- Briefing note for geriatricians on job planning

The new consultant contract is fundamentally different to the current consultant contract. The current contract states you will do a minimum of 35 hours a week for the NHS and stipulates a maximum 7 fixed sessions.

The new consultant contract is time sensitive, employs consultants for a minimum of forty hours a week, working to a jointly agreed job plan. It may vary from year to year. Equally, it may also vary where the Trust may ask (and pay for) work done over forty hours per week. The significant new benefit for geriatricians is that all work, such as post take ward rounds, relatives’ clinics, and multi-disciplinary meetings are now fully taken into account for those choosing to sign the new contract.

The two key documents for any geriatrician to read before starting this are:

• Job planning for the 2003 consultant contract; guidance from the central consultants and specialist committee
  
• Consultant physicians working for patients; the duties, responsibilities and practice of physicians, Second Edition, RCP (2001). Pages 142 - 149 set out the basis for job planning for specialist physicians in geriatric medicine.

Implications
There will be no one universal job plan for all consultant geriatricians. Indeed the RCP document states, “the work of individual geriatricians differs widely, both in content and load, across the UK. This reflects variation in local supporting services, specialist activity and geographical sites to be covered, as well as the involvement in acute work”.

BMA diary
To start job planning, a consultant should work their current job and complete the BMA diary over a 4-week period. It is self evident that for geriatricians, direct clinical care includes activities such as inpatient work (acute, rehabilitation, continuing care, referral work on other wards, case conferences and multi-disciplinary meetings, inter-specialty and interdisciplinary liaison regarding current patients); outpatient work (carers’ clinics, specialty clinics such as TIA and falls clinics, day hospital clinics and reviews, outreach clinics, and hospice work); and clinical administration (writing letters to GPs, corresponding with Social Services, phoning patients and/or their carers, reviewing the results of tests and getting investigations performed in a timely manner.

The document, Consultant physicians: working for patients, gives guidance as to the number of patients that an average consultant would see in an outpatient clinic, day hospital or as an inpatient service. It is clear that these are only indicative and will rise with the amount of clinical and administrative support available. This can only be agreed by local negotiation. However, the nature of a time sensitive contract is that if a 4 hour outpatient clinic, including administration, is regularly taking 6 hours, the Trust will need to pay for that whole 6 hours activity.

Using the BMA template, carefully recording supporting professional activities (training, education, CPD, audit, clinical governance, etc) will allow geriatricians to be able to demonstrate that they are already undertaking the full 2.5 programmed activities. Many trusts are happy for a degree of flexibility, for example, allowing one of these programmed activities to be carried out at home, at nights and at weekends, for activities such as preparing presentations, keeping up with journals etc. Where consultants find that they are undertaking more than 2.5 programmed activities in this area, they will need to discuss this with the Trust as it would be up to the Trust to decide if they wish to continue purchasing such extra work.

Additional NHS responsibilities
Many geriatricians have considerable additional NHS responsibilities. These may be formal posts such as clinical director, college tutor and other posts recognised by both the contract and the Trust. However, it is the nature of geriatric medicine that considerable time may have to be spent in meetings to deliver the National Service Framework, liaison with Social Services over issues such as reimbursement, and on service development issues with the PCT. This activity must be recorded through the diary exercise and, through the job plan review, will need to be negotiated as additional NHS responsibilities that the Trust require and, by implication, must recognise in the job planning review and pay for.

Domiciliary visits
Some geriatricians are still continuing to do significant numbers of domiciliary visits. These must be handled in one of two ways. Either the time for this is agreed within the clinical programmed activities of the working week and, under these circumstances, no fee can be claimed by the consultant. The other possibility is that the consultant will continue to do them in their own time (quite clearly outside of any programmed activity). Under these circumstances the consultant will continue to retain the fee payable.

Travelling time
Many geriatricians have to travel between multiple sites. Travelling time between sites (but not from home to the first site of work) is regarded as time to be taken off clinical programmed activities.

Two way process
As set out in the BMA document, the job planning process is a two-way process between a clinical manager and the consultant. It needs to set out the resources required to meet the objectives being agreed. It is certainly an opportunity for people to raise important questions about, for example, a junior doctor or secretarial support, particularly if increased efficiency or performance is being suggested through the annual objectives agreed at the end of the job planning exercise.

Both the old contract and the new contract have an appeals mechanism for people who are not happy about the job plan currently being done by consultants, but they may well wish to negotiate changes in the future. It is strongly advised in any case that might lead to appeal, the geriatrician should seek advice from the BMA Industrial Relations Officer at an early stage.

David Black