Scotland Consultant Contract

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Questions and answers on the Scottish consultant contract

These FAQs cover the following areas

Contract Information
Domiciliary visits, fee paying work, family planning
Working hours, working week, management control, job plans
Part time consultants
Private practice issues
Other Information


Contract information

Q1. How do I find out more about the contract?
A All the relevant documentation is available here online. The most important documents are

The terms and conditions of service for the consultant grade (PDF)
Model diary (Word)
Model job plan (PDF)
All the necessary information on becoming a consultant in Scotland can be found on the contract page


Domiciliary visits, fee paying work, family planning

Q2. What is the position regarding payments for domiciliary visits etc?
A Under the contract, fees for domiciliary visits, medical services to local authorities, etc can only be claimed for work undertaken outside agreed programmed activities.

Q3. Can I claim for Fee Paying Work (Appendix 5(a)) activities?
A. The contract operates on the general principle that you are entitled to receive fees for work done in your own time but should not receive extra fees for work done during NHS programmed activities. However, there is scope for you to retain fees for work done in your programmed activities where there is ’minimal disruption to NHS work’. Alternatively, you could agree that you will ensure that your NHS work is made up at another time - effectively time shifting your work. You might also negotiate that the work is part of your working week, and through the job planning process negotiate an allocation in terms of programmed activities.

This issue may have been dealt with by the local negotiating committee reaching a collective agreement on behalf of the consultant body.

Q4. How is Family Planning treated under the consultant contract?
Family planning work is treated within the terms and conditions of service as contracted work to be carried out within programmed activities, comprising an element of the direct clinical care work undertaken within consultants’ job plans. A fee-paying option for undertaking family planning work is not available under the contract.


Working hours, working week, management control, job plans

Q5. Can I be asked to contract for all of my programmed activities as direct clinical care therefore leaving no time for supporting professional activities?
A. The split in duties in the terms and conditions of service is 7.5 programmed activities allocated to direct clinical care and 2.5 programmed activities allocated to supporting professional activities, unless otherwise agreed. If you look at the type of activities falling within the definition of SPAs, you will see that they relate to quality of service and clinical governance issues. It is therefore not in your interests, or those of your employer, to do less SPAs.

Employers in Scotland have agreed not to advertise consultant posts specifying a balance between clinical and non-clinical duties, with the balance being the subject of discussion and agreement between the employer and the successful applicant. However, the actual job description in the application pack is likely to contain a breakdown of duties which will indicate the SPA allocation: this may well be less than 2.5 SPAs.

An appropriate balance of duties between clinical and non-clinical work is essential for all consultants and newly appointed consultants should not be disadvantaged compared to their colleagues. Some employers contend that "new" consultants need fewer SPAs. However, consultants at the start of their career have just as much to offer in teaching, training and managerial roles and have just as much, if not more, need for professional development.

For these reasons, offering new consultants fewer SPAs is not justified. Consultants with 2 or fewer SPAs will find it extremely difficult to take any active role in teaching, training or management. Over time, the absence of such duties will also potentially prejudice that consultant being able to make a wider contribution to the development of the service as well as their own career development.

Q6. Is there a standard length of working day under the contract?
A The contracted length of any particular day is the result of agreement in the job planning process. Differential rates of pay are attached to work undertaken outside the hours of 8am to 8pm, Monday to Friday.

Consultants have always undertaken emergency and planned work out of hours. Evening and weekend sessions can be worked, but always by agreement through the job planning process. Employers are not, for example, able to run an evening operating session unless they have the theatre space, the nurses and the full back up team.

It is important to bear in mind that the contract is based around a 40 hour week for a full-timer. If you are working in the evenings or at night either on emergency work or as a programmed activity, your daytime commitment will be reduced, more than pro-rata.

