We've compiled answers to some of the questions you might have about the impact of COVID-19 on your working patterns as we move into the recovery phase and plan for future waves.
During the initial response to the pandemic, many senior doctors changed their ways of working. Some saw dramatic changes, others may have been less noticeable. As we move forward into the recovery phase, a return to existing job plans and contractual terms should occur.
If new ways of working are going to be an ongoing part of your working week then a review of your job plan should take place. This is a partnership process and should be informed by departmental team service planning.
Working patterns must be safe, sustainable and allow you a balance between clinical and professional responsibilities. In normal circumstances, in Scotland no more than three PAs (programmed activities) of a consultant's working week can be scheduled out of hours.
Things that should be agreed as part of your job plan
- The number of PAs you are contracted for.
- Pattern of work, on-call frequency and availability supplement as appropriate.
- Designated place of work.
- Clinical and professional responsibilities.
- Number of PAs allocated to direct clinical care, SPA (supporting professional activities) and additional responsibilities.
- Details of work to be done in any additional/extra PAs.
Can my employer cancel my SPA?
In the initial response to the first phase of COVID-19, some workplaces shifted activity away from SPA time and towards more direct clinical care. This may have been appropriate at the time, but this is no longer the case. Services have directly benefited from senior clinicians being given the time and resources to lead the response.
SPA time has a vital role to play in reflecting on lessons learned so that we can plan the next phase. In some cases, there may be a need for increased SPA time. Time will be needed to:
- evaluate the effectiveness of new services
- learn new skills
- keep up with your own learning needs
- teaching and training others.
Unless you agreed changes to your job plan, then existing contractual terms continue to apply, including sufficient SPA time. Changes to SPA time should not have a detrimental effect on your ability to plan and deliver a safe, effective service during this time.
Use the Dr Diary app to:
- track your activities
- know your work patterns
- steer your job plan.
My employer has asked me to work additional hours - do I have to?
No, and many doctors, particularly some who are working LTFT (less than full time), will be unable to respond to such requests due to caring responsibilities, disability etc.
You should ensure that you only agree to additional working hours that provide you with sufficient rest to ensure both patient safety and your own health and wellbeing.
We strongly recommend that you agree in advance the applicable rates for any additional work being undertaken beyond your contracted PAs. Work contracted through the medical staff bank will be remunerated in line with prevailing hourly rates.
Local arrangements will be in place to claim for additional hours worked.
My employer has not asked me to agree to additional work, but I find that I am working longer hours anyway
If employer has not asked you to agree additional work you should raise with management in writing.
Our advice is to record all the additional hours and seek payment as you work them. This includes if your shifts overrun.
The Scottish Government have told us they expect all NHS boards to have systems in place to capture and remunerate the extra hours that all staff undertake during this time.
If you have problems securing payment for additional work, contact the BMA for advice.
Disruption to your working pattern in Scotland
Our proposal to Scottish Government
The existing T&Cs for consultants and SAS doctors were not designed with shift-working in mind. We proposed a temporary national solution to Scottish Government in April where substantial disruption to normal working patterns (ie a move to overnight shift working) would be adequately remunerated. This meant all out of hours worked between 8pm and 8am for consultants, or 7pm and 7am for SAS doctors, would be temporarily paid at double time.
This is similar to rates already agreed in Wales.
This was formally presented to Scottish Government in April and, despite our best efforts to reach agreement, our proposal was totally rejected in early July. Instead Scottish Government has indicated that local agreements should be reached. BMA local negotiating committees must now engage with NHS board management to try to reach these local agreements.
Some specialties have, even pre-COVID-19, agreed preferential local arrangements. These agreements should inform local negotiations.
It can also be argued that shift working is an extension of 'resident on-call provisions', which is the one area where the consultant T&Cs expect NHS boards to reach local agreements with LNCs.
You may already be covered by local agreements for such work, so if you believe the work you are being/have been asked to do falls under that heading then claim accordingly.
SAS doctors asked to ‘act up’ to a higher level of responsibility, should be remunerated in line with the level of work undertaken.
Agreeing any additional hours or temporary working patterns going forward
Going forward and particularly in the event of a second wave, you should agree the remuneration in advance of agreeing to any additional hours or temporary working patterns that vary from your agreed job plan.
The T&Cs require a job plan review and agreement before any changes to working patterns are made. All the provisions of the T&Cs, including the mediation and appeals process, continue to apply at all times.
Moving back to your usual job plan
Being asked to work outside your area of practice
In such unprecedented circumstances, many senior clinicians are likely to be asked to work in ways for which you will not have trained or not have worked in for some time.
This will be a particular concern for those of you who work in non-acute specialties or in niche subspecialties and either don't have a wider breadth of previous training, or, it was many years ago.
You will want to ensure that you are working as safely as possible and not putting yourself at professional risk.
While we understand that NHS indemnity will apply, we would strongly recommend that you consult your MDO (medical defence organisation) before undertaking such work.
Before starting work in a new clinical environment, you must make sure you have had an appropriate induction. You may need to be supervised by other colleagues.
Many NHS board employers have already committed to providing induction/refresher training. You should check what is available in your area and not take on any work you do not feel competent or trained to perform.
If you are asked to provide cover for an absent colleague
Local arrangements for cover will apply – if in doubt, email your LNC or contact the BMA for further advice.
There is generally an expectation that you will provide cover for colleagues at an equivalent level where you are competent to do so and, crucially, where providing such cover is ‘practicable’.
This will depend on the circumstances, including your personal circumstances and should take account of your own work schedule and levels of rest and recuperation.
If you are asked to cover junior colleagues
Cover by consultants for junior colleagues is usually dealt with under any locally agreed ‘acting down’ policy.
Currently there is no similar provision for specialty doctors or associate specialists, however in the current emergency we would anticipate the same provision being made.
If you are covering the work of junior colleagues, you do not have the option of acting as if you are working at a lesser level of responsibility than you do normally. You will be expected to work to your normal level of seniority.
'Acting down' should not mean that you are paid at the rate of the individual you are covering.
This should only ever be a short-term measure. You should check for local agreements and ensure that pay or time off in lieu arrangements are in place. If in doubt, email your LNC or contact the BMA for further advice.
Moving temporarily from non-resident on call to resident shifts in Northern Ireland
The BMA Northern Ireland position is that in light of no local agreement in place you should be paid in accordance with your existing terms and conditions. Please email your LNC or contact the BMA for further advice if you are unclear on what these are.