Contract Implementation

1

• Contract Implementation
• Amit Kochhar
• 20th January 2009

Northwest SAS Conference
2
History

• 23 May 2005 - Contract negotiations began
• 23 November 2006 - joint BMA/NHSe proposals for
  the new contract submitted to ministers
• 4 December 2007 - Contract released by Government
  with new provisos
• 15 December 2007 - Government response indicates
  no further negotiation.
• 4-29 February 2008 SASC Communication Events
• 17 March 2008 - Vote response received
• 1 April 2008 Implementation
• 9 September 2008 JNC (SAS) inaugural meeting

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Suggested Implementation Timeline

• 1 April 2008
• Contract Implementation Date
• Old AS Grade Closed
• During April-June 2008
• Employers will invite expressions of interest to
  the contract and SAS doctors will have 12 weeks
  within which to respond
• SAS doctors continue diary exercises (6- 12
  weeks)
• Before October 2008
• Job planning undertaken
• Before November 2008
• confirm prospective job plan
• Formal Offer of new TCS made to doctor
• February 2009
• Doctor paid arrears back to April 2008

4

• Structure

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Structure of the new contracts

• New single spine specialty doctor grade
• New (closed) AS grade
• For new AS and specialty doctor grade
• Similar contractual arrangements for both grades
• Similar career progression (incremental scale
  including 2 thresholds) for both grades
• OOH (out of hours) Time and a third for hours
  actually worked
• On-call arrangements 6, 4, 2
• contract available on an optional basis to AS,
  staff grades, S/CMOs, clinical assistants and
  hospital practitioners

6
Job Planning

• Initial Job plan is basis for contract crucial
  part
• Agreement between doctor and employer
• Before discussions - 12 week diary exercise is
  strongly advised
• Job plan review at least annually
• Sets out working arrangements
• - timetable of activities
• - responsibilities
• - personal objectives
• - supporting resources for coming year
• BMA/NHSE guidance on website on diary exercise
  and job planning

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Job Planning (2)

• Based on 10 PA contract
• - majority of PAs for direct clinical care
  (including associated admin)
• - At least 1 PA for supporting professional
  activities, such as CME (can be more).
• - Balance between SPA and DCC to be negotiated
  in each individual's case - expected to increase
  as one gains seniority.
• Feeds into appraisal and pay progression process
• Mediation and appeals processes if disagreement
  occurs

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Duties and responsibilities

• This should build on the previous duties,
  responsibilities and objectives as set out in
  your last job plan (if applicable) or as informed
  by your current work / diaries
• 4 types of Programmed Activities
• Direct Clinical Care
• Supporting Professional Activities
• Additional NHS responsibilities
• External Duties
• See TCS definitions for more detail
• Minimum 1 SPA for CPD etc but this should
  increase with seniority and will be reviewed at
  least annually

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Direct Clinical Care

• Work that relate directly to prevention,
  diagnosis and treatment of illness. It includes
• Ward rounds (preop, postop or other)
• OPD Clinics (activity and diagnostic care)
• Theatre lists (preop and postop care)
• Ward duties
• Reviewing results and Patient Management plans
• Admin related to patient care
• Team meetings and tel calls related to Patient
  care
• Travel time (to peripheral clinics or sites)
• Emergency duties
• Multidisciplinary meetings

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Supporting Professional Activities (SPA)

• Examples include participation in
• audit
• continuing professional development
• local clinical governance activities
• training
• formal teaching
• appraisal
• job planning
• Research
• Management
• Note All clinical associated administrative work
  (e.g. telephone calls, letters, reviewing results
  etc.) is part of direct clinical care.

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Additional NHS Responsibilities

• Dept of Health Working Party
• Clinical Manager Work
• Clinical Audit Lead
• Clinical Governance Lead
• College Tutor
• IT Discussion Group (eg. Lorenzo, C Book)
• Optional/Discretionary Panel Work
• Appeals Panel Work

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External Duties

• BMA Committees or other Trade union Activity
• Royal College/Specialty Association/GMC Work in
  the wider interest of the NHS
• Local Negotiating Committee work
• Trade Union Activites
• Work for a Government Department

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Portfolio development

• File for storing ongoing evidence of clinical
  work and professional development
• Essential requirement for
• threshold progression
• Also useful for
• appraisal
• GMC revalidation
• Article 14 PMETB applications (CESR)
• identifying training needs
• helpful to your career as a whole
• Contractual obligation for employer to support
  professional development
• See BMA guidance (members) on BMA website

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360 Degree Appraisal

• To pass either threshold doctors will have to
  have undertaken 360 degree appraisal/feedback (No
  pass or fail)
• Your employer should set up training on this
  process
• This criterion would be evidenced by written
  confirmation by the appraiser that a 360
  appraisal has been undertaken

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Specialty Doctor progression through threshold
one

• Must satisfy following criteria
• Made every effort to meet time service
  commitments in job plan
• Participated satisfactorily in appraisal process
• Undertaken 36o degree appraisal/feedback in yr
  preceding T1
• Administration/payroll process only
• Systems set up to pay the doctor automatically
• Will not be paid only if payroll informed
  otherwise
• Arrangements set out in the Terms Conditions of
  Service
• Appeals (including mediation) if problems
• All doctors expected to pass through level one.