Q7. How does the contract fit in with the European Working Time Directive and does the EWTD mean I can’t earn any more money for working more than 48 hours per week?
A The core contract for a full-time consultant is 40 hours per week. There is no limit on the number of extra programmed activities (EPAs) that can be contracted for separately. However, any agreement to undertake EPAs that would require a consultant to work in excess of 48 hours per week for the employer would require the consultant to sign a waiver opting-out of the requirements of the Working Time Regulations regarding the maximum working week of 48 hours.

Private practice is outside of the EWTD and does not count towards the 48 hour limit. There is no restriction on the hours you can work in private practice, provided that you always fulfil your professional obligation to be fit for work.

Q8. Can my manager force me to work any time between 8am and 8pm on weekdays?
A No. The scheduling of programmed activities during the job planning process is by agreement only. Where there is disagreement over scheduling work, the appeals process can be invoked and the status quo applies until the appeals panel has reached a decision.

Q9. Can I be made to work until 8pm?
A No. Evening clinics are put in the job plan by agreement. If you agree to do an evening clinic, then either another clinic or other direct clinical care activity must be removed from elsewhere in your working week, or you will be paid for an EPA.

Consultants should have control over what programmed activities they work and BMA advisors and the LNC are able to provide support to consultants who face unreasonable demands from their employers.

Q10. Do I have to work on Saturday mornings?
A First of all, Saturday morning working requires to be agreed with the individual consultant as part of the job plan. It is therefore up to you to decide what is reasonable in your circumstances. If your employer asks you to work occasional Saturdays or every Saturday and you refuse, the employer has the option of taking this to job plan appeal. An appeals panel would probably make its decision on what was reasonable.

You should also remember that the job plan is reviewed every year, or more frequently if changes to staffing resources, working practices or the consultant’s circumstances require it. Therefore an agreement to work occasional Saturday mornings can be reviewed.

Also remember that Saturday morning is seen differently from 8.00am-8.00pm weekdays by being paid at premium rates.

Q11. Can my employer make me do a session on a Saturday morning as part of my working week despite the fact that this work previously attracted waiting list initiative (WLI) money? When does a WLI become a service redesign and therefore not attract extra payments?
A Waiting list initiatives should attract the enhanced-level payments set out in the terms and conditions when they are the direct result of published national or local waiting times targets and specific funding has been identified for them. If the employer requires and requests such work, it is obliged to pay the enhanced rate. They are also voluntary.

Also remember that Saturday morning working requires to be agreed with the individual consultant as part of the job plan (see Q 10).

Q12. Could you clarify the arrangements for out of hours working with regard to my obligations to work at these times and what payment I am entitled to?
A The scheduling of non-emergency work after 8pm on weeknights and any time at weekends or on public holidays can only take place by agreement with the consultant, i.e. it is voluntary. However, for the period 9am -1pm Saturday and on public holidays, the employer can decide to impose non-emergency work at such a time, in which case, the consultant can appeal against the decision and the status quo will apply until the appeals panel makes a decision. Non-emergency work is scheduled as programmed activities (PAs) as it is in normal hours, but each PA only lasts 3 hours rather than the standard 4 hours or is paid at the premium rate of time and one third.

Emergency work undertaken out of hours is recognised in programmed activities and paid accordingly, i.e. during job planning the average amount of this type of on-call work is recognised as a certain number of PAs. PAs worked during the out of hours period are only 3 hours long or is paid at the premium rate.

Q13. Do I need to keep additional information as well as a diary of my work?
A It is crucial in preparing for job planning meetings that you have good, accurate information about the job you do. This is particularly important if you are going to argue that your work justifies the payment of extra programmed activities. There is no real alternative to collecting this data via a diary of your activity. The terms and conditions include a model diary (appendix 6) for you to use in carrying out this task. This has been agreed with the SGHD on behalf on NHS Scotland employers and is therefore accepted by them as being the agreed documentation to use.

For the most part, your work is likely to follow a regular pattern from week to week and should be relatively easy to assess. There will undoubtedly be exceptions for consultants who do not have such a regular pattern, such as consultants in public health medicine, and in those circumstances a longer and more detailed diary exercise will be necessary. The assessment will then need to be over a longer period. Note in particular that your workload is likely to be higher when you have colleagues on annual leave. Think about this when you complete your diary.

