NHS Education for Scotland. Board Paper Summary. 1. Title of Paper. Doctors and Dentists in Training Lead Employer Arrangements. 2. Author(s) of Paper

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1 NES Item 3 May 2017 NES/17/38 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Doctors and Dentists in Training Lead Employer Arrangements 2. Author(s) of Paper Stewart Irvine, Medical Director Dorothy Wright, Director of Workforce Morag McElhinney HR Business Partner 3. Purpose of Paper To update the Board on progress made by NES in assuming a Lead Employer role for General Practice Trainees (GPSTs) throughout their training programme. 4. Key Issues This change programme was commissioned by NHSScotland Chief Executives to improve the employment experience for doctors in training and the attraction of Scotland as a place to work and train. The key issues covered in this paper are: - Description of the agreed model of employment for doctors and dentists in training. - The NES role in testing the model. - Collaborative working with NHS Grampian as early adopters of the model. - The development of an Employment Responsibilities Agreement. - Communication milestones for early adopter work. - Systems development support from NES for the employment model. 5. Educational Implications The employment model will eventually impact on all doctors and dentists in training. It is essential that the employment model improves the experience of doctors and dentists in training in Scotland, and does not t impact adversely on recruitment and retention. 6. Financial Implications A key objective of the new employment model is to reduce duplication of effort across Health Boards in Scotland in the employment of doctors and dentists in training. 1

2 The cost implications of the employment model will require full analysis. The current arrangements for providing funding to Boards for the employment of doctors and dentists in training is being reviewed for inclusion in the Employment Responsibilities Agreement. The impact of the new employment model on expenses entitlements is being analysed by Finance. 7. Which of the 9 Strategic Outcome(s) does this align to? Implementation of the new employment model aligns to the following strategic outcomes: 9: An effective organisation where staff are enabled to give their best and our values are evident in every day work. 7: Improved and consistent use of technology with measurable benefits for user satisfaction, accessibility and impact 8. Impact on the Quality Ambitions To assist in the provision of well trained staff, through improved recruitment and retention of doctors and dentists in training, due to an enhanced and simplified trainee journey. The reduction in employment administration for doctors and dentists in training should enable their focus to remain on maximising their training experience. Improved information flow to the Responsible Officer where doctors in training encounter any difficulties/ fitness to practise issues. 9. Key Risks and Proposals to Mitigate the Risks A failure to test the new employment model could lead to reputational damage to NHS Scotland This could have an impact on patient safety if doctors were not appropriately cleared to commence work or able to rotate to placements. There may also be an impact on recruitment and retention. There may be legal risks (employment tribunals) if the model is not properly tested. The early adopter work mitigates this risk by enabling arrangements to be developed and tested, and fine tuned prior to larger scale implementation. Failure to implement the new employment model in Scotland could result in doctors/ dentists in training continuing to be onboarded and exited multiple times during their training programme impacting on the overall employment experience and in limiting personal ambitions e.g. access to a mortgage. To mitigate this a Core Group has been established to oversee the implementation. Work streams and leads have been identified. Development of and agreement to an Employment Responsibilities Agreement also mitigates this risk. Poor communication with stakeholders could result in a failure to implement the model due to a lack of awareness and buy in. To mitigate this a stakeholder engagement and communications plan is being developed. Trainee representatives should be engaged across the project work streams. Digital technology and systems should be fully utilised to facilitate and enhance communication. 2

3 National policies are being developed to ensure doctors are treated consistently across specialties/ employers. Standardised documentation will also improve trainee experience and understanding of the model. Failure to understand the financial implications of the new model could lead to increased costs. The Employment Responsibilities Agreement sets out the financial arrangements under the new model and this can be developed by the workstream to include forecasting and monitoring of the cost of the new model. 10. Equality and Diversity Briefly describe: a. Any equality and diversity impacts or risks which have been considered and actions identified for mitigating any negative impact or managing risk. b. Opportunities identified for the work to reduce inequalities, advance equality of opportunity or foster good relations. c. Arrangements for completing an equality impact assessment (where the paper describes a new policy or workstream or a substantial revision to a policy or workstream). See guidance note on how to complete this section (available on Intranet, Meetings section). Your paper should include relevant details, including assessment of alternatives if required. As an integral part of testing through the Early Adopter work with NHS Grampian consideration will be given to an Equality Impact assessment that could be used to support the wider roll out of the model going forward. 11. Communications Plan A Communications Plan has been produced and a copy sent to the Head of Communications for information and retention: Yes No A Communications Plan format template is available in the Meetings and Communications sections of the NES Intranet. See paper for details. 12. Recommendation(s) for Decision The Board is asked to note the progress being made in developing structures to support NES as an early adopter of the new employment model for doctors and dentists in training. NES May 2017DSI, DW, MMcE 3

