Consultant Job Description Checklist Advice for Regional Advisers Although this advice is intended for Regional Advisers, consultants drawing up job descriptions, CSAC chairs & those acting as assessors on advisory appointment committees may also find it useful The role of the Regional Adviser in approving consultant job descriptions: In commenting on job descriptions the central concern of the Regional Adviser should be the professional content of the post in relation to clinical, teaching and research work. The governance of the Trust is the responsibility of the Chief Executive. However, it is the role of the Regional Adviser to ensure that the conditions of the post will enable the appointee to work to safe clinical standards set by the College and other relevant bodies, without exposing him / her to professional risk in the discharge of his / her duties. Regional Advisers should look at the proposed job description in relation to other posts in the department, recognising that Trusts will often be seeking consultants to take specific responsibility for certain areas of activity (e.g. in service, teaching or subspecialty work). Early discussion with the Trust, and particularly the appropriate clinical director, is likely to be helpful in resolving concerns. Foundation Trusts are not under any statutory obligation to involve the Medical Royal Colleges in the approval of consultant job descriptions or the appointment process. However, in August 2005 the Foundation Trust Network, which represented all 32 NHS foundation trusts in existence at that time, signed a concordat with the Academy of Medical Royal Colleges to enable the two organisations to work together on the appointment of consultant medical staff. In our experience it is currently the exception rather that the rule for Foundation Trusts to fail to involve the RCPCH in consultant appointment processes. A list of sources for this guidance is given at the end of this document. Where relevant, our advice has been benchmarked against guidance released by other Medical Royal Colleges to ensure consistency of approach. However, Regional Advisers should not approve posts or job plans that do not meet the standards set out in A Charter for Paediatricians, which represents the specific principles of practice agreed by the RCPCH. Approval process It is important for Regional Advisers to respond to requests for job approvals in a timely manner (i.e. within 3 weeks). If awaiting advice from a specialist colleague, it is good practice to keep the Trust informed of progress. In all circumstances where additional advice is sought, the decision of the Regional Adviser is final. For speed of communication, it is usual for Regional Advisers to handle the initial advice and recommendations by email. However, once the job description has been finalised, the Regional Adviser should send a letter of approval to the Clinical Director and HR department of the Trust. A copy of the approval letter and the final job description should be sent to John Pettitt at the RCPCH. Where a Regional Adviser is concerned that an employer has chosen not to accept their advice they may wish to raise the issue with the College Registrar. This will not, however, prevent an employer advertising the post. 1
Conflict of interest If the post is based at the Regional Adviser s Trust, he/she should delegate approval to the deputy Regional Adviser or a Regional Adviser from a neighbouring region. If the post is based at the CSAC Chair s Trust, he/she should delegate approval to one of the CSAC training advisers. The Post: The job title should clearly define the post, and should specify the number of programmed activities (PAs). There should be a brief summary of the purpose and context of the post, which should guide subsequent action. It is useful, but not essential, to have an indication of whether this is a replacement or a newly established post. Question Is this an NHS Consultant post? Is this a Senior Lecturer post? Is this a specialist post* Is this a community post? Is this a neonatal post? Action Standard procedure See section on Academic Posts, and consult Regional Academic Adviser Send to chair of relevant CSAC for advice OR if no CSAC to relevant speciality or intercollegiate group Send to Regional BACCH representative for advice Send to local neonatal network lead (for Level 2 & 3 posts), as well as to CSAC chair for full speciality posts * Defined as >40% of time spent in the stated subspecialty The Department: The job description should contain a description of the department, including relevant information about medical and multi-disciplinary team members, clinical activity, workload, training activity, and administrative infrastructure. This should enable the Regional Adviser to judge whether the departmental arrangements are such that an appointee would be able to meet clinical obligations within the framework outlined in Duties of a Paediatrician (see A Charter for Paediatrians; Section 6 The duties of a paediatrician and also Section 19 Facilities for Paediatricians). For example: Are colleagues listed by title and named? Are the junior staff posts recognised by the College / PMETB? Is there evidence of collaboration by other relevant departments (e.g. obstetrics)? Is there evidence of support from paediatric specialties such as radiology? 2
Are the facilities described? e.g. bed numbers, ambulatory unit, intensive care support etc. Is the range of specialist clinics described? Does the job description suggest an active audit and CPD programme within the department? The list is not intended to be exhaustive, but to give some indicators which would suggest an active and appropriately functioning department. Duties of the Post: The main duties of the post should be described in detail. Particular attention should be paid to the following: If this is a subspecialty post, will the post-holder be expected to undertake any general paediatric duties or on call? If there is a general on call requirement, the job plan must include sufficient time to allow a post-take ward round. There must also be sufficient CPD time to maintain both specialist and generalist skills. If this is a general post, is a clinical special interest (more correctly described as a special responsibility ) defined? Applicants have been disadvantaged because the department has undeclared preferences for one specialty