Job Planning - How to do it and why it matters (7 Dec 2023)

SPEAKER_01 0:13

Hello and welcome to Consultant Conversations brought to you by the recently appointed Consultants Committee at the Royal College of Physicians of Edinburgh. My name is Helen Liddycoat. I am co-chair of the Recently Appointed Consultants Committee and a respiratory consultant working at NHS Tayside. This podcast has been developed to support early career consultants, and today I will be discussing job planning, how to do it and why it matters. We will begin with the nuts and bolts of job planning to try and give you all the essential information you need. Following this, I will be joined by my colleague, Dr. Gary Campbell, who is a consultant nephrologist, to discuss our experiences of job planning and why it's important to get it right. Supplementary materials to support this podcast will be available to help with all the numbers and maths. Let's start with the nuts and bolts of job planning. On the face of it, not the most inspirational or stimulating topic, but bear with me, as I personally think a good job plan is key to well-being and job satisfaction. It's also very different to a standard rotor, which trainees often use to define roles and responsibilities, and is therefore one of the first things you might encounter as a new consultant. I wish I had known more at this point of my career, as sadly I know of many circumstances, my own included, where new consultants' job plans have been really difficult to deliver, and this has made the transition to consultant harder than it needs to be. So I really would encourage everyone, even prior to starting posts, to review and discuss the proposed job plan and talk to people about that. The technical definition of a job plan is an agreement between the consultant and employers that sets out a consultant's duties, responsibilities and objectives, which should include your personal objectives and how these also align with the organizational priorities. It's an annual process, mostly performed with a slightly fiddly IT software system, and at its best, according to NHS employees, it should be undertaken in a spirit of collaboration or cooperation, not just a timetabling exercise and a great opportunity to drive improvements and quality of patient care. Now, I do actually believe all those things, but what I've seen is that it's more of a negotiation and a time to assert what you need in order to deliver patient care and develop your career interests. Consultant job plans are split into blocks of time called programmed activities or PAs. Within hours between 7 a.m. to 7 p.m., Monday to Friday, 1 PA equates to 4 hours. Outside of this is premium time, and 1 PA equates to 3 hours. A doctor working full-time will be on 10 PAs across the week. Therefore, if you're working sessional time in the evenings or weekends, you can take this time back during the week. Many doctors choose to work additional or extra programmed activities called APAs or EPAs. This is any work additional to your 10 PAs. It requires a separate contract that often has a shorter expiry date. For example, my EPAs could be removed with a three-month notice period. Income earned over 10 PAs is non-pensionable, so money that you earned doesn't go into your pension pot. Programmed activities can be split into direct clinical care and supporting professional activities, SPA. DCC is any work that involves the delivery of clinical services and admin related to them. SPAs underpin clinical care and contribute to professional development, including roles such as teaching, clinical governance, clinical management, appraisal and revalidation, audit, and your own CPD. Within model contracts across England, Northern Ireland and Scotland, it is advised we should typically have a split of 7.5 PAs and 2.5 SPAs. This is a 7-3 split in Wales. The model contract states that this is not a universal allowance, and in reality, SPAs have been significantly reduced in many hospitals. However, at the minimum, you should be seeking one SPA for your own CPD. This comes from advice from the Academy of Royal Colleges, of which the RCPE is part. And if you're an educational clinical supervisor or have any additional roles, you will likely need a further one SPA to support this. There are guidelines related to this from each of the health education bodies across the UK that you can use. In addition to DTC and SPA, you may have additional roles at a given PAs, for example, roles in clinical leadership, quality improvement, research or education. I'm going to talk now about annualising your job plan. I found this particularly confusing, so I'll try and explain it as best I can. Essentially, you can only deliver your allocated sessions within working weeks. Once you take away annual leave, bank holidays, and study leave, this is generally accepted to be 42 out of 52 weeks per year. Therefore, when planning your rotor, you can either work out and place the number of sessions you need to deliver across the whole year. For example, if I deliver one clinic per week, I would need to plan 42 clinics per year and can slot my annual leave in at other times. Or if your router includes your annual leave, for example, if you're part of an acute medical rotor and would need to move sessions to create space for this, your sessions may be annualised. For example, 1PA in the AMU would count for, wait for it, as a bit of math, 52 divided by 42 times the 1PA, which is equivalent to 1.24 sessions. More departments are annualising job plans and creating flexibility by allowing different working patterns at different times of the year. So it's good to know how to do this. Admin time is really important to consider in your job plan because there's a lot of it. Admin time for clinics should normally equate to one hour for four hours of work or 0.25 PAs for one PA. Therefore, taking the example above, the number of clinics I need to perform for one PA of time per year would actually be 42 times 0.75, taking away the admin, which equates to 31.5 clinics per year. Admin time for other roles is often individually negotiated depending on the role, but my advice is really that you always try to get time for it. On-call supplements can vary between 1 to 8%, and these are calculated based on your likelihood of your needing to return to the site or complexity of telephone consultations combined with the frequency of your on-call commitment. And I've put details of that in the supplementary materials. A note on less than full-time posts, which is how I started my consultant career, you should be eligible for the same amount of SBA activity described above, although this is often a point of negotiation. If you have a contract with less than 10 sessions, even if this includes extra or additional PAs, this will still all contribute to your pension. Lots of less than full-time consultants end up in the position of starting with a contract and building on this with additional PAs over time. For example, I actually started with a contract of five PAs and then picked up another three and even more EPAs over time. It's really worth renegotiating this over time and getting your extra or additional PAs included in your main contract for better job security. Because as I said earlier, these EPAs could all be taken away over a short period of time. Remember that if you're undertaking private practice, even if it's out of NHS hours, then this should form part of your job planning discussions. Another top tip about job planning software is to ask a colleague for help and how best to input different parts of your job plan, as some of this can be a bit tricky, and there's often multiple ways of doing this. So it's a good idea to look at their job plan and see how they've inputted all that data to help you out a bit and make it easier. Often takes a bit longer the first time you do it and then gets easier the next time. We've covered the how to do it, and now I'd like to welcome my colleague, Dr. Gary Campbell, who's a consultant nephrologist at NHS Tayside, to discuss further why it matters. Gary, thank you so much for joining us.