In order to be useful in justifying workload, consultants may need evidence, not just of total hours in broad categories, but more detail of what they are doing in those hours to enable them, if challenged by employers, to explain why the work is necessary and to account for it more specifically. We would therefore recommend that, alongside the actual diary, consultants might consider having more detailed information available.

For many consultants, the most difficult task is to assess the amount of time spent doing actual work whilst on-call because this can vary from night to night or there may be a concerted period of on-call, say one week in five. Therefore, there may need to be an assessment of on-call work over a longer period.

In completing the diary, include all the work you do; from when you arrive at work each day until the time you leave. Travelling time is included between sites and where extra time is taken to get to a site different to your normal one. All work you do when on-call should also be included, such as telephone advice, travelling to and from work and waiting to begin work e.g. an operation. Consultants, like most other professionals, would expect to be contactable during their lunch breaks and to take such breaks flexibly. Where this happens, it is reasonable to count such breaks as part of programmed activity.

Q14. Do I round up my programmed activities on a daily or weekly basis?
A The number of programmed activities should be assessed by determining the average number of hours spent on each activity per week, under each category of direct clinical care, supporting professional activities, additional responsibilities and other external duties, adding these hours together, and then converting the total number of hours into programmed activities, rounding up to the nearest half-unit.

Q15. If I cannot agree a job plan with my manager, can my employer impose one on me?
A It is explicitly stated in the terms and conditions that job planning is based on agreement between the employer and the consultant. However, if attempts to reach agreement fail, there is a referral for mediation initially to the medical director and subsequently to the divisional chief executive, followed by a formal appeals process if there is continuing disagreement.

Q16. How do the appeal panels work?
A If the consultant cannot agree a job plan or disputes a decision relating to pay progression, there is a process of mediation and appeals set out in the terms and conditions of service (section 4). The mediation process has two stages that normally involve meetings with the Medical Director at stage 1 and the Divisional Chief Executive at stage 2. If that fails to address the problem, there is a formal appeals process.

The membership of the appeal panel is a chairman nominated by the employer, a representative nominated by the consultant and a third independent member from a list approved by the Local Negotiating Committee with the NHS Board. The consultant can object to the independent member who would then be replaced.

The consultant can present his or her own case or be assisted by a representative. The panel’s decision is final and binding.

Q17. Does the contract represent a loss of professional autonomy?
A While it is true that the job planning process is more robust, it is still a matter of agreement between the consultant and manager, and there are benefits for both sides. There are no new powers to impose unreasonable targets or working patterns, and it is explicit that factors outside the individual’s control must be taken into account.

Having a core working week of 40 hours for full-timers gives consultants much greater ability to resist the uncontrolled explosion of unpaid, additional work which has traditionally fallen on consultants’ shoulders.

Q18. Currently, I do quite a lot of work from home, writing up notes and dictating letters. How is this time included in the contract?
A There is nothing to stop you reaching agreement with your employer on reasonable flexibility about where you do your work. Arrangements to work off-site or at home at specified times may be agreed in relation to specified duties and should be set out in the job plan, while some supporting professional activity time can be scheduled flexibly and undertaken off-site.

Q19. What about lunchbreaks? Are they part of the 40 hours, or in addition?
A Lunchbreaks are not mentioned in the terms and conditions of service. It is probably better to be flexible about individual lunch arrangements, rather than suggest that lunchbreaks be timetabled into the job plan, which would then extend the working day. The Working Time Regulations specify a lunchbreak of 20 minutes for every six hours worked.

Q20. There are many duties carried out e.g. College Tutor, arranging complex rotas etc. which are divided up between the department and carried out on an ad hoc basis. How should this work be dealt with under the contract?
A Under the contract you are obliged to identify and record all work done. Where such work comes under the definition of "other external duties", such as College Tutor, then it has to be explicitly agreed in advance with the employer. If the volume of such work is significant, it might be necessary to agree to the substitution of these duties for other programmed duties.