over another. Departments should have some idea of what they need and can accommodate, and present this transparently in the job description and job plan. Are other specific responsibilities specified in the job description? For example, designated doctor for child protection, leadership in developing an ambulatory unit, or specific educational roles such as College Tutor. In these circumstances, sufficient support professional activities (SPAs) must be allocated in the job plan to undertake these roles (see section on the Job Plan). The Job Plan: Full job plan guidance is beyond the scope of this document, but is set out in the 2003 Consultant Contract (England), and relevant supporting documents. Within a full-time framework of 10 PAs, it has been agreed that a consultant will normally devote an average of 7½ PAs to direct clinical care (DCC) and 2½ PAs to supporting professional activities (SPA). Does the job plan specify a requirement in excess of 10 programmed activities (PAs)? New consultant job descriptions should not specify a requirement in excess of 10 programmed activities (PAs) including on call work. Any work in excess of 10PAs will be by subsequent negotiation once in post, and should be paid at the appropriate rate. 3
Are there enough direct clinical care (DCC) PAs to manage the clinical workload? It is recognised that paediatrics involves a heavy workload in clinical administrative duties; for example, office-based clinical administration, as well as non-clinic based meetings with parents, and with multi-disciplinary and multi-agency colleagues. Sufficient time must be allowed for this within the DCC allocation of the post (i.e. a minimum of 1½, and often 2½ of the 7½ direct clinical care PAs). All predictable out-of-hours work (e.g. weekend or evening ward rounds) should be included within the DCC allocation of the job plan. For work performed outside 7am to 7pm Monday to Friday, a programmed activity equates to 3 rather than 4 hours. Unpredictable out of hours work also needs to be factored into the job plan (see section on Emergency On-Call Work) Travel time to outreach clinics should also be included in the DCC component. Are there enough supporting professional activities (SPAs) to cover both specific responsibilities set out in the duties of the post and the generic requirements for all paediatricians Sufficient SPAs must be allocated to cover any specific educational or management roles defined within the job description, as outlined above. For all consultants, the processes for revalidation recommended in the Donaldson report (2006) will strengthen the stated need for adequate SPAs to be devoted to continuing professional development, audit and governancerelated activities. Routine educational supervision also requires an explicit commitment and should be properly reflected in supporting professional activities. This requirement will increase with the advent of competency-based training and its assessment. Has a weekly timetable been provided, and does it match the stated number of PAs? Where there is a mix of attending and non-attending weeks or an annualised programme, this will need to be calculated over the cycle-length of the rota. PAs for Additional NHS Responsibilities and External Activities are unlikely to be included, since these are roles and activities that the appointee is more likely to negotiate once in post. However, should such activities be specified in the job description, it is important to ensure that they are adequately accounted for in the job plan. N.B. Check that the job plan should carries a statement that it is subject to renegotiation and review annually with the Clinical Director, any changes being by agreement within the department. 4
Variations for Wales, Scotland and Northern Ireland: Advice relating to job planning is based primarily on the English consultant contract. For Wales, Scotland and Northern Ireland, reference should be made to the appropriate contract arrangements. N.B. In Scotland, job descriptions are approved by National Panellists rather than by the Regional Adviser. Emergency and On Call Work: Paediatrics is recognised as a speciality with one of the highest on-call and out of hours commitments. On call rotas should currently be no more frequent than 1 in 5, and it is likely that consultant team sizes will need to grow further in the next few years to fully meet EWTD and to move towards 10PA job plans. Pragmatically, a department may be some way from achieving this ideal and it would be unhelpful to the existing departmental staff to refuse to approve a job description on this basis. However, the Regional Adviser should write in strong terms to the Chief Executive advising of the need for further expansion. Under EWTD provisions, consultants should have 11 hours rest in every 24. Although most consultants currently work for longer than this, the rota should allow for adequate compensatory rest to be taken in a timely manner. In high intensity specialties such as neonatology and intensive care, extended weekend rotas, particularly in the absence of a 2 nd on call consultant colleague, should be discouraged. The job plan should demonstrate that unpredictable out of hours activity, including telephone calls for advice and recalls to hospital, has been assessed (for example, by means of diaries) and factored into the job plan. Further extensive advice is given in the Charter for Paediatricians (see Section 16 Consultants on call and Section 17 Residence on call ) including guidance on PA allocation for out of hours activity, advice for sub-specialty on call and advice on facilities and conditions for agreeing to be resident on call. Key issues regarding residence on call are that consultants should not be first on, but should always be on call with an SHO or nurse practitioner, and that the agreement to be resident on call should normally be for a maximum of 5 years, with annual review. Part Time Working: The 2005 census indicated that 52.9% of the career grade workforce and 43% of the consultant workforce was female. 30% of female consultants were working part time, compared to only 7.2% of men. Currently 60% of trainees are female and it is likely that an increasing percentage may wish to work part time as consultants. There should be a presumption that all consultant posts are suitable for those wishing to work less than full-time (e.g. job sharers and flexible workers). If there are specific reasons why the post is deemed inappropriate for someone wishing to work less than full-time, this decision should be justified. The job description should also state how the post will be adapted to meet the needs of job sharers or flexible workers. In particular, additional PAs (for example, 2x 6PAs) may be needed to allow adequate time for handover and CPD. The BMA recommends a lower DCC to SPA ratio for those working less than full time. Exact ratios will be a matter for local negotiation, but the Regional Adviser should ensure that the SPA allocation allows sufficient time to meet CPD requirements and any additional supporting activities expected of the post holder. 5