SPEAKER_00 8:24

Thank you very much for having me.

SPEAKER_01 8:25

So, what advice would you give to a new consultant about job plans before starting a post? And why do you think it's so important?

SPEAKER_00 8:33

So, if I go back to my own experience, I've been a consultant in two different hospital, well, trusts and boards. The first was in England and the second here, obviously, in Scotland. When I was invited to do this podcast, I thought a little bit about my journey up to the point of becoming a consultant. And I suppose the first thing to say was I never worked an EWTD compliant route in my training. So the first thing you do with that is you're sort of unlimited with how much work you do. You're given a 100% supplement for your own calls, and you're then sort of unlimited in how many hours you can work. And then with my first consultant post, it was a replacement post for a senior consultant colleague. And the first thing you do then is a 12 PA job plan and saying your EWTD waiver, and again, then you're sort of unlimited in the hours that you work to some extent. And that perhaps should have rang some alarm bells, but you're just so appreciative of finally landing a consultant post that you kind of are just willing to take on anything. So I suppose it depends what sort of post you're going into. Is it a new post that's just been created or is it a replacement post? And is there an expectation that you almost walk straight in and fill the shoes of whoever vacated the post? If it's the latter, I think you have to be very careful because what a seasoned pro of 40 years experience can do in a week will be far greater than a new consultant. They will know the nuances and the ways of cutting through a lot of the bureaucracy and just will be a lot quicker at doing the same job.

SPEAKER_01 10:09

Time to bed in.

SPEAKER_00 10:10

Yeah, absolutely. I would hope that nowadays whoever is employing you will look at the job plan and draw up something that is fair and representative. But that I think in most of my colleagues' experiences is not the case. What's written in the job plan of what you end up doing week to week is not the same thing.

SPEAKER_01 10:29

I really echo that. I think it's really important to look at your job plan before you start and see if it's got a good balance of things like direct clinical care and other activities and whether it gives you time to develop your own specialist interests, whether or not you're starting from scratch or picking up the previous job plan. And sometimes just by looking at the job plan, you can look at it and see, hang on a minute, I'm working across three different areas here with three different teams, and I'm doing a huge amount of DCC, and that probably isn't going to work. So I think that's a starting point.

SPEAKER_00 10:57

Yeah, no, absolutely. And I think also your training will have identified areas that you're particularly interested in, and perhaps you've done an out-of-program MD PhD in a certain area, and you really want to utilize those skills. So I think it's really important that you have that discussion up front to say, look, I've actually got a lot of experience I could bring to your department in this area. Okay, you want to fill this gap in the service, but actually I'd probably be better doing this part of the service and somebody else could perhaps move sideways into that. I suppose in the first six to twelve months, you really are just getting your feet under the table. You're trying to work out how the hospital in the department runs and the culture of the place, get to know the faces around you and let everyone get to know your face. Probably that first year is just treading water, and then that's probably when the first proper job planning conversation comes into play. Then you could say what's working, what's not, what could be better for both you and your job plan. I wasn't verbalizing all this, I'm thinking, and I should really take my own advice because it's not something I've really ever done.

