Guidance

Job planning for consultants: a collaborative approach

Guidance on consultant job planning has been released following agreement between the BMA and NHS Employers.

Managers and consultants will need to work even more closely together to ensure that NHS organisations are able to meet the challenges created by structural change and financial pressure. Effective job planning is a key mechanism through which consultants and managers can agree, monitor and deliver this shared responsibility.

Here’s a summary of the guidance:

A job plan can be described in simple terms as a prospective, professional agreement that sets out the duties, responsibilities, accountabilities and objectives of the consultant and the support and resources provided by the employer for the coming year.

However, in order to drive measurable and sustainable improvements in quality, an effective job plan needs to be more than a high level timetable which sets out in general terms the range of a consultant’s activity. It is vital that it articulates the relationship between the organisation and the consultant and the desired impact on patient care.

Key principles

Job planning should be:

• undertaken in a spirit of collaboration and cooperation

• completed in good time

• reflective of the professionalism of being a doctor

• focused on measurable outcomes that benefit patients

• consistent with the objectives of the NHS, the organisation, teams and individuals

• transparent, fair and honest

• flexible and responsive to changing service needs during each job plan year

• fully agreed and not imposed

• focused on enhancing outcomes for patients whilst maintaining service efficiency.

Objective setting

Objectives should be set for most of the activities the consultant has in their job plan. This can be explicit – in a stated objective, or implicit in the agreed job schedule and annually agreed Programmed Activities (PAs) delivered. They should set out a mutual understanding of what the trust and consultant will be seeking to achieve over the year and how this will contribute to team, service and organisational objectives.

Clear objectives provide focus for consultants and managers and will help with both service provision and quality improvements. Objectives may be ‘hard’, relating to quantifiable achievements, or ‘soft’, where they may be more descriptive about how someone goes about their job.

The process should follow the SMART formula: specific, measurable, achievable and agreed, realistic, timed and tracked.

Objectives should cover all aspects of a consultant’s role; direct clinical care (DCC), supporting professional activities (SPAs) including personal development and those which are more professionally oriented and academic sessions, where appropriate.

All objectives should ultimately focus on the benefits to patients, and remain focused on key strategic and service aims.

Team planning

The team of consultants should meet and look at the team’s objectives for all. Individual consultant objectives should link to the team objectives and individual job plans should be considered collectively to see how they fit together and work as a whole towards meeting the needs of patients.

The clinical director’s aims should be to:

• enhance the quality and efficiency of patient care

• remove unnecessary duplication of effort amongst the consultant and wider medical team

• achieve comprehensive coverage of the SPA and other non-clinical work needing to be done. An example would be the contribution of the consultants to delivering the education and training of junior doctors

• assure that responsibility for this work is shared and does not rest with one individual consultant

• provide the supporting resources needed for this work

• regularly monitor progress.

Pay

It is the norm for consultants to achieve pay progression, but progression is not automatic. Consultants should not be penalised for failing to meet objectives for reasons beyond their control, such as illness, whether this is due to a lack of agreed supporting resources or another reason. However, both employers and consultants have a responsibility to identify potential problems with achieving objectives as they emerge rather than waiting for an annual job plan review meeting.

Supporting resources

The job plan review should identify and agree the resources that are necessary if the objectives are to be met. There is no point in agreeing objectives if they cannot be realistically achieved.

Not completing an objective may be because of a lack of necessary resources or the existence of organisational barriers to progress. If this happens the consultant and manager should meet to discuss how such barriers could be overcome at the earliest possible opportunity.

Preparation

Preparation is the key to effective job planning. The teams should meet beforehand so that job planning flows naturally from organisational and team objectives and that job plans are not drawn up in isolation. Some of the areas the team should explore include:

• mapping the current commissioning and contracting environment, including expectations for the coming year and beyond

• reviewing the previous year and identifying what went well and where there might be areas for improvement across the organisation/directorate

• identifying the actions and resources needed to improve quality

• reviewing areas of strength and weakness and methods to maximise the opportunities and minimise the possible threats

• identifying the priorities the organisation(s) and the team(s) want to deliver and the shared objectives which might influence job plans

• setting out what will be needed to meet clinical governance requirements, including education, training and research

• improving the use of data in setting objectives and the job plan

• linking to personal objectives around appraisal

• determine any known or likely significant demands on consultant time away from the trust (for example, senior college roles) that will impact on service delivery.