Split Site Working: Care should be taken in evaluating job descriptions for consultants working across split sites as these may sometimes place excessive demands on the post holder. It is important to ensure that adequate time is allowed to complete administrative work and to attend essential team meetings on both sites. There should also be adequate CPD allowance within the job plan to maintain competence for the full range of clinical duties across both trusts. Except in the case of academic contracts, it is usual for the primary contact to be held by the trust in which there is the greater clinical commitment. The primary employer will usually take lead responsibility for appraisal, revalidation, and job planning, as well as for any performance concerns, although both trusts should obviously contribute. It is strongly recommended that there is a statement clarifying these arrangements, and a commitment to an early job plan review. With the development of clinical networks, a consultant may provide out-of-hours clinical input across more than one site, particularly for specialist services. However he / she should not be the only available paediatric consultant across two acute sites. Clinical Academic Contracts: Clinical academics will vary in the split between clinical and academic responsibilities. Typically they will be employed by a university and hold an honorary clinical contract at an NHS Trust. However, there should be a single integrated job plan, and a joint appraisal process (see Follett report, 2001). The role of the Regional Adviser is to assess the clinical and relevant professional aspects of the job description, and confirm approval to the academic department, as well as the Trust and the College. If the post is in a defined subspecialty, it should be referred to the CSAC chair in the usual way. The academic component of the post is the responsibility of the academic department but, where the Head of Department is not the Regional Academic Adviser, he or she may wish to discuss this with the RAA, particularly if there is concern regarding the feasibility of the balance between clinical and academic sessions. Advice may also be sought from the Chair of the Academic Panel / CSAC. A similar DCC to SPA ratio as for a full time NHS consultant may be applied (for example, an academic working 5 clinical PAs might notionally have 1.25 SPAs). However, as with those working part time, an irreducible amount of time is still required for CPD, and hence a relatively higher SPA allocation may be necessary. In assessing the overall job plan, the Regional Adviser should make a judgement as to whether the appointee would have adequate time to meet the required clinical commitments, to maintain competence in the defined areas of practice and to undertake the necessary CPD to underpin revalidation. Other Work Conditions: Suboptimal work conditions can impede the ability of the paediatrician to function effectively, and the job description should include information about the work setting and environment. Check the following: Is there adequate secretarial support? Is there personal access to IT and the internet / e-mail? Is there appropriate office accommodation? 6
Although the Trust is not obliged to respond to recommendations regarding facilities and infrastructure, it is important to draw attention to obvious problem areas. The Person Specification: It is essential that the applicant is on the Specialist Register in paediatrics or a UK SpR within 6 months of CCT date. An AAC assessor will not necessarily know if there have been concerns about an SpR, so to aid the AAC process, it is advised that the essential person specification should include a clause to say the applicant can produce evidence that he / she is within 6 months of CCT date, and is expected to achieve a CCT. It will then be the responsibility of the applicant to obtain a suitable letter from his / her Regional Adviser to confirm this. Other headings, classified as essential or desirable would include qualifications, experience (including on call experience), research, teaching, management, audit, personality and motivation. Job descriptions for subspecialty posts do not necessarily have to specify subspecialty accreditation as essential although it would be unusual for them to fail to do so. Although this is primarily a Trust, not a College function, check whether the specification meets equal opportunities standards. For example, has a valid driving licence discriminates against some disabled people, whereas able to travel to meet the requirements of the post is fair. Has the post been designed to attract a specific individual? Relevant supporting documents: Charter for Paediatricians. Royal College of Paediatrics and Child Health; 2004 The NHS (Appointment of Consultants) Regulations: Good Practice Guidance. Department of Health, 2005 The 2003 Consultant Contract (England). Department of Health; 2003* Job Planning. Standards of Best Practice. Department of Health; April 2003 Guidance on the new consultant contract, and its implications for Job Plans (Programmed Activities). Academy of Medical Royal Colleges; March 2004 Guidance for Regional Specialty Advisers on Approving Job Plans. Royal College of Surgeons of England; January 2005. Consultant Physicians Working For Patients. 2nd Edition. Royal College of Physicians of London; 2001 Professor Sir Brian Follett and Michael Paulson-Ellis A Review of Appraisal, Disciplinary and Reporting Arrangements for Senior NHS and University Staff with Academic and Clinical Duties. DFES 2001. * Including supplementary academic information 2005 Hilary Cass 7
Registrar (November 2006) 8