It has become clear that the pandemic has and will continue to bring significant disruption to your normal working patterns; your working conditions; your teams, your role and the very locations in which you work.
Infection rates have risen once again and that we are now working through a second wave and possibly towards a third. The BMA are concerned about the impact that dealing with this second wave has on an already stretched and fatigued workforce.
This page sets out how to agree changes to your job plan, payment for additional and high intensity work, annual leave and changes to your rota.
Job planning process
The process of job planning has not been abandoned. The job planning process is part of your contract. Changes to your job plans can only occur in advance, by mutual consent and as part of the formal job-planning process associated with your contract. Changes to your job plan cannot be imposed by your employer alone.
Agreement to vary job plan
Some departments may attempt to simply reissue previous 'COVID emergency' rotas with an expectation that you will once again adhere to these without question. This is not acceptable.
All your existing T&Cs (terms and conditions of service (consultant contract) and Schedule 4, Clause 1 (terms and conditions of service for the 2008 SAS contract) remain in place at all times. Any changes to your working patterns can only be through the established job planning process.
Job planning will be based on a partnership approach. This includes the facilitation and appeals processes where necessary. Temporary changes to your working patterns require your explicit agreement.
Discussing temporary changes
If, however, after discussion between you and your clinical manager, you wish to agree a temporary change in your job plan in order to prioritise work towards COVID-19, you can do so.
We recommend that you clearly state and confirm in writing that you agree to do so on a temporary time limited basis and that this does not constitute a permanent change to your job plan.
We would also recommend that you retain the right to return to your pre-existing job plan at a time of your choosing and this should be stated in the temporary job plan.
Work required to be done on top of your contracted PAs should be remunerated via extra contractual payments or time off in lieu. The rates should be negotiated locally in advance and agreed in writing.
If you are a part-time worker, you cannot be compelled to increase your hours or move to full-time working.
We recommend that any temporary changes proposed by management are discussed by you and your colleagues as a whole team. You should consider elements such as:
- how to flex emergency cover in the case of a local outbreak
- if high numbers of staff are self-isolating or shielding
- what elective work has to be dropped or must continue
- how to arrange staffing to meet those demands.
The T&Cs require a job plan review and agreement on any changes before any changes to working patterns are implemented.
Protecting against fatigue and burnout
Consultants and SAS doctors are frequently being asked to alter their work plans during the pandemic. Invariably this often means providing a greater level of work at evenings, weekends and overnight.
It is clear that the work you are being asked to do is of high intensity and significantly more tiring, particularly when considering the prolonged periods spent wearing PPE.
Any revised work plan must still provide you with sufficient rest and breaks to ensure both patient safety and your own health and wellbeing.
If you have difficulty in working the new temporary work plan due to caring responsibilities, disability etc, discuss this with your employer. If you encounter any difficulty, contact BMA.
Working patterns and shift changes
Recommended length of programmed activities for consultants
The BMA believe that for high intensity weekend working, two hours per PA (programmed activity) should apply between 7am and 7pm.
Furthermore, given the high intensity nature of COVID working and the additional demands of working with PPE, the BMA believe that when adopting work of this intensity, three hours per PA during plain time is more appropriate when considering a temporary change to such a high intensity job plan.
In order to protect staff and avoid burnout, the Royal College of Emergency Medicine have recommended reducing the number of hours that constitute a PA for high intensity working undertaken in premium time and overnight.
Table of recommended length of PAs
|Day||7am to 7pm||7pm-11pm||11pm-7am (for high intensity working)|
|Monday to Friday||3 hours per PA||2 hours per PA||1.5 hours per PA|
|Saturday, Sunday and bank holidays||2 hours per PA||2 hours per PA||1.5 hours per PA|
Twilight shifts and out of hours working
Consultants and SAS doctors are increasingly being asked to undertake resident on-call night shifts, twilight shifts or OOH (out of hours) working. These working patterns were not envisaged when the 2004 (consultants) and 2008 (SAS) contracts were agreed, and the three hour per PA specified in the contracts was essentially designed for on call working at a time when call back to the hospital was a rare event.
The existing T&Cs for consultants and SAS doctors were not designed with shift-working in mind, and did not cover the substantial changes asked of many career grade staff at the start of this emergency.
The 2004 contract sets a maximum limit of two PAs per week for emergency work arising from on call. Schedule 7, Clause 6 of the consultant contract sets a limit of three PAs occurring in premium time. Consequently, the BMA do not believe that three hours per PA is appropriate for frequent twilight shifts or resident on-call/night shifts/OOHs work patterns.
There are no overtime rates built into the 2004 consultant contract, which contrast with other NHS contracts such as agenda for change workers who have contractually agreed overtime.
Time spent working for your employer is considered work and should be both paid and contribute to your PA allocation. This also applies to resident on-call shifts. It is important to note that resident does not necessarily mean in the normal place of work, it could mean working at home or other location in some circumstances eg during a pandemic.
We proposed a temporary regional solution to the Northern Ireland Department of Health where substantial disruption to normal working patterns would be adequately remunerated.
However, despite our best efforts to reach agreement, the NI government indicated that local agreements should be reached.
BMA local negotiating committees have been engaging with HSC trust management to try to reach such local agreements.
A number of organisations have implemented shadow on-call rotas to cover periods of sickness absence or 'second on' on-call rotas to come in if 'first on' consultants are busy. Again, this is a change to your job plan and can only be implemented by mutual agreement.