Q21. If someone is doing paid NHS work for another NHS employer, how is this treated?
A The contract provides that where a consultant works for more than one NHS employer, the employers agree a designated lead employer and design one integrated job plan. This work is therefore included in your programmed activities.

Q22. What happens when I deal with telephone calls during the night?
A Such telephone calls are regarded as work and count towards the number of programmed activities scheduled in the job plan for direct clinical care.

Q23. What payment will I get for being on call, including first on call?
A On-call supplements reward you for being on call, the value being dependent on the size of the on-call rota and the need to immediately return to site. The value, as a percentage of full-time salary, ranges from 1%-8%. There is no extra recognition for being first on call, unless resident on call (see Q 24).

Actual emergency work done while on call is assessed and remunerated as part of your programmed activities. A full-time consultant working in a high intensity post can expect one or probably two of their ten programmed activities to be allocated to emergency work.

Q24. When do consultants have to do resident on call? How are ’exceptional circumstances’ defined? Why do we have local arrangements and not a national agreement?
A The need for consultants to be resident on call is determined by the employer and agreed with the individual consultant. There is no definition of the ’exceptional circumstances’ in which this is necessary and questions should be raised as to whether this is an acceptable way of covering the service.

It was not possible to reach a national agreement on the rate payable for resident on call, since there was an unbridgeable negotiating gap between BMA Scotland and the SGHD. However, the inclusion of a reference to resident on call in the national terms and conditions of service (in paragraph 4.9.1) means that employers have to negotiate resident on call arrangements with the BMA’s Local Negotiating Committees.

Q25. What about providing prospective cover for colleagues’ on-call duties?
A If you cover your colleagues’ on-call duties when they are away on study leave, annual leave and public holidays, make sure you bear this prospective cover in mind when assessing your workload for both predictable and unpredictable emergency work. With 6 weeks’ annual leave, on average 2 weeks’ study leave and public holidays, you are likely to be covering 10 weeks of each colleague’s duties. This may mean your average out of hours workload is greater than that measured when nobody is on leave.

Prospective cover results in a change in the frequency of your rota commitment and therefore of the frequency band. For example a 1 in 10 or 1 in 9 rota with prospective cover is pushed into the medium frequency band, becoming at least a 1 in 8 rota, and a 1 in 5 rota is in the high frequency band, becoming a 1 in 4 rota. This is based on the formula: Rota after including prospective cover is 1 in (number on rota x 42/52).

Q26. How am I remunerated for providing long term sickness / vacancy cover?
A. While it is possible to agree in the job plan to provide cover for annual and study leave prospectively provided that the extra work involved is accounted for in the job plan, this is not possible for any other forms of leave, even for short periods, since such leave is unpredictable. While consultants may agree that they will provide cover in circumstances of sick leave or vacancies, (and this would be reasonable, for example, in relation to unexpected short periods of sick leave where it may not be possible to arrange locum cover at short notice) it must always be by an arrangement whereby any extra work involved is remunerated by payment of extra programmed activities on an ad hoc basis.

Q27. What will my availability supplement be if I am doing on-call on two rotas where frequency and immediacy of recall are different?
A In cases where cover is provided for two rotas, the on-call should be aggregated, adding it up over a reference period. If someone is on a 1 in 1 and a 1 in 10, then they are on a 1 in 1 rota and in the high band. If they are on a 1 in 4 and a 1 in 10 rota, then they are on a 1 in 3 and also in the high band.

Q28. I undertake regular outreach clinics which mean an overnight stay. What hours contribute towards the calculation of my programmed activities?
A The time spent at the outreach clinic counts as part of direct clinical care duties. In addition, all of the travelling time involved is counted as part of direct clinical care duties. You cannot count any time when you are not travelling or working - while it may be inconvenient and disruptive to spend time away from home in a hotel, this time is your own and you are not required to work or be on-call.

