Validation Date: 22 nd April Ratified Date: 18/06/2014. Review dates may alter if any significant changes are made

Transcription

1 Document Type: PROCEDURE Title: Remuneration procedure for senior doctors Scope: Senior doctors, i.e. Consultants & Specialty and Associate Specialists (SAS) who may be expected to undertake additional duties to cover planned clinical activity arising from vacant posts or absent colleagues or may undertake additional duties for unplanned additional clinical activity. Author/Originator and title: Sonya Clarkson, Head of Medical Workforce Replaces: NEW Name Of: Divisional/Directorate/Working Group: Validated by: JLNC Ratified by: Trust Management Team, Chairman s Action Unique Identifier: CORP/PROC/640 Version Number: 1 Status: Ratified Classification: Organisational Responsibility: Human Resources and Organisational Development Description of amendments: Date of Meeting: Validation Date: 22 nd April 2014 Ratified Date: 18/06/2014 Review dates may alter if any significant changes are made Risk Assessment: t Applicable Financial Implications t Applicable Which Principles of the NHS Constitution Apply? 1-4 Issue Date: 18/06/2014 Review Date: 01/04/2017 Does this document meet the requirements of the Equality Act 2010 in relation to Race, Religion and Belief, Age, Disability, Gender, Sexual Orientation, Gender Identity, Pregnancy & Maternity, Marriage and Civil Partnership, Carers, Human Rights and Social Economic Deprivation discrimination? Initial Assessment

2 CONTENTS 1 PURPOSE SCOPE PROCEDURE Introduction Scope of Policy Short-Term Leave or / Absence Cover for Absent Colleague s Work during Core Times Cover For Absent Colleagues On Call Duties Prolonged Absence Remuneration Arrangements Additional Commitments t Related to On-Call Rotas Additional Commitments Related To On-Call Rotas Capacity Lists and other Capacity Work ATTACHMENTS ELECTRONIC AND MANUAL RECORDING OF INFORMATION LOCATIONS THIS DOCUMENT ISSUED TO OTHER RELEVANT/ASSOCIATED DOCUMENTS SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS CONSULTATION WITH STAFF AND PATIENTS DEFINITIONS/GLOSSARY OF TERMS AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL... 8 Appendix 1: Decision flow chart for unplanned absence... 9 Appendix 2: BMA advice on covering absent consultant colleagues Appendix 3: Equality Impact Assessment Form Page 2 of 12

3 1 PURPOSE This procedure offers clarity to all parties on how and when to apply the hourly rate agreed for extra clinical activity, as the best financial option to provide services for 52 weeks of the year, and when it is more appropriate to manage the agreed elements of the contract of employment. In addition, this procedure offers an understanding to all about the need for cross cover. 2 SCOPE To provide managers, who have responsibility for managing the medical workforce, with guidelines in managing the contractual arrangements for cross covering absent colleagues, if, how and when prospective cover has been planned within the job plan. To deliver the planned activity for that service and obtain the best cover from our existing Consultant Medical Staff who may have capacity beyond their contract to provide extra clinical activity. Consultants who have agreed to provide extra over and beyond contractual activity are remunerated for clinical activity on the same terms across the Trust. 3 PROCEDURE 3.1 Introduction The contract of employment states and may assume prospective cover has been agreed within the job plan where services have planned ahead (ref: paragraph 3, Schedule 2 of the Terms and Conditions of Service (2003)) The Trust policy CORP/PROC/602 Medical Workforce Absence further defines as far as is practical to mean cover will be provided for a maximum of 7 working days before formal review and recourse to this procedure or longer term recruitment cover plans. It is expected that an informal review will also take place after the first 48 hours Consultants are expected to undertake additional duties to provide short term cover for emergency and current in patient activity as a result of vacant posts or colleague s absent for a variety of reasons. These duties may include: On call cover Care for inpatients (outpatients under current review) Additional on-call commitments Consultants and Specialty and Associate Specialists (SAS) doctors may be asked to undertake additional duties in situations where additional activity requires covering in the department, such as additional capacity lists. Arrangements must be made to cover these above contractual duties and locally agreed payments will be paid for this unplanned additional activity. Page 3 of 12

