Junior doctor and consultant contracts – get the latest update now.


At work blog



Cover for absent colleagues hits its limit

The consultant contract provides for ‘reasonable cover’ for absent colleagues. But what is reasonable?

Doctors expect to cover the usual amount of holiday and sickness absences, but for three consultant members their trust’s idea of ‘reasonable’ left them covering for an entire year when two colleagues went on successive sick leave.

The consultants had already been covering for six months when they called the BMA for support. Naturally, their day-to-day workloads had become more intense, but their concerns focused more on the extra on-call commitments.

Between them, they provided on-call cover for an extra 3.5 days per month, and between one and two extra weekends. On several occasions, this meant one of the consultants had to cover consecutive weekends.

As they worked in an onerous specialty, most of the on-call time was spent at the hospital. In addition, they found it very hard to take annual and study leave, knowing that when they did it would make the situation even harder for those left at work. I took this forward on behalf of all the consultants as a collective issue.

I had about five meetings and a great deal of email correspondence with the trust, which appeared to be dragging its heels. The trust’s view was that sickness absence is something the consultants would reasonably expect to cover, so if the purpose was reasonable, the length of time was less important.

An easy point to make if you’re not having to provide the cover yourself. Even with additional pay, long-term cover can be unreasonable. The trust also argued that it had tried hard to find a suitable locum, but they could not get one of sufficient quality and did not want to risk patient safety. I pushed them for the evidence of their locum search, but it was not forthcoming.

Our persistent pressure on the trust won the day. A locum was found. The trust also agreed to an appropriate level of payment for the extra work the doctors had done. But as is so often the case with consultants, it was not about the money, but about maintaining adequate staffing and ensuring doctors’ goodwill was not being exploited.

Some local negotiating committees have developed policies for covering absent colleagues, also known as acting across, which seek to ensure any additional activity is paid and that anyone undertaking it is not overworked. Such policies tend to promote the early engagement of a locum because they put a cost and a limit on cover.

The difficulty of this case was that as the ‘temporary’ arrangement became ever more permanent, it was difficult for the members to know exactly when enough definitely was enough. And consultants being consultants, they will often just get on and do the work to ensure that patient care does not suffer.