SPEAKER_01 12:01

So, Gary, in your experience, how can a job plan affect your well-being at work and satisfaction with your job?

SPEAKER_00 12:09

So, going back to my first consultant post, I was there for seven years, and by the time I left, and I did leave it because of work-life balance and a lack of acknowledgement from the NHS trust and management about the workload and the effect that the workload had, and a resistance to change because change has a knock-on effect on other departments and other individuals who were protecting their own job plans. By the time I left, I was on 14 and a half PAs, but my BMA job plan was coming out at over 18. And at the same time, I had three children all under the age of five with no relatives or family support in the whole of England. It was really tough. And those seven years, if I had any inclination that things were going to get better, then I probably would have stayed, but the direction of travel was the wrong one. If I I never had a job planning meeting in the whole time I was there, and if I did, it was very much a tick box. It was just this is the amount of work, this is the number, and at the time there's only five nephralogists covering a catchment of just shy of a million. Basically, we we split the work five ways, and the job planning and PAs and tariffs just didn't come into it. And that perhaps was a failure of the clinical lead of the department as well to sort of I suppose once you get so far behind the curve, it's very hard for an individual department when you're cash-strapped. And of course, this was around the time of the first sort of financial crash in the late Gnothsies. So there was just no money to pay for more consultants in lots of departments. And if your job planning had been so poorly organised in the decade running up to that, then you were never going to sort of catch up with the curve.

SPEAKER_01 13:52

Things have hopefully improved since then, and the fact you have to do this in on an annual basis is really helpful, isn't it, to try and kind of break that cycle. What do you think you've done, or how do you think you leveraged a better job plan now? It might not be perfect, but it might be better than that.

SPEAKER_00 14:07

No, it's definitely not perfect, but I think to some extent my bluff was called. Uh, you know, I had threatened with my prior employers. It was all to do with staff retention now. And in fact, two out of the five consultants left within a fortnight, which was pretty devastating for the department and was sort of a bit of a nuclear option. And it was the two latest into the department with the first two to go. And I think when you are a new consultant, you're very keen to please, you have that new consultant sort of concerns that you really want to prove yourself. You don't want to drop a ball, that you're perhaps a bit slower but a lot more thorough than perhaps some of your more senior colleagues who, you know, can commonly do the job with their eyes shut. So you, you know, you will take longer, and perhaps that's reflected in just how many hours you're putting in the week, that you know, that will get better as time goes on. But coming to this current job plan, again, you know, the same issues still affect NHS Scotland, but to a lesser degree, I think, you know, that you just need to look at the population difference and the number of trained doctors that are in Scotland compared to England to see that you're never going to, I think, get such extremes. But undoubtedly, you know, that's not to say that jobs are easy up here. And ultimately, if you end up still taking on more work than your PA allocation, then you do run the risk of poor job satisfaction and increased stress and ultimately burnout. If you don't really get a good job planning review and address those concerns that, you know, if you feel you're just Cinderelling some of your responsibilities, then that just leads to sort of a buildup of stress that affects all aspects of your work.

SPEAKER_01 15:50

Yeah, I agree. I think it's really interesting when you talk to different people about at their approach to job planning. I think often different departments and different specialties do this quite differently. Do you think we're that generous in medicine, often with the time that we give to do certain things? I know that one of my anesthetic colleagues, before she has a job planning meeting, audits everything that she does in a few weeks and the time taken to do all of the tasks in her job plan and uses that to say, okay, actually, this is in reality how much time it's taking me to deliver this quality of patient care. And she sort of uses that for negotiation because I've often thought that some of the things that we are asked to do don't really add up with the time that is in our job plan. I don't know if you've got any advice on how to approach that negotiation and how to approach job planning discussions with your team or your clinical lead.

SPEAKER_00 16:37

I think your colleague has a very healthy approach. If you're a member of the BMA, you can have access to the BMA diary. It's quite work-intensive, you know, it's every sort of 15-minute leap slots. But I haven't done it in years, but when I did do it, it's fascinating because you know you're busy, you know that your working day sort of full, you work over your lunch or whatever, and you're answering emails and doing your admin. But when you actually document it and you see the split and you realise that your SPA is always getting eroded by the DCC stuff, having that on paper is this sort of irrefutable evidence that what you're working is beyond your job plan is a very useful tool, I think, if you really do feel that your job plan needs a major review.