Q29. How is the pay rate for extra programmed activities calculated?
A Each EPA is paid at 1/10th of the full-time salary, including any discretionary points held. However, if you are a distinction award holder, the level is restricted to point 8 of the discretionary point scale. EPAs are not pensionable.

Q30. I cover emergency theatres (or ICU) and have to be in the hospital and immediately available. There are times when this is quiet and I am not involved directly in providing clinical care. Is it appropriate that my employer should seek to deduct the time when I am not actually working from my allocation for supporting professional activities and substitute additional clinical work at another time?
A Your time and service commitments are for agreement between you and your employer. The BMA’s position is that one of the tenets of the contract is that all work done at predictable times should be timetabled and categorised into one of the four types of programmed activity. Presumably your employer wants you to be available to cover emergency theatres or ICU and this comes within the definition of direct clinical care. You cannot be expected to undertake supporting professional activities at the same time since this would disrupt the integrity of your SPA time. Our view is that a reasonable interpretation of the contract would not permit the two different categories of direct clinical care and supporting professional activities to be undertaken and timetabled at the same time.

Q31. My colleagues and I work an on-call system which has one consultant on call for 24 hours for 7 days (which gives 6 weeks free of on-call commitments). This means that I am also on-call for emergencies during my normal daily clinics. How is this counted for diary purposes?
A An accurate diary is the key. Time spent in the daily clinics is timetabled in your diary as programmed direct clinical care duties. Your availability supplement recognises the frequency and level of your availability and any on-call worked should be included in the diary and count towards the number of direct clinical care programmed activities. You obviously cannot do the two types of work at the same time and the diary should be clear whether the work you are doing is programmed direct clinical care (D) or on-call worked (OCW).

Q32. How should the on call availability supplement be calculated when I am only on call at weekends?

A There is no specific provision in the contract about how to calculate the availability supplement in circumstances where you only cover on-call at weekends.

Paragraph 4.10.12 states ’the frequency of availability and the associated banding supplement will be agreed prospectively during the job planning process following assessment by aggregating the number of on-call duties over an agreed period’.

The fairest way of assessing this is in terms of the number of hours spent on call. If a weekend includes Friday night, then a weekend on-call equates to 64 hours. If the working week is 40 hours, then in any week, there are 128 hours which need to be covered by an on-call rota (168 - 40). If a consultant works 3 in 11 weekends, this means that they are available for 192 (3 x 68) hours out of a possible 1408 (11x128), which is equivalent to a 1 in 7 rota (1408/192). Therefore a medium frequency supplement is appropriate. If a consultant only works 48 hours at the weekend, then this equates to 144 hours out of a possible 1408, which is equivalent to a 1 in 10 rota. A low frequency supplement would therefore be appropriate


Part time consultants

Q33. What does the contract offer to part-time consultants?
A The contract offers advantages to part timers in a number of ways:

First, because emergency work is the first call on your time and is paid for; the on-call availability supplement of 1 - 8 per cent is paid as a percentage of the whole time salary, not the part time salary.
The more tightly defined and limited working week means you should be able to contract for precisely the number of programmed activities that you want and limit your commitment to that level. There is also scope for annualised hours, which helps those consultants who, for example, want to avoid working in the school holidays.
The contract recognises all clinical and supporting professional activities work and your on-call work, and pays the availability supplement for being on-call, at the appropriate percentage of a full-time salary.
Part-time consultants can base their contract on the number of PAs nearest to their current notional hours, or they can have the number of PAs nearest in equivalence to their previous working hours;
Any rise in work is only by agreement, and receives extra pay;
Part-time consultants need to have pro-rata more supporting professional activities than full-time colleagues. For example, a 6 PA consultant should have 2 supporting PAs;
Consultants who have trained flexibly and have therefore had longer training should have their pay progression adjusted to make sure that they can reach the top of the pay scale.