4 3.1.5 SAS doctors who perform activities and/or are in roles where they manage patients autonomously (being responsible for their assessment and delivery of care episode without Consultant support), will be remunerated at a level equivalent to that of a Consultant. 3.2 Scope of Policy Consultants who may be expected to undertake additional duties to cover planned clinical activity arising from vacant posts or absent colleagues Consultants, Specialty and Associate Specialists (SAS) doctors who may be asked to undertake additional duties for unplanned additional clinical activity. 3.3 Short-Term Leave or / Absence Cover for Absent Colleague s Work during Core Times Annual leave and study leave are planned a minimum of six weeks in advance and it is expected that activity not listed in paragraph during core times of 7am to 7pm Monday to Friday will be cancelled, and emergency and current inpatient activity is covered by colleagues. It is expected that the work/activities that will be prospectively covered will be discussed and agreed through the Job Planning process It is deemed reasonable that cover for an unexpected short term absence (lasting up to 7 days) will also be covered and the practicalities of providing such cover should be determined locally by mutual agreement, in accordance with Medical Workforce Absence policy (ref CORP/PROC/602). For instance, it may be possible to re-arrange, by agreement, duties flexibly so that a consultant providing additional cover for an absent colleague can take time off in lieu later. Alternatively, duties may be re-arranged temporarily so that, for example, extra DCCs are worked to cover the absence, with SPAs time shifted to be taken at a later, more convenient date perhaps in lieu of DCCs at that time. Alternatively, or in addition, thought may be given to a temporary reallocation of specified responsibilities (with enhanced supervision as necessary) to an associate specialist or specialist registrar. When considering the practicalities of the arrangements for cover, the Head of Department and Directorate Manager must appraise all feasible options available and take into account the working hours and current workload demands of individuals, to ensure duty of care towards the employee are factored into the decision. The care of a patient is always the main concern for any doctor, and care must be delivered safely In the event that work cannot be cancelled, and there is no extra capacity within the individual s job plan, a doctor may be asked to provide direct clinical care cover for colleagues. Compensation, such as time in lieu or payment, for the additional work/ extra duties should be in accordance with the applicable contract. Page 4 of 12

5 Every attempt should be made not to disrupt the service, but equally consideration must be made by the Head of Department to ensure safe practice in accordance with the Working Time Regulations 1998 prior to making arrangements with a doctor to cover the short term absence or at least the appropriate Opt Out form has been signed by the individual Cover For Absent Colleagues On Call Duties In the case of short-term sickness absence and emergency/special leave, it is expected that colleagues will undertake the necessary cross cover (including on-call cover) for the first 7 days of the absence, without additional payment. On-call commitments will be organised with colleagues in order that adequate cover is maintained without the need for additional compensation. Exact arrangements for such cover should be agreed by the members of individual departments. Where arrangements have been agreed, the Head of Department will undertake a review after 48 hours of the cover is provided and confirm the arrangements in place for alternative cover should the absence exceed 7 days. 3.4 Prolonged Absence Where a colleague s absence is likely to be prolonged, for example, vacant posts, individuals may be asked to provide cover for direct clinical care and predictable oncall. These duties will attract additional remuneration at the locally agreed hourly rate until alternative arrangements can be arranged and ordinarily, should not exceed three months It is recognised that prolonged absence may give rise to increases in on-call commitments and may lead to additional programmed activities above those in the agreed job plan of individuals Where the absence is likely to be prolonged, the Trust will take all reasonable steps to recruit an NHS locum to cover the absent colleague(s) provided this is considered by the Head of Department to be the most appropriate course of action Where an NHS locum cannot be recruited, or it is not deemed to be the most appropriate course of action, the Head of Department will review whether there is any extra capacity within individuals job plan, and additional programmed activities may be offered on a fixed basis to provide direct clinical care cover for the absent colleague(s). Where this is agreed, the individual will be remunerated at their substantive rate of pay. 3.5 Remuneration Arrangements Additional Commitments t Related to On-Call Rotas Where the unplanned absence is likely to last for a significant period, it is envisaged that the services may approach individuals with extra capacity to provide cover for additional direct clinical activity in the form of operating lists, ward rounds, clinics and reviewing patients. Payment will be at the current agreed remuneration hourly rate for Consultants Additional Commitments Related To On-Call Rotas The new contract recognises on-call work through an availability supplement Page 5 of 12