SPEAKER_01 17:21

The other thing that's really fascinated me is how different job plans are between consultants in departments, especially the consultants who are new and consultants who've maybe been there sort of in excess of 10 years. And I wondered what you thought about whether consultants' job plans should be published, because it's often quite a secret thing, but no one really knows in a department what anyone else is actually supposed to do.

SPEAKER_00 17:44

You're absolutely right. And I think you can sometimes look longingly at a colleague who seems to have a similar PA allocation yet have an awful lot more redundant time. I think certainly in our own departments in the last couple of years, I think we have tried to increase that transparency. We've tried to allocate tariffs for different parts of our work and a standardization of what we expect you to deliver to acquire a PA and the things that we all rotate around and we all share the same responsibility for that standardized so that one person isn't getting two PAs for it and someone else is only getting 0.75. So I think that's very important. I think you can look within a department and go, right, everyone has to cover the ward, everyone has to cover anaphrology clinic, you know, these sort of things are giving us a tariff. But equally, if you see two patients a fortnight, that's not one PA's worth of work and somebody else is squeezing 14 or 17 patients in a clinic. So again, clinic bills have to be similar as long as it's a similar type of patient that's coming through the door. Obviously, super specialist areas will require longer. But I think having a sort of standardized route to the things that can be standardized and giving a reasonable tariff, some of these things will be agreed at a national level. But if not, then coming up with something that is reasonably acceptable locally, like a local tariff for workload that will be agreed by the managers as well.

SPEAKER_01 19:10

Yeah, it's a good idea. Because there are some things that you can fix like a DCC as you discuss, and then SPA times and are the big ones. When I started, I think I was offered 0.5 as an SPA. And at the time I was only working sort of 70%, but it still didn't seem like enough. And then I think some of my colleagues were on 2.5 for a full-time post. So actually one of the things that happened during COVID was that our jobs became more transparent as well, and everyone's now on more of an equal playing field, too. So that's really good. But I think, you know, naturally, because we've all got different specialist interests, it is nice that your job plan is flexible to allow that. And you know, while I might have some PA time for quality improvement, my colleagues have got research and other things. So yeah, I suppose no one's job plan is going to look exactly the same, but it's nice to know that those key components are fair among teens, isn't it?

SPEAKER_00 19:57

Yeah, absolutely. And I think you're right, there's a lot of older job plans that have two two and a half PAs on it. But I think there has to be something measurable out of that SPA time as well. And if there isn't, then they shouldn't be set in stone either. I think, you know, if literally you just need one for CPD and you're not actually supervising or doing other things, then I think that's a PA that could go back in the pot or be converted to DCC. You know, resources are finite, and if it's clear that the work's not getting any less, then I think we have to really cut out any dead wood in people's job plan just to make sure. And that's not saying that you have to run to the wire and risk burnout as well. I think it is just making sure that there's that little bit of redundancy in everyone's job plan rather than just in some members of the team's job plan or other departments. You need to make sure that there's a bit of resilience built into every department.

SPEAKER_01 20:49

It's clear that it's very much about having a conversation, isn't it? That these things are just about talking together and working out what's best for us as professionals for our work and well-being, but also for patients to make sure that we can continue to provide the patient care that you want. And I think when I initially saw job plans, it seemed very, very thick. I have realized that it is about negotiation and conversations and kind of working together over a period of time, like you say, as you get more experienced and know what it is you want. I think it's important to say that if you're I'm happy with your job plan, there are kind of more formal steps that you can take. So most people are able to resolve any issues just by talking to their clinical lead and clinical directors, but you can request mediation through your organisation, which initially is still an informal process, usually led by a medical director, and then can even go up a level to become a formal appeal that goes to a panel and then the trust board. But I think just by sitting down and talking, most things are normally worked out. And obviously, again, the BMA can support that process if you are that unhappy with your job plan. Thank you so much, Gary. It's just been so insightful to learn about your experiences and really valuable for especially early grade clinicians to hear that and how they can improve job plans and improve their working lives. So thank you so much for sharing all of that with us.

SPEAKER_00 22:05

Well, thank you very much for having me.

SPEAKER_01 22:06

I hope that you found this consultant conversation podcast on job planning helpful. Please do join us on other podcasts in the series produced by the recently appointed Consultants Committee for the Royal College of Physicians, Edinburgh.