4 1. Summary This report describes the progress being made by NHS Education for Scotland (NES) in developing structures to enable the agreed employment model for doctors and dentists in training to be tested by NES in August Overview & Background the agreed employment model In October 2015, the Scottish Medical Training HR Subgroup (SMT HR Subgroup) was asked by the Chief Executives Group to take forward a Programme to enhance the employment of Doctors and Dentists in Training (DDITs). This project had the following objectives: Provide DDiT with optimum continuity of employment and positive employment experience across NHSS. Ensure consistent application of employment policies for DiT across NHSS. Minimise duplication or unnecessary processes in onboarding throughout rotations for clinical placements. Promote continuity and consistency in Payroll arrangements. Ensure access to appropriate and high quality training experiences. Effective information sharing and engagement between NHS Boards and NES in the management of performance and training of DDiT. In December 2016, agreement was reached on the following new employment model to deliver the above benefits: All Boards in Scotland would continue to employ DDiTs but that this employment would be based on programmes, and specialties, rather than location; DDiT would have one contract of employment for the duration of a programme of training; DDiT would be employed with one PVG and OH assessment at the beginning of training, rather than each time they changed Boards; DDiT would have a standard contract letter and communications, with single policies covering for example, travel, relocation, leave and previous experience recognition in pay; Boards would employ most DDiTs in programmes within a regional set up with some Boards being the single employer for national programmes; NES would employ all GPSTs in Scotland, throughout their training programme and All Boards would therefore be employing Boards and placement Boards (bar NES), sharing the employment responsibilities in a clear defined agreement. For an overview of the model see Appendix NES role in testing the model NES already has responsibility for the management and quality management of training programmes undertaken by DDiTs. The Director of Medicine has Responsible Officer accountability for all doctors in training (DiT) in Scotland. 4

5 Since 2011, NES has employed General Practice Specialty Trainees (GPSTs) 1 for the duration of their placement(s) in General Practice as part of the General Practice Specialty programme. NES also provides Tier 2 Sponsorship for all Specialty Doctors in Training and provides a PVG checking service for all doctors in training in Scotland. In the new model NES, will be the employer for all trainees undertaking General Practice Specialty Training. 2 This means that NES will employ all GPSTs as they move between hospital placements and general practice placements to complete their training programme. NES will be the employing Board and all the other Boards will be placement Boards for the GPSTs. NES has been tasked with testing the employing Board/ placement Board model for the GPSTs in August The other Health Boards will then implement the model across all the specialties on a regional basis from August Progress to date 4.1 Early Adopter Project It was agreed that NES would work with NHS Grampian as early implementers of the model from August 2017 to test the journey, processes and agreements before full implementation across all specialties. A Steering Group has been established for the early adopter work cochaired by the Directors of Workforce from NES and NHS Grampian and involving Medical Directors, finance and payroll colleagues, and trainee representatives. The General Practice Grampian programme has an establishment of 94, of which 50 are already NES employed and 43 are NHS Grampian employees (1 post is in Shetland). From August 2017, GPSTs in this programme will be employed by NES as the employing Board, and NHS Grampian will be the placement Board. This allows the two roles to be tested, and the Employment Responsibilities Agreement (section 4.2 below) to be fine tuned. If there are no major difficulties, more Boards can come on stream in February 18. During this time, the technical underpinning for information sharing can be put in place, working with trainees as well as HR and finance staff to ensure pay, terms and conditions and performance are managed with an improved experience for trainees who will not have to change employer when moving from secondary to primary care placements. Policies and single processes can be rolled out with the limited number of trainees, and will provide a clear test of the model so that in August 18 the move is as smooth as possible for the full implementation of the model across NHSScotland. 4.2 Employment Responsibilities Agreement In the new employment model, it is essential that the responsibilities of all parties are clarified and agreed. Drawing on other similar operating models implemented elsewhere in the UK, an Employment Responsibilities Agreement ( the Agreement ) has been developed 1 ~600 GPSTs employed by NES per annum 2 ~1,100 doctors in training on a General Practice Specialty Training programme in Scotland 5