6 (determined by the frequency and category of on-call work) and an assessment of the predictable and unpredictable emergency work reflected in the number of PAs in the job plan Where consultants agree to cover ad-hoc on call commitments for absent colleagues beyond 7 days absence, remuneration will be paid in accordance with the current agreed ad hoc on call commitment rates, available to view on the One HR website Capacity Lists and other Capacity Work Doctors are often asked to do additional operating lists, clinics, investigations or reports in order to reduce or maintain patient waiting times. One of the important principles within the Medical and Dental Terms and Conditions of Service is that individuals cannot be paid twice for the same period of time. For this reason, individuals must not, under any circumstances, do capacity lists or other capacity work whilst on-call The Trust will not, under any circumstances, ask individuals to do capacity lists or other capacity work whilst on call In accordance with the Trust s Senior Doctor Job Planning procedure, if individuals do capacity work during their SPA time, the displaced SPA will be performed at a specified time when the Consultant is not contracted to work for the Trust (such as an evening) through agreement and monitoring by the Head of Department. The individuals will be entitled to payment for the capacity work at the locally agreed remuneration rate and the displaced SPA will be offered back as time in lieu Consultants will be required to complete a time sheet detailing the additional duties, which will be countersigned by the Head of Department. These should be forwarded via the e-system to the Directorate Manager for counter signature. 4 ATTACHMENTS Appendix Number Title Appendix 1 Decision flow chart for unplanned absence Appendix 2 BMA advice on covering absent consultant colleagues Appendix 3 Equality Impact Assessment 5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION Electronic Database for Procedural Documents Held by Policy Co-ordinators/Archive Office 6 LOCATIONS THIS DOCUMENT ISSUED TO Copy Location Date Issued 1 Intranet 2 Wards, Departments and Service Page 6 of 12

7 7 OTHER RELEVANT/ASSOCIATED DOCUMENTS Unique Identifier Title and web links from the document library CORP/PROC/602 Medical Workforce Absence docx CORP/POL/504 Appraisal Policy For Medical Staff docx Page 7 of 12

8 8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS References In Full Crown. (1998). The Working Time Regulations Available: Last accessed 12/05/2014. BMA. (2014). Website. Available: Last accessed 12/05/ CONSULTATION WITH STAFF AND PATIENTS Name Designation JLNC meeting members 10 DEFINITIONS/GLOSSARY OF TERMS DCCs NHS National Health Service SAS Specialty and Associate Specialists SPA 11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL Issued By Sonya Clarkson Checked By N Ingham Job Title Head of Medical Job Title Director of HR&OD Workforce Date 22 nd April 2014 Date April 2014 Page 8 of 12

9 Appendix 1: Decision flow chart for unplanned absence Service identifies the need to cover an absent consultant Long term NO Is the absence likely to be less than 7 days? YES Short term Establish reasons for absence Start to source resources, agency and recruitment Commence team job planning Re-distribute oncall PAs Review intensity payments NO Is cover required to provide planned in patient activity? MAINTAINING PLANNED CLINICAL SERVICES QUALITY OUTCOMES YES Establish reasons for absence; Sickness Unplanned emergency Contractual cover may be applied, if practical, including on call Informal Review after 48 hours Formal Review after 7 days Has external resourci ng been found? NO Seek cover from existing Consultant workforce for those who have extra contractual capacity To undertake direct clinical care cover at the locally agreed rate NO Has predictable on call been covered? YES YES Cover has been agreed for an absent consultant Page 9 of 12

