Guidance

Job planning and appraisal for consultants

In 2000, the NHS Plan called for a new career and reward structure for consultants that would raise productivity. It started a process of developing better arrangements for professional development and increased clarity around a senior doctor’s commitments.

After protracted negotiation and revision, the consultant contract was implemented on 31 October 2003. It’s a time-based contract with consultants employed to work a basic 40-hour week, divided into ten programmed activities (PAs). Seven and a half of these PAs should be for direct clinical care and associated administration, with two and half SPAs for career and service development and research. 

The contract is designed to pay consultants for all the hours they agree to work and to ensure that there is accountability for the work agreed in the consultant’s job plan. Most consultants are contracted to work more than the basic 40 hours and are now paid for this extra work at the same hourly rate.

Job planning for doctors

Job planning is a systematic activity designed to produce clarity of expectation for consultant and employer about the use of time and resources to meet individual and service objectives. A job plan review must occur at least annually and it culminates in a job plan meeting.

The review considers progress against agreed objectives and the factors affecting it. It is the opportunity to agree changes to duties and responsibilities, a plan for achieving personal objectives, the need for additional programmed activities, the relationship with other paid work, the support needed from the employer and establishment of eligibility for pay progression.

Similar information is required for the doctor’s job plan review and appraisal and the timing and inter-relatedness needs consideration.

Relationship between job planning and appraisal

The job plan is a prospective agreement setting out duties, responsibilities, objectives and supporting resources for the coming year and should cover all aspects of the consultant’s professional practice.

An appraisal seeks to identify personal and professional development needs. Appraisal is based on the GMC’s document Good Medical Practice (General Medical Council, 2001), which describes the principles of good medical practice, and standards of competence, care and conduct expected of doctors in all aspects of their professional work.

The process of job planning for doctors

A job plan should include the consultant’s main duties and responsibilities, the scheduling of commitments, the support needed in fulfilling the job plan, and personal objectives, including any continuing medical education and training, and their relationship with wider service objectives.

A wide range of people may be involved in the job planning process, including the consultant, clinical manager, general manager and chief executive. For clinical academic staff both NHS and university representatives should be present.

Prior to the job plan meeting, the two most important activities are collection of information and reflection. In addition, it is essential that the consultant has undergone their appraisal, resulting in a personal development plan (PDP).

The meeting must be informed by the job plan’s purpose which is to: prioritise work and reduce excessive workload, agree how a consultant can support the wider objectives of the service, agree how the NHS employer can best support a consultant, provide the consultant with evidence for appraisal and revalidation, and agree the appropriate number of programmed activities for the workload.

A partnership approach should be adopted to job planning. The consultant and the clinical manager will probably collect different supporting information and it is good practice to share this prior to the job planning meeting. Consultant information may include the previous year’s job plan, workload, clinical audit and governance issues, wider internal and external commitments, ideas for improving the service and the PDP from the appraisal process. 

The clinical manager may bring wider information such as quantity and quality targets for the directorate and performance against them, clinical audit and governance issues, proposed changes to service and changes in skill mix and numbers of staff. 

Both the consultant and clinical manager have to be aware of the effects of other initiatives and how the service offered needs to meet the service required. These could include changes in practices and services of other directorates or of other providers, national clinical audit and governance issues, change in requirements of local health community or tertiary referrals, even the requirements of doctors in training or education. 

Team approach to job planning

Team job planning takes account of the role of each team member in terms of service delivery and their achievement of team objectives. Team job plans can be powerful tools so long as each individual agrees to participate and that they still retain the right to sign an individual job plan agreement with the employer.

Job planning by team, rather than by individual, should not be viewed as a timesaving solution. If anything, it will take considerably longer and can be structured on a consultant-only or multi-disciplinary basis.

To team job plan the clinical lead needs to understand the demand, capacity and gap. They must determine what direct clinical care activities are required to deliver the full service, ensuring there is a detailed understanding of the consultant role and hours required.

Then individual work programmes need to be developed from the team job plan. Individuals should have personalised schedules based on their average NHS working week and any individual external commitments they may have. The team should agree and sign a ‘statement’ about how they work as a team, defining their shared objectives and detailing how they intend to share the responsibility of the team job plan.

A regular review is required to assess progress against the annualised job plan and to ensure working arrangements agreed remain the most effective and appropriate.

Flexibilities in job planning

Local contractual flexibilities can be introduced for those consultants on the 2003 contract. In work schedules, for example, the hours worked on a day to day basis can be varied. PAs can be worked in half units as well as whole, and the number of PAs per week can vary. A location other than principal place of work may also be agreed.

Pay progression for consultants

A key criteria for consultants to progress on pay is to have participated satisfactorily in the appraisal and job planning process; they must have done their best to work to the agreed job plan. They also need to comply with the provision for offering to perform up to one more additional paid PA per week if they wish to undertake private work.

Objective setting for doctors

Job planning is more than agreeing a timetable. The objectives should set out a mutual understanding of what the consultant should achieve over the period that they cover. An objective is a task, target or development that needs to be achieved. It should reflect the needs of the consultant, organisation and health community, and its resource implications should be known. 

A mix of objectives may be agreed. Some will be hard objectives – these refer to something quantifiable that must be achieved, such as meeting waiting targets or gaining accreditation. Some will be soft objectives – these refer to activities that are difficult to quantify. They describe how someone goes about their job, such as patient involvement.

Personal development objectives relate to improving skills or knowledge that improve care. While team objectives might include improving pathways and protocols. Performance standards can also be used to ensure performance doesn’t dip below acceptable standards.

To craft an objective the consultant needs to agree, with their clinical lead, the local priorities to be addressed; they need to define an objective for each priority; detail the actions required to achieve the objective; then agree the measures against which the objective will be reviewed, and how it will be monitored; and, finally, discuss the support required to achieve the objective.

It can by useful to use a framework, such as SMART, when discussing and agreeing objectives. SMART stands for specific, measurable (quantified or descriptive), achievable and agreed, relevant, timed and tracked. 

More guidance

See the Department of Health’s Consultant job planning – standards of best practice.

Many hospitals also have guidance, for example: Kingston Hospital, Cambridge University Hospitals, Oxford Radcliffe Hospital.

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