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SD Progression through threshold two - criteria

• As threshold one plus
• Demonstrate an increasing ability to take
  decisions and carry responsibility without direct
  supervision
• Also, demonstrate contributions for example, to a
  wider role, meaningful participation in or
  contribution to relevant
• - Management or leadership
• - Service development and modernisation
• - Teaching and training (of others)
• - Committee work
• - Representative work
• - Innovation
• - Audit
• List not exhaustive but is intended to give an
  indication of the types of evidence. Overall
  picture will be considered

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New AS Grade - annual increments and threshold one

• Progression subject to
• Time service commitments in job plan
• Satisfactory appraisal
• Review job plan satisfactorily
• Met personal objectives
• Supported achievement of joint objectives
• Taken up offer of extra programmed activities
  in line with Good private practice conduct
• In order to pass threshold one - you must also
  undertake 360 degree appraisal / feedback in
  year preceding threshold one (point 5 on new
  scale).

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New AS GradeProgression through threshold two

• As threshold one plus
• Demonstrate an ability to make independent
  decisions about diagnosis, management follow up
  and definitive treatment within the defined field
  of expertise.
• Also, Doctors should also provide evidence to
  demonstrate, for example
• A proven ability to lead a team
• Regular completion of audits to demonstrate high
  quality work
• An ability to innovate within their area of
  specialisation
• Evidence of involvement in the wider management
  role
• Significant involvement in research or,
• A leading role in teaching.
• List not exhaustive but is intended to give an
  indication of the types of evidence. Overall
  picture will be considered

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Mediation and appeals

• Where there is disagreement between a doctor
  employer regarding threshold progression or job
  planning (including Job Plan reviews and interim
  reviews) there should be informal attempts to
  reach agreement.
• Where these have failed, the mediation and
  appeals process should be used
• Mediation
• refer the dispute to the medical director (within
  2 weeks)
• meeting, involving the clinical manager, the
  doctor and the medical director
• medical director will take a decision or make a
  recommendation to the chief executive of the
  employing organisation (within 10 working days)
• Appeals
• An appeal should be lodged by the doctor in
  writing to the Chief Executive (within 2 weeks of
  the mediation decision).
• appeal panel convened (to meet within 4 weeks)
• Appeal hearing (written and oral submissions) and
  decision
• BMA can support

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• The new contract
• Assimilation

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New Transitional Arrangements

• Transitional arrangements translate the original
  proposals so that all SAS doctors would receive
  half an increment in year 1 and a further half at
  the start of year 2
• During the course of year 1 doctors assimilated
  to a point below threshold 1 will move up one
  increment on the transitional scale at their
  usual incremental date.
• These transitional arrangements apply only to the
  pay increase of one extra increment and do not
  affect other elements of the proposal (eg AS move
  to 40 hours)

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Transitional arrangements continued

• If, during this assimilation only, a threshold
  would be passed the move will be automatic (no
  requirement to meet relevant criteria)
• During Year 1 doctors assimilated to points 0 to
  4 below threshold 1 on the transitional scales
  will move up one increment on that scale at their
  usual incremental date
• if as a result of this increment threshold 1
  would be passed the doctor must evidence meeting
  the threshold criteria before the move can be
  made pay will be backdated to the incremental
  date so long as this is achieved within 12 months
  of that incremental date
• 1 April 2009 all doctors will move to next point
  above transitional salary on the relevant final
  scale.

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SD Transitional pay scales (2008)
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AS Transitional pay scales (2008)
69,366
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Pay protection

• the vast majority of doctors should receive an
  increase in pay
• pay protection arrangements on assimilation for
  those who require them
• subject to the work contracted for in the new
  contract being of the same time and nature as
  work done under the old contract,
• any remuneration paid to an individual doctor
  under the national contract in force at the time
  will be protected.
• Protection will be at mark time of the value of
  payments as of 1 April 2008 plus the 2.2 annual
  pay increase recommended by the Doctors and
  Dentists Review Body for 2008/09 only.