10 Appendix 2: BMA advice on covering absent consultant colleagues 43. Cover for colleagues absent through sickness Before the introduction of the 2003 contract, consultants in our Trust would normally automatically cover for a colleague's absence through sickness. Some of those who have taken up the 2003 contract are now questioning whether they have any obligation to continue to work in this way. There is acceptance of the need to cover the emergency aspect of work long enough for the Trust to employ a locum (perhaps 48 hours) but beyond this, some are of the view that these additional duties are not part of a consultant's contracted work and should be separately remunerated. As the work covered is not specified in their agreed job plans, these consultants are now asking for payment at an enhanced additional rate, equivalent to agency locum rates of pay. How should we deal with the requests for additional payment? Schedule 2.3 of the Terms and Conditions (T and Cs) contains a specific obligation that consultants are expected "in the normal run of their duties to deputise for absent consultant or associate specialist colleagues so far as is practicable, even if on occasions this would involve interchange of staff within the same employing organisation. This does not include deputising where associate specialists are on a rota with doctors in training". This is not a new requirement. It is expressed in almost identical terms to the obligation that arises from Paragraph 106 of the 'old' contract T and Cs. There is, therefore, a continuing general obligation to provide cover where practicable. Some Trusts have put in place a policy to cover this matter, an approach we would endorse. In the absence of such a policy we would offer the following guidance. Employers and consultants are encouraged to come to agreement locally on what is deemed to be practicable, what the proposed cover entails and establish that the work is of a suitable nature to be covered by the consultant. In establishing suitability, due regard must be given to a doctor's duty to recognise and work within the limits of their professional competence. It may be necessary to agree re-arranged duties for one or more consultants in the short term in order to provide adequate cover. In terms of remuneration, obviously it is not possible to schedule PAs for unexpected absences into a prospective job plan. There are a number of ways of addressing the issue of compensation for additional work. The 2003 contract is sufficiently flexible that the length of the working day (or week) is not expected to be the same week in, week out. It may be possible to re-arrange, by agreement, duties flexibly so that a consultant providing additional cover for an absent colleague can take time off in lieu later. Duties may be re-arranged temporarily so that, for example, extra DCC PAs are worked to cover the absence, with SPA PAs time shifted to be taken at a later, more convenient date perhaps in lieu of DCC PAs at that time. Alternatively, or in addition, thought may be given to a temporary reallocation of specified responsibilities (with enhanced supervision as necessary) to an associate specialist or specialist registrar. In the longer term, the question of additional remuneration may arise, including in respect of On-Call Availability Supplement (if the rota frequency has increased) and PAs for on-call work undertaken. These may need to be re-calculated. The formula for calculation and payment is that contained within the T and Cs. Schedule 16.4 of the 2003 contract T and Cs anticipates changes in rota frequency, which may require a change in On-Call Availability Supplement. Schedule 5 deals with recognition for work arising from on-call duties, while Schedule 13 deals with payment for additional PAs. In summary, cover for an unexpected absence is not 'extra-contractual' but is a contractual obligation for consultants, whether on the 'old' contract or the 2003 contract. The practicability of providing such cover should be determined locally by agreement. Compensation for the additional work should be in accordance with the applicable contract. Reference: Page 10 of 12

11 Appendix 3: Equality Impact Assessment Form Department HR Service or Policy Medical Page 11 of 12 Date Completed: 8 th May 2014 Workforce GROUPS TO BE CONSIDERED Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider community, offenders. EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic / deprivation. QUESTION RESPONSE IMPACT Issue Action Positive Negative What is the service, leaflet or policy development? What are its aims, who are the target audience? Does the service, leaflet or policy/ development impact on community safety Crime Community cohesion Is there any evidence that groups who should benefit do not? i.e. equal opportunity monitoring of service users and/or staff. If none/insufficient local or national data available consider what information you need. Does the service, leaflet or development/ policy have a negative impact on any geographical or sub group of the population? How does the service, leaflet or policy/ development promote equality and diversity? Does the service, leaflet or policy/ development explicitly include a commitment to equality and diversity and meeting needs? How does it demonstrate its impact? Does the Organisation or service workforce reflect the local population? Do we employ people from disadvantaged groups Will the service, leaflet or policy/ development i. Improve economic social conditions in deprived areas ii. Use brown field sites iii. Improve public spaces including creation of green spaces? Does the service, leaflet or policy/ development promote equity of lifelong learning? Does the service, leaflet or policy/ development encourage healthy lifestyles and reduce risks to health? Does the service, leaflet or policy/ development impact on transport? What are the implications of this? Does the service, leaflet or policy/development impact on housing, housing needs, homelessness, or a person s ability to remain at home? Are there any groups for whom this policy/ service/leaflet would have an impact? Is it an adverse/negative impact? Does it or could it (or is the perception that it could exclude disadvantaged or marginalised Target audience are senior doctors employed by the Trust and this procedure aims to provide a comprehensive and transparent framework for payment of additional activity. N/A Transparent and consistent practice on arrangements for payments related to additional activity Yes although scope is limited to a specific staff group Yes additional working is monitored regularly and considerations must be made in line with Working Time Regulations X

12 Appendix 3: Equality Impact Assessment Form Department HR Service or Policy Medical groups? Does the policy/development promote access to services and facilities for any group in particular? Does the service, leaflet or policy/development impact on the environment During development At implementation? N/A Workforce Date Completed: 8 th May 2014 ACTION: Please identify if you are now required to carry out a Full Equality Yes (Please delete as Analysis appropriate) Name of Author: Signature of Author: Sonya Clarkson Date Signed: May 2014 Name of Lead Person: Signature of Lead Person: Name of Manager: Signature of Manager Date Signed: Date Signed: Page 12 of 12