If agreeing to this change, it is again essential that you make clear to your employer in writing that this is a temporary change and that you reserve the right to revert to your pre-existing job plan.
The BMA recommends that these rotas are paid at a ‘standby rate’ that applies when you are available but not working. The BMA minimum recommended standby rate, when not working but available, is £50 per hour.
You may find yourself unable to agree to work a temporarily requested work pattern or roster, or to take on certain clinical responsibilities during the pandemic, for a variety of reasons.
Declining to accept temporary changes to your working patterns or additional work must be without detriment. It is important to remember that:
- you do not have to agree to change your normal hours
- if you have already changed your hours and wish to revert back, you have a right to do so.
Annual, study and professional leave
Appropriate provisions for rest and taking of annual leave must be part of any working patterns; consultants and SAS doctors must be allowed to take planned leave.
It is not acceptable to have to work for extended periods without being able to take proper leave, as was the case for many in the first peak, and as we know has proven to be unsustainable.
Employers cancelling leave
Whilst employers can lawfully cancel pre-booked days of annual leave, they have to act reasonably. For example, if it is an important family event then it might not be lawful to cancel your holiday. You have a good argument for asking for reimbursement of any reasonable losses you suffer (unless already covered by insurance).
Your employer is legally obliged to offer at least one day notice for each day of leave to be cancelled. In the first instance, employers should do this on a voluntary basis rather than enforcing cancellations.
Carrying over leave
Temporary statutory rules introduced by the Government mean that employees who are unable to take their annual leave entitlement due to COVID-19, can carry over up to 20 days of annual leave over a two-year period (2021/22 and 2022/23).
As study and professional leave operate across a three-year cycle, they can be carried over and you should not lose your entitlement because of the pandemic. Agreed local study leave budgets should similarly roll over (many study leave budgets – both time and funding – are over three years, eg 30 days in a three year period).
SPA (supporting professional activities) time
SPA time is essential in ensuring that consultants and SAS doctors continue to deliver high quality clinical care. In such a fast-moving clinical situation it is essential that new treatments and procedures are rapidly learnt by other doctors. You will need sufficient time for this to happen – SPA time.
It is essential that SPA time continues to be recognised and remunerated. It is appropriate that SPA time is reprioritised towards supporting the pandemic, but it should not be suspended or simply converted to direct clinical care sessions.
That would vastly limit doctors to further reconfigure services to ensure that as many patients as possible can access clinical care. Very high proportions of direct clinical care sessions within job plans, and particularly when these are at very high intensity, are simply likely to lead to burn out of consultant staff.
If SPA time is reapportioned to COVID-19 related SPA, then other commitments that would normally be undertaken in SPA time should be removed with no expectation for these to be repaid at a later date.
Undertaking clinical activity within SPA time
SPA time should continue to be supported, but in an emergency, it may be necessary to undertake direct clinical care activity within a SPA.
The BMA is aware of some trusts refusing to remunerate doctors on such occasions as they claim the doctor is already being paid and 'cannot be paid twice'. This is not the case as in the vast majority of instances, the SPA or administration time has not been cancelled by the trust and they still expect that work to be completed.
In reality, this work is in effect time shifted to outside of your normal working hours. It is therefore appropriate to be paid for this time at the rates above or to have a subsequent direct clinical care session cancelled to allow time for the displaced work to be completed.
If it becomes a regular occurrence that you are being asked to perform direct clinical care work in SPA time, then the trust should make appropriate changes to the service to prevent this happening in the future.
Providing cover for an absent colleague
There needs to be clear and understood limits to the level of cover that any individual can be expected to provide. There is generally an expectation that individuals will cooperate with their employer to provide cover for colleagues at an equivalent level where they are sufficiently competent to do so and, crucially, where providing such cover is ‘practicable’.
There is no strict definition of ‘practicable’ but in general terms it means something close to ‘able to be done’ or ‘able to be put into practice’. Whether something is practicable or not in a given situation will depend on the circumstances, including your personal circumstances. If, for example, you have caring responsibilities towards family members, you may be justified in saying that it is not practicable for you to provide unforeseen, short notice cover that conflicts with these responsibilities.
Alternatively, if providing the cover requested would compromise patient care or safety because it's above your competency, then it would not be practicable to provide the cover.
Generally, it is only expected to cover absent colleagues for a short period eg up to 72 hours. This allows internal cover to be provided where practicable to cover a weekend. This additional activity should be remunerated in line with the BMA recommended rates above.
Beyond 72 hours, if colleagues remain absent then it is the trust’s responsibility to arrange cover including securing the services of a locum.
Consultants (including clinical academics) are only contractually obliged to provide cover for other consultants and associate specialists – there is no obligation for them to provide cover for junior colleagues and this is dealt with under any locally agreed ‘acting down’ policy.
If you are a SAS doctor and are asked to ‘act up’ to a higher level of responsibility, you should be remunerated in line with the grade at which you are working and the level of work undertaken.
Being asked to move to a different specialty
The decision to move to another clinical specialty is similar to other job planning decisions, a matter best approached by individual discussion and agreement.
Any moves that were made possible during the first wave by a general reduction in activity in all other areas of clinical activity with the exception of urgent and emergency care and activity related to the pandemic.
During subsequent peaks there is an expectation that standard, including elective, clinical activity will be preserved. However, it is difficult to see how such activity could, in reality, be preserved should consultants or SAS doctors be moved into other clinical areas. Read our guidance on redeployment.