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Window of Opportunity

• Those eligible can apply to re-grade to AS until
  midnight 31 March 2009
• Senior AS may be part of the panel (at employers
  discretion)
• Existing criteria and grievance procedure for
  re-grading will apply
• Re-grading dependent on employers discretion if
  there is a service need
• 4 million allocated in joint financial modelling
  for Window of Opportunity re-grading should not
  be denied for financial reasons
• Old AS grade therefore, closed to new applicants
  from 1 April 2008.

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• Considering making an expression of interest?

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Ready Reckoner

• Check what your estimated salary would be under
  the proposals
• Available on the BMA website
• Use diary planning exercise (over 6-12 week
  period)
• Guidance on using ready reckoner available on
  website

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Benefits of the new contract for individuals

• Pay rise for most doctors
• Job planning advantages and opportunities
• Guarantee of at least one SPA for CPD
• More transparent processes for progression
  through the scale (subject to meeting criteria)
• Abolition of optional and discretionary points
  (consolidated into salary).
• Clear mediation and appeals processes
• Pay protection
• Portfolio support

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Drawbacks of the new contract for individuals

• Loss of 11th NHD/paid ½ day leave (if applicable)
  
• No additional increment for those at top of grade
• Reduced premium pay time (16 hours to 12 hours)
• Some doctors currently have more advantageous
  local arrangements
• Reality of Window of Opportunity - will
  re-grading happen?
• Potential difficulties with progression through
  the grade
• Loss of fee payments in some circumstances
• Welsh good practice guidance allows for 20 of
  time for CPD Welsh SAS doctors may be
  disadvantaged
• Are TCS as clear as it was originally hoped?
• Closure of the AS grade no movement

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Additional points to remember

• BMA members will be able to get support as
  necessary via askBMA (0870 60 60 828) and the BMA
  LNC and Regional SASCs
• It might not be in everyones interest to change
  to the new contract with effect from 1 April
  2008.
• For some SAS doctors, such as those who have a
  reasonable expectation of receiving more than one
  optional or discretionary point payable from 1
  April 2008, it might be better to remain on the
  current contract initially and assimilate after
  the award
• You will need to make a decision based on your
  own personal and financial circumstances
• Express an interest in order to retain right to
  back-pay should the DP/OP not materialise.

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• No matter how long the job planning process
  takes, you will retain the right to backdated pay
  to 1 April 2008 if you have expressed an interest
  within the initial 12 weeks
• SASC will be working with NHS Employers to
  resolve any problems that emerge
• SASC will continue to create further guidance to
  assist members and will be working with BMA
  Regional Services to ensure the smoothest
  possible implementation.
• Current SAS doctors may remain on their current
  contracts indefinitely, if they wish, while
  retaining the ability to transfer to the new
  contract at any time they choose (although not
  then eligible for backdated pay to 1 April 2008).

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What action LNC's need to take

• Agree a local implementation framework
• Support those remaining on current contracts
  (Points awards)
• Support regrading applications within the Window
  of Opportunity
• Assist with assimilation (2007/08 points, job
  planning etc)
• Allocate time for consultants and medical
  managers in their own job plans for SAS job
  planning discussions
• Agree 360 degree process with employers
• BMA letter sent to all LNC chairs with more
  detail
• LNC Guidance available from IROs

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Main issues affecting contract implementation

• The majority of SAS doctors are expressing an in
  interest in the contract. However, a number of
  issues have been affecting the implementation
  process, including
• The failure of some Trusts to send out letters
  inviting SAS doctors to express an interest in
  the new contract
• The failure of some Trusts not to include
  non-standard non-training grades when sending the
  letters out,
• That some Trusts are seeking to timetable duties
  as half hourly units, and
• That some trusts are still failing to regrade
  eligible doctors

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What has SASC been doing to facilitate
implementation?

• Following discussions, a letter was sent to all
  MDs and LNC chairs in the UK, enquiring as to
  whether they were intending to offer the new
  contract to eligible non-standard grade doctors.
  Although response has been slow, those that have
  been received are broadly positive. In
  particular, just over half of the Trusts
  employing eligible non-standard grade doctors
  have offered them the new Specialty Doctor
  contract.
• Discussions were held at JNC(SAS) in September
  and NHS Employers have now included a statement
  in their September workforce bulletin and on
  their website, urging trusts to send out
  expression of interest letters and clarifying the
  funding for regrading
• Several guidance notes have been published on all
  aspects of implementation and SASC continue to
  monitor the situation

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Other developments

• 12m Funding for SAS development
• Choice and Opportunity Discussions
• SASC seat on NHS MEE
• JNC (SAS) ongoing discussions

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Information

• All guidance and updates at
• www.bma.org.uk/sascontract
• Members can sign up for
• email alerts
• SASC News on the website
• Encourage colleagues to join the BMA
• Contact askBMA with any queries