monitor on the part of the doctors in training, in which case banding on available evidence could occur. Breaches can be removed where compliant monitoring is confirmed by the ISG (see section (4) below for further details). Breach removal process (4) A breach, whether serious or other, can be removed in the same way as applies to the PRHO 3 strike process, detailed in Trevor Jones letter of 4 November A breach can be removed after 2 consecutive 6 month periods of compliant monitoring. A further breach can be removed after a further 6 month period of sustained compliance has been met. Breaches (6) Note (9) below describes the breaches which will count as serious breaches under this system. Other reasons for non-compliance will count as breaches and include: failure to achieve natural breaks on more than 50% and less than 75% of occasions. failure to achieve rest requirements on more than 50% and less than 75% of occasions. failure to monitor 6 weeks after provisional re-banding takes place breach of maximum shift length by less than one hour on the first occasion only. (Thereafter on subsequent monitoring occasions, it will constitute a serious breach.) The following paragraph sets out how many of the above breaches will constitute 3 serious breaches. A letter will be issued to the employer on each occasion that a breach is identified by ISG, or successor. Repeated breaches (8) Three breaches will be deemed to constitute a serious breach and will give rise to a first serious breach warning. Two subsequent breaches will trigger a second serious breach warning, and a sixth breach will trigger a third serious breach warning. Therefore a total of 6 breaches will constitute 3 serious breaches.

5 It should be noted that only one breach or serious breach will be awarded for a single valid period of monitoring. In the event that both breaches and serious breaches occur in a single valid monitoring episode, this will be counted as one serious breach. Serious breaches (9) The following will count as a serious breach: Failure to complete a valid monitoring exercise as per HDL (2000) 17. Exceeding total hours limits, either actual or duty. Exceeding maximum shift length by one hour or more. Exceeding maximum continuous duty days (13 day rule) Failure to achieve 48/62 hours rule Failure to achieve minimum time between shifts and will be designated so by ISG who will issue a warning letter to the employer. As with the PRHO strike system, 3 serious breaches will give rise to measures agreed by the ISG Project Board. Redesign plan prepared (10) The Project Board regards a redesign plan as an essential part of tackling non compliant rotas which should apply to all breaches - serious or otherwise. Redesign plans may be straightforward or complex depending on the reasons for non compliance. Employers should take action after every identified breach whether serious or not to prepare a redesign plan as set out in the flow chart: this may or may not require redesign of the rota template. They should involve all relevant parties (such as the postgraduate dean) to secure compliance. These plans must be agreed with the ISG. ISG Central Team may seek guidance from the Project Board in order to ensure that realistic proposals are agreed which achieve compliance. 3 rd serious breach (11) and ISG Project Board review (12) As noted above, there will be a maximum of 3 serious breaches. At the stage where ISG has identified a 3 rd serious breach, the Project Board arrangements will review the proposals in the redesign plan as a matter of priority at their next meeting. They will also receive a report from the ISG Central Team and the NHS Board concerned. The Project Board can seek any additional information or evidence from other concerned parties such as the postgraduate dean. Appropriate measures (13 and 14) A series of measures, including ultimately a recommendation to withdraw posts, is available to the Project Board arrangements, in considering how to respond to employers with SHO or SpR rotas which have 3 serious breaches. Key stakeholders will be informed at each stage of the Project Board s, deliberations and be involved in the solutions required to rectify the situation. These will include: - the NHS Board Chief Executive;

6 - the Medical Director; - the relevant postgraduate dean; - the Royal Colleges; - the relevant regional workforce lead. The Project Board body will, if necessary, go through a three-stage process to resolve these cases. All decisions taken by the Project Board throughout this process will be on the basis of unanimity and agreement will not be unreasonably withheld by any one party: a) as an initial step the Project Board will agree with the NHS Board a time-limited and rigorous action plan for correcting the problem, with agreed timescales and clear milestones for delivering on the plan. All parties will use their best endeavours to agree on such a plan and on a reasonable timeframe for its delivery. b) There will be regular dialogue between the Project Board and the NHS Board on the delivery of the action plan, and the Project Board will regularly review progress against the plan. This will include regular monitoring by, and contact with, the ISG. If it becomes clear that the plan is not deliverable or that the NHS Board is not engaging with the plan, the Project Board may agree with the NHS Board to adjust the plan accordingly. However if all such adjustments and alternatives have been fully explored and the plan remains ineffective or undeliverable, the Project Board may move to recommend withdrawal of posts. c) If the NHS Board is not able to deliver on or engage with the original action plan or an adjusted action plan, the Project Board can decide at any point to recommend withdrawal of post(s), outlining the reasoning for their recommendation, to the Chief Executive of NHSScotland. Where there is a recommendation for withdrawal of post(s) a default period of a maximum of 24 months (or earlier where deemed feasible and preferable by the NHS Board) will be proposed.

7 ANNEX B New SHO/SpR Process Support Proportionate Response Re-design plan prepared (10) Appropriate measures Rota Monitored (1) Balanced interpretation Checked by ISG/ successor (2) Compliant (3) Breach removed (4) Non Compliant (5) 1 st or 2 nd Serious breach warning issued (9) Other Breach Letter issued (6) Action to remedy Non-compliance (7) 3rd Serious breach (11) Project Board review (12) Repeated (3,2 or 1) Other breaches= Serious breach (8) Other measures to be decided by Project Board (13) Withdraw Posts (14) This flowchart needs to be read in conjunction with the guidance, System for Managing New Deal Non Compliance for SHO and SpR Grades abcde abc a