6 by NES. At this stage, the Agreement has been developed specifically for doctors in training but can be reviewed to include dentists in training at a future date. The Agreement seeks to clearly describe the responsibilities of the 3 parties (i) employing Boards (including NES as the employer of GPSTs), (ii) placement Boards and (iii) NES. NES is acknowledged in the Agreement as a single legal entity, but it is recognised that NES and the other Boards may have dual roles within the model (i.e. NES as an employing Board and as the deanery; other Boards may be the employing Board and the placement Board). The Agreement is focussed on employment responsibilities and should be read alongside the training responsibilities described in the Service Level Agreement: Arrangements to support the delivery of undergraduate and postgraduate medical education and training in Scotland. The Agreement articulates and emphasises the responsibility of all parties for the flow of information to the Responsible Officer regarding doctors in training. It also provides clarity around the clinical governance arrangements, the placement Board retaining clinical governance responsibility for its patients and for those engaged by the placement Board to deliver clinical care to these patients. The employing Board must be able to demonstrate that it is the employer and has sufficient control over the employment relationship should this ever be tested at tribunal. The Agreement has been developed to ensure that the employing Board retains responsibility for communicating terms and conditions to the employee, and the placement Board has the scope to manage the day to day supervision of the trainee (including rota management and issues of clinical governance). 6

7 4.3 Communications Table 1 below identifies key milestone communication deadlines for the early adopter work. The extranet is currently utilised to communicate with those GPSTs employed by NES and this will be extended to cover those employed by NES, where NHS Grampian is the placement Board. Future communications may be developed on Turas. Table 1: Communication Milestones Date Activity Milestone May/June 2017 June August Communication to all those on GPST Grampian programme regarding early adopter programme. 2. Offers issued to new starts and preemployment checks. 1. Placement letters issued and ERAs signed. 2. Work commences on digital solution 1. Grampian programme GPSTs all commence as NES employee Newsletter/ s. Offers issued Chief Exec sign off on ERA Project report Contracts issued 21 Nov day review of early adopter project Recommendation to Steering Group 2 Feb Contracts issued to existing Grampian GPSTs. 2. Second phase early adopter starts March Review of early adopter and progress toward full model implementation readiness: Go/No Go recommendation Contracts. Recommendation Core Group A full communications plan for the implementation across all specialities is being developed by the SMT HR Sub Group. An overview of the model is being presented (by the SMT HR Subgroup Chair and Co Chair) at the NHS Scotland Conference in June. 4.5 Systems At the core of the new employment model is the ability to share information between the DDiT, the employing Board, the placement Board and NES (Scotland Deanery & Finance functions). Currently, Turas Trainee Programme Management (TPM) allows a DiT to be tracked throughout their training, showing their level, progression, any change to their working hours, additional time required to train, their trainers and their locations. The system also holds the pre employment information carried out by NES for PVG checks and visa status. There is therefore a single NES dataset on all DiTs in Scotland which shares a large number of fields with e:ess 3 (70% of data fields). to NES has been tasked by the SMT HR Subgroup with identifying how Turas TPM can be used to support implementation of the model in August The preferred option is a module added to Turas that wraps around e:ess to provide a front end that records more 3 NHSScotland HR system (not all Boards have completed implementation) 7

8 information. The module would be designed to focus and promote ease of data entry and self service for trainees and local managers to aid in the information flow. A full business case has been completed outlining the development work (and associated costs) required to support this additional Turas module. 5. Conclusions Through collaboration with NHS Grampian and the development of an Employment Responsibilities Agreement, NES will be able to test the employment model in August This learning can then be used to inform systems development and to further refine the model for further implementation across all specialties in Scotland, ultimately making Scotland the training destination of choice due to an improved trainee journey. The Board is asked to note the progress made by NES in developing arrangements to enable the agreed model of employment for doctors and dentists in training to be tested in August The Board is asked to note that NES and NHS Grampian will work as partners in early implementation and testing of the model of employment. Morag McElhinney HR Business Partner May

9 Appendix 1: Employment Model for DDiT in NHSScotland 9