Q34. How family-friendly is the contract?
A Several features of the contract make it family-friendly:

(i) the contract, through the job planning mechanism, should accurately reflect the actual workload, so there is limited scope for uncontrolled extra workload to impinge upon consultants’ family lives and responsibilities.

(ii) the agreement provides for annualisation of workload, so those with children may be able to arrange to work less during school holidays without overall financial detriment.

(iii) there are no restrictions on pay progression for those who choose to work 40 hours or fewer for family reasons, or indeed any reasons other than private practice.

(iv) the scheduling of commitments is only by agreement with your manager.

(v) the location of some programmed activities is flexible.

(vi) weekend (apart from Saturday morning) and weeknight working after 8pm is voluntary and attracts premium rates.


Private practice issues

Q35. What is the status of the code of conduct on private practice?
A The code of conduct is an appendix to the terms and conditions of service and therefore part of a consultant’s contract.

Q36. Why is there a requirement to offer an extra NHS programmed activity before I can do private practice without potential detriment to pay progression?
A Some consultants may be unhappy about the requirement to offer one extra PA to the NHS in order to undertake private work and not potentially suffer in relation to pay progression. However, this is part of the contract agreement. It is important to stress that the extra PA is paid, and is not obligatory. Any consultant who declines the offer of an extra PA is still free to do private practice, but in doing so places their pay progression at risk.

Q37. Isn’t it illegal for consultants to be required to do extra work for the NHS before doing what they wish in their own time?
A The requirement to offer an extra programmed activity to the NHS before undertaking private work, in order to qualify for pay progression, is unlikely to be illegal. It is a restriction, but is a valid restriction if it is reasonable. The restraint must be capable of justification on the basis that it satisfies a legitimate interest of the employer, and is reasonable in the interests of the public. An NHS employer has an interest in consultants devoting substantially the whole of their professional time to NHS duties. Further, it is clearly in the public interest for consultants to do an extra PA for the NHS if there is a need for that extra work to be carried out.

Q38. Do I have to work an extra programmed activity before undertaking private practice?
A If you wish to undertake private practice and want to progress through the pay points in the normal way, you must be willing to work a paid extra programmed activity if your employer requires it of you. Employers must offer any extra work to all consultants in the specialty who could undertake them. They must not single out those who practise privately.

Alternatively, you could decline the extra programmed activity and face the prospect that your NHS salary will be pegged, i.e. you may not pass through the next pay point. That is a calculation that consultants have to make on an individual basis.

Q39. Can I do a private practice session between 9am-5pm?
A Yes. There is nothing in the contract and code of practice that rules this out.

Some employers may not be receptive to the idea that consultants may be working elsewhere during the day and want to deploy them inside their own board. However if they want to propose a change to existing working arrangements, this must be done through job planning, and they need to be able to show that they have the staff and other facilities available. They cannot contract with you for more than 10 four hour programmed activities without your agreement. The scheduling of work is also by agreement and can be flexible.

Q40. If I work 40 hours for the NHS does the European Working Time Directive mean I can only do 8 hours private practice?
A No, the European Working Time Directive is health and safety legislation aimed at protecting the employee from excessive demands made by the employer. Private practice is outside of the EWTD and does not count towards the 48 hour limit. There is no restriction on the hours you work in private practice, provided that you always fulfil your professional obligation to be fit for work.

Q41. Does the contract mean that I cannot do a private practice session if I am on call for the NHS?
A This might be permissible if the arrangements were agreed with the employer and satisfactory arrangements were in place to ensure safe emergency cover of NHS patients, for example by collaborative arrangements with named colleagues. The contract contains two different levels of on call availability - calls which typically require an immediate recall to site and those which are dealt with in other ways. This should facilitate pragmatic arrangements at local level.

The code of conduct governing NHS and private work provides more details.



