We're committed to ensuring that temporary working arrangements are only in place during the fight against coronavirus.
We've compiled answers to some of the questions you might have as a consultant about the impact of COVID-19 on your contract terms and conditions.
BMA Cymru Wales has agreed temporary pay arrangements with Welsh Government that apply from 1 April 2020 to 31 July 2020 for consultants whose working arrangements have changed as a result of COVID-19.
What value will SPA (supporting professional activities) bring to the COVID-19 response?
SPAs are the quality underpinnings of consultant clinical performance. Planning, training and review of performance are critical elements in the response to COVID-19, and will give consultants and the teams they lead the confidence and skills they will need in this crisis.
As we move further into the response it may be that an increase in direct clinical care is warranted. Such change should be made as that becomes necessary rather than as a starting point, lest the opportunity for planning and training be lost.
Use the Dr Diary app to:
- track your activities
- know your work patterns
- steer your job plan.
Can my employer cancel my SPA?
Our view is that changes to working patterns are always best done through agreement. If you find yourself asked to convert SPA time to more direct clinical care, your employer should work with you to ensure that it is done safely and proportionately. Discussions regarding recompense and when SPAs will be restored should be had so that changes do not have an effect on your ability to plan and deliver a safe, effective service.
We have already had suspension of appraisal and revalidation timetables, as well as cancellation of non-essential CPD - this may free up time during your working week.
There are serious implications to shifting a doctor’s focus solely to direct clinical care and should only be made where it is absolutely essential. Insisting that senior clinicians remain on the front line with no respite may exacerbate the risks of exhaustion and burnout that, in such a crisis, will already be high.
Responding to this crisis will likely be a marathon, not a sprint and the service will need to preserve the capacity of its senior staff if it is to navigate it successfully.
I'm a senior clinician - how do I need to adapt?
In such unprecedented circumstances, doctors are likely to be asked to work in ways for which they will not have trained. Some may well be asked to work very far outside of the clinical areas they have spent many years training to deliver care in.
This will mean:
- you require additional time to undertake entirely new training
- you will need to refresh and update in areas of practice that they will not have worked in for a number of years
- there will be a need for supervision by other senior colleagues to ensure that you are delivering your new or modified roles as well as possible
if you're working outside of your specialty area, you will need feedback and review of your clinical work in order to ensure that it continues to be well delivered
you will need to carefully review and reflect on the work you have undertaken in order to ensure you address areas of difficulty
- for others, time will be required to train your colleagues in these new or updated ways of working.
Senior clinicians are extremely skilled and experienced in their customary roles. However, we would not expect any doctor currently being trained to have to work in new areas entirely independently and without oversight.
My employer says my working pattern will need to change significantly - what are my rights?
In an emergency such as this it is not unexpected that employers will wish to amend rotas and make changes to doctors hours of work while the crisis continues.
However doctors should be fully consulted on such changes and discussions must take place with individuals, especially those who have particular difficulties with any proposals.
We would suggest initially that you discuss any concerns with your clinical manager and/or HR or Medical Staffing to enable an informal resolution.
- Any proposed changes to hours of work should include appropriate remuneration, rest time and adequate breaks.
- Any revised work patterns must be accommodated within your contracted hours, including with respect to plain and premium time (where applicable).
- Any additional work that goes beyond your contracted hours is optional and if agreed, it should be paid at an agreed rate (see rates agreed in Wales).
If matters cannot be resolved informally, then members should contact the BMA for further advice.
When considering the an employer’s proposals doctors should also be mindful of paragraph 26 of the GMC’s Good Medical Practice which states that:
You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care.
I’m being asked to work very long shifts/periods of resident on-call – is this acceptable?
Some employers have introduced shift or resident on-call rotas with insufficient numbers of consultants, particularly in ITU, though the same approach has been taken with other specialty groups such as anaesthetists.
Such under-staffed rotas result in excessively long periods – sometimes greater than 24 hours – of consultants having responsibility and clinical oversight for their patients.
Taking such an approach is unacceptable and places both consultants and patients at considerable risk. It is not in anyone’s interest for a doctor to be treating patients while tired.
Clinicians must always be conscious of their obligations under Good Medical Practice which require them to consider their own health and safety.
A rota with fewer than eight participants is likely, given the frequency of nights and weekends, to be unsafe for doctors and patients. A full rota should have 10+ participants to ensure that it is resilient enough to cope with the demands created by the COVID-19 crisis.
Payment for resident on-call
The entirety of a period spent resident on-call or on shift constitutes work and you are entitled to be paid for it. Pay arrangements for these long shifts will be subject to local agreement (see rates agreed in Wales).
Working in this way for long periods is likely to use up most of your weekly PAs/sessions very quickly. Employers should consider whether this is the most effective use of consultant time, even in a pandemic.
Consultants should also remember that working resident on-call is not a contractual obligation. If you have agreed to work in this way during the pandemic, this will be on a temporary basis only.
For consultants and SAS doctors in Wales, a specific national agreement on pay has been reached.
We have a range of services to support you.
- Peer support
- UK wellbeing support directory
Call our free and confidential helpline on 0330 123 1245
What if I am asked to provide 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.
Contractual arrangements are different depending on the grade and country you are employed in.
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.
Coming to an agreement with your employer
Unless there are local or national arrangements already in place, you are encouraged to come to agreement locally with your employer on:
- what is deemed to be practicable
- what the proposed cover entails
- that the work is of a suitable nature to be covered by you
- that the right clinical need has been prioritised in a situation where clinical personnel is limited in number.
In establishing suitability, due regard must be given to your duty to recognise and work within the limits of your professional competence, as well as your assessment of the likely impact on your wellbeing.
It may be necessary to agree to re-arrange other duties (eg cancelling a clinic) for you in the short term in order to provide adequate cover for the prioritised work.
Your contractual obligation
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 (see above).
For clinical academics, where you are asked to deputise for an absent colleague, account shall be taken of your duties for your substantive employer.
Read the specific BMA guidance on consultant cover for colleagues
What if I am asked to provide cover for a junior colleague?
You should only act within your existing competencies. If you are working at different levels, you should be paid appropriately.
Covering for a junior colleague
If you are covering the work of a junior colleague, you do not have the option of pretending that you are working at a lesser level of responsibility than you do normally.
Accordingly, you are not ‘acting down’ – you are acting appropriately in response to the unusual circumstances.
As a result, you should continue to be remunerated in line with your usual rates of pay for that particular type of work.
‘Acting down’ should only ever be a short-term measure and is not a long-term solution. You should check for local agreements on acting down and ensure that pay or time off in lieu arrangements are in place.
This should not be necessary for a period of longer than 72 hours, after which the employer should be in a position to employ a locum if needed.
You should notify your LNC of every occasion of acting down so they can monitor the effectiveness of the local policy.
Can my employer ask me to work on a bank holiday that I was scheduled to have off and will I receive TOIL?
Yes, your employer can ask you to work on a bank holiday. However, they should provide you with as much notice as possible if you were not previously rostered to work.
If you are scheduled to work, including being on-call, on a bank holiday then you must be paid for the hours you work (on premium time in Scotland) and receive a standard day off in lieu that you should be able to take at a time of your choosing in the future.
Additionally, if you were ‘required to be present in hospital or other place of work between the hours of midnight and 9am on a statutory or public holiday’, you should also receive a day off in lieu. This is even if you are not otherwise scheduled to work after 9am on the statutory or public holiday, on the basis that your day off will have been impacted by being in the hospital earlier that day.