The NHS Quality, Innovation, Productivity and Prevention (QIPP) challenge and CQUIN (Commissioning for Quality and Innovation) are encouraging NHS organisations to think critically about how they can continue to improve the quality of the care they provide and to do so more efficiently. It follows that job planning should also focus on outcomes and the patient experience.

The job plan diary has the potential to provide the most immediate piece of data on activities undertaken by consultants, which can then be supplemented by other sources of information, for example Finished Consultant Episodes (FCE) spells linked to service level agreements.

Some of the data being used to assess the productivity of consultants can be limited in scope, and can fail to measure quality of care or reflect the intricacies of patient care and how consultants contribute to that care. Those involved in job planning should bring all the relevant data needed to plan the activities for the coming year.

For example this could include:

• a working time diary

• appraisal and agreed personal objectives

• any academic objectives

• service business plan and performance over past 12 months covering the ‘whole practice’ of the consultant

• individual performance over past 12 months

• information on activities undertaken in supporting professional activity (SPA) time, such as audits, teaching, clinical management and CPD

• relevant specialty advice, for example, royal college and specialty association guidelines

• evidence of the benefits of external duties/work for outside organisations to the trust and local patients.

The job planning process

It is important that at the outset there is a common understanding of the purpose and scope of the meeting. At least an hour should be set aside for the meeting at a time when all parties are free of other commitments and can avoid interruptions.

The job planning meeting will generally take place between the individual consultant and their clinical manager (who will usually be the clinical director) and academic manager for clinical academics.

As objectives are at the heart of the consultant job plan it is best to start by reviewing the objectives from the previous job planning round. If any have not been achieved then the reasons for this should be explored in a non-critical fashion. If any change in overall direction of the consultant’s job plan is anticipated this should be discussed at this point.

The next step is to consider what objectives are appropriate for the new job plan. It may be helpful to consider the organisation’s objectives and ask the consultant how they think they can contribute. This should lead to the agreement of a new set of objectives for the coming year. It can be entirely appropriate for some of these to be identical to the previous year’s objectives but, in general, to have a completely unchanged set suggests poorly chosen objectives.

Once the objectives are agreed, the resources required to achieve them should then be considered. These could, for example, include clinic or operating theatre time, support from other staff, SPA time, or secretarial and IT support.

Disagreement

The job plan is so central to the work of consultants that it is worth taking the time to get it right. If an element of the job plan cannot be agreed then it may be best to leave that issue for further discussion at another time.

Both parties should consider if they can meet half way for example, where there is an activity that the consultant wants to continue but there seems little room within the overall PA envelope for it, alternating this activity with another on a weekly basis may satisfy both parties.

An alternative strategy may be to suggest a trial of a particular job plan and schedule a review within six months. While there is an agreed process for mediation and appeal, it is best if the parties can arrive at an agreed job plan by themselves.

End product

A job plan should include:

• a timetable of activities

• a summary of the total number of PAs of each type in the timetable

• on-call arrangements i.e. supplement category and rota

• a list of agreed SMART objectives

• a list of supporting resources necessary to achieve objectives

• a description of additional responsibilities to the wider NHS and profession

• any arrangements for additional PAs

• any details of regular private work

• any agreed arrangements for carrying out regular fee-paying services

• any special agreements or arrangements regarding the operation/interpretation of the job plan

• accountability arrangements

• any agreed annualised activity (annualisation is an approach to job planning in which a consultant contracts with their employer to undertake a particular number of PAs or activities on an annual, rather than a weekly, basis).

Read the full guidance.

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