Q42. What is pensionable under the contract?
A Basic pay up to 10 programmed activities is pensionable. Extra PAs above the full time commitment are not pensionable. Discretionary points, distinction awards, on-call availability supplements and separate domiciliary visit fees not undertaken during programmed activities are pensionable. There is no change to the pension arrangements for a consultant who has Mental Health Officer status.

Q43. Do extra programmed activities count towards my pension?
A Extra programmed activities in excess of the full-time commitment of 10 are not pensionable under the NHS Pension Scheme. However, you can choose to include them in private pension arrangements.



Q44. How is my 6 weeks’ annual leave calculated?
A You are entitled to annual leave at the rate of 6 weeks per year. The number of days to which ’6 weeks’ equates, where leave is taken in periods of less than 1 week, is assessed for full time and part-time consultants by calculating the average number of days per week when the consultant is on duty as agreed in the job plan, including on-call availability, and multiplying it by 6.

The following table, applicable to full-time consultants, might be helpful:

 Rota Leave in days 
 1 in 1  42
 1 in 2  36
 1 in 3  34
 1 in 4  33
 1 in 5 to 1 in 8  32
 1 in 9 to 1 in 24  31
 1 in 25 or less frequent  30

Q45. Does the contract provide for sabbaticals?
A Arrangements for consultants to take sabbaticals are set out in the terms and conditions of service (section 7.4). Basically, after 7 years service in the consultant grade, a consultant is eligible to apply for one period of paid sabbatical leave of up to 6 weeks or after 10 years service, up to 3 months sabbatical leave.

Q46. What does the contract mean for professional leave such as leave for BMA or College duties, etc?
A The study and professional leave provisions are a maximum of 30 days (including off-duty days) in any period of three years.

The contract makes provision for ’other external duties’, which are defined as work not directly for the NHS employer, but relevant to and in the interests of the NHS, to be included in the allocation of programmed activities in the job plan. Trade union and professional association duties, including travelling time associated with these duties, come within the list of examples. You can therefore agree the inclusion of such work with your employer. This would be in addition to the 30 days for study and professional leave.

Q47. Is study leave part of the supporting professional activities allocation?
A No. Study leave is additional to programmed activities. There is therefore no question of a consultant being asked to increase their level of direct clinical care activities for part of the year to ’compensate’ for study leave.



Q48. Is there any problem regarding GMC standards of good medical practice because of the time based nature of the contract and its conflict with the concept of continuing clinical responsibility?
A The concept of ’continuing clinical responsibility’ as contained in the pre-2004 consultant contract, has disappeared in the 2004 contract which states that the consultant’s duties and responsibilities are as defined in the job plan.

The GMC document Good Medical Practice does not use the term ’continuing clinical responsibility’. It states that the doctor must ’be readily accessible to patients and colleagues when you are on duty’. It also states that ’You must be satisfied that, when you are off duty, suitable arrangements are made for your patients’ medical care. These arrangements should include effective handover procedures and clear communication between doctors’. The consultant therefore has to be satisfied with the arrangements for cover when off duty but does not have any further responsibility.

Q49. Can I remain on the pre-2004 consultant contract?
A Yes, you retain the right to stay on your existing contract, but can transfer to the 2004 contract if you wish.

Q50. What payments are available for waiting times initiatives?
A The contract provides that the employer and consultant can agree a separate voluntary contract to cover increased ad-hoc activity not identified in the job plan to meet published national or local waiting times targets. Such work is paid at three times the hourly rate appropriate to point 20 of the seniority scale, or alternatively, and by agreement with the employer:

  • paid at twice the hourly rate appropriate to point 20 and equivalent time off in lieu; or
  • paid at the hourly rate appropriate to point 20 and twice the equivalent time off in lieu.

Q51. How is locum experience counted on taking up a consultant post?
A All locum service in a consultant post undertaken for three or more continuous months prior to first appointment as a consultant in the NHS will count at the rate of one half in determining the starting salary, seniority point and seniority date. All locum service as a consultant undertaken after first appointment to the consultant grade will count in full. Locum service in grades other than consultant does not count in determining starting salary as a consultant..