A practical guide on successful job planning

1. A practical guide on successful job planning Martin DeBono Divisional Director/Associate Medical Director Calderdale & Huddersfield NHS FT

2. Best Practice • Partnership approach • Fairness • Equity

3. Best practice • Better prioritise work and reduce excessive consultant workload • Agree how a consultant or consultant team can most effectively support the wider objectives of the service and meet the needs of patients • Agree how the employer can best support a consultant in delivering these responsibilities • Provide the consultant with evidence for appraisal and revalidation • Comply with EWTD regulations • Reward activity above the standard commitment via prospectively agreed additional programmed activities

4. Goals • Set out agreed personal objectives and their relationship with the employing organisation’s wider service objectives • Set out how the employer will support consultants in delivering agreed commitments • Include a work schedule that covers all professional work, including teaching, research, management or other service responsibilities and clinical governance activities • Set out agreed arrangements for the location at which consultants carry out their duties and responsibilities • Review annually • Be undertaken on a team basis

5. How we did it • Corporate steer • Team Job planning • Individual job planning • Portfolios

6. Team Job planning • SPAs 1.5 PA • Ward rounds 0.5 PA x 4 • On-call 0.5 PA unpred 1.0 PA pred(resident) • Fixed OPD 0.75 PA • Fixed OT 0.875 • Portfolio 0.5 – 1.0

7. Individual job planning • What do you require? • Development needs • Stage of your career • CME and training objectives • Changes in ways of working • What does the service require? • Needs of the patients • Wider objectives of the organisation • How can we achieve your and the service requirements?

8. Portfolios • Individual development • Examples • Clinical Risk Lead 1.0 PA • Colposcopy lead 1.0 PA • Audit lead 0.5 PA • Educational Lead/College tutor 1.5 PA • Deputy Educational lead 0.5 PA • Obstetric Lead 0.5 PA • Antenatal Screening lead 0.5 PA • Gynaecology lead 0.5 PA • Urogynaecology lead 0.5 PA • Cancer lead 1.0 PA

9. Clinical Risk lead • To regularly monitor clinical incidents within obstetrics and gynaecology and report to the Directorate team members • To facilitate audit based on clinical risk, along with the Clinical Audit Lead. • To work closely with the Trust Complaints and Risk Manager in monitoring risk • To audit complaints

12. Challenges • Variation • Financial efficiencies • Flexibility • Trainee support • Longer days and 7 day working

13. Keogh 7 day workingThe evidence • Significant variation in outcomes for patients admitted at weekends • Increasing mortality at weekends • Lack of 7 day services has an adverse effect on measurable outcomes

14. Clinical standards • Patient experience • Patients and families actively involved in shared decision making • Time to 1st consultant review • Review by consultant asap and within 14 hours of arrival • If mortality >10%, consultant review within 1 hour • All patients admitted during consultant residency, should be assessed by consultant within 6 hours. • MDT review • All acute patients to be reviewed by MDT within 14 hours • Shift handovers • Led by a competent decision maker • Kept to a minimum

15. Clinical Standards • Diagnostics • Available 7 days a week reported within 1 hour for critical patients • 7 day consultant radiologist service is envisaged • Intervention/Key services • 7 day a week consultant directed interventions • Mental health • Assessment by psychiatric liaison within 1 hour for emergency care • On going review • Review on MAU, SAU and ICU twice daily by consultant • General ward review by consultant every 24 hours

16. Clinical Standards • Transfer to community and primary care • Support services available 7 days a week • Quality improvement • Review of patient outcomes • Duties, working hours and supervision of trainees must be consistent with the delivery of high quality, safe patient care 7 days a week.

17. 7 Day working • Reality • Organisational • Better decision making • Faster diagnosis • Appropriate diagnostic testing • Expert review of treatment • Support for trainees • Improved morbidity and mortality

18. Women’s 7 day workingClinical Benefits • Direct Consultant cover 08.00 to 23.00 weekdays • Direct Consultant cover 08.00 to 19.30 weekends • 4 hourly ward rounds • 12 hourly safety briefings • Consultant led decision making • Consultant supervision and training

19. How we did it • Prolonged discussions • Robust and fair job planning • Additional consultant appointments • Compensatory rest

20. Paediatrics • Consultant direct care 08.00 to 22.00 weekdays • Consultant direct care 08.00 to 17.00 weekends • Business planning process • 2 additional consultants requested • Job planning processes modelled to ensure that it is deliverable

21. Challenges • The resistance from colleagues • Support and change from other departments • Funding • Developing the model to ensure that clinical benefits are achieved