Scotland Consultant Contract

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Structure of the consultant contract in Scotland

The 2004 consultant contract

Since 1 April 2004, the ‘2004 consultant contract’ has been the only contract permissible for new NHS consultant posts, including locums. Consultants in post before 1 April 2004 had, and still have, the choice of moving on to the 2004 contract or remaining on the previous contract. Consultants working as clinical directors, medical directors, or directors of public health are covered by the 2004 contract.

The basic work commitment

The contract is based on a full-time work commitment of 10 programmed activities (PAs) per week, each having a timetabled value of four hours (or three hours if the PA is undertaken in premium time – see below). Each consultant must have a job plan that sets out the number of agreed PAs the consultant will undertake, plus a list of the duties they are expected to perform within those PAs.

A key feature of the contract is that it provides a clear maximum commitment to the NHS, including work done while on call. Any additional work above 10 PAs will be by agreement and paid at the appropriate rate. There are additional conditions applying to consultants wishing to undertake private practice.

Reference - TCs section 4

 

The working week

A full-time consultant’s job plan of 10 (or more) PAs will consist of work from any of the following categories as defined in the TCS:

Direct clinical care (DCC) includes:

  • emergency duties (including emergency work carried out during or arising from on call)
  • operating sessions
  • pre- and post-operative care
  • ward rounds
  • outpatient clinics
  • clinical diagnostic work
  • other patient treatment
  • public health duties
  • multi-disciplinary meetings about direct patient care
  • administration directly related to patient care (eg. referrals, notes, complaints, correspondence with other practitioners)
  • on-site medical cover
  • any other work linked to the direct clinical care of NHS patients and travelling time associated with any of these duties.

Emergency duties (both predictable and unpredictable) will be given first priority when allocating PAs for direct clinical care.

Supporting professional activities (SPA) includes:

  • continuing professional development
  • teaching and training
  • management of doctors in training
  • audit
  • job planning
  • appraisal
  • revalidation
  • research
  • contribution to service management and planning
  • clinical governance activities
  • any other supporting professional activities
  • and travelling time associated with these duties.

Additional responsibilities are duties of a professional nature carried out for or on behalf of the employer or the Scottish Government, which are beyond the range of the supporting professional activities normally to be expected of a consultant.

Additional responsibilities are:

  • Caldicott guardians
  • clinical audit leads
  • clinical governance leads
  • undergraduate and postgraduate deans
  • clinical tutors
  • regional education advisers
  • formal medical management responsibilities
  • other additional responsibilities agreed between a consultant and his or her employer which cannot reasonably be absorbed within the time available for supporting professional activities and travelling time associated with these duties.

This is not an exhaustive list.

Other external duties

These are duties not included in any of the three foregoing definitions and not included within the definition of fee paying work or private practice, but undertaken as part of the job plan by agreement between the consultant and the employer. They comprise work not directly for the NHS employer, but relevant to and in the interests of the NHS.

Examples include:

  • trade union and professional association duties
  • acting as an external member of a consultant appointment committee
  • undertaking assessments for NHS Education for Scotland
  • NHS Quality Improvement Scotland (now Healthcare Improvement Scotland) or equivalent bodies
  • work for the royal colleges
  • work for the General Medical Council (GMC) or other national bodies concerned with professional regulation
  • NHS disciplinary procedures
  • NHS appeals procedures and travelling time associated with these duties.

This list of activities is not exhaustive.

It is SGHD policy to encourage NHS employers, as part of a corporate commitment to NHS Scotland, to release consultants wherever possible for work that is not directly for the NHS employer but is relevant to and in the interest of the wider NHS and which may involve consultants being away from their employment base. Where agreement cannot be reached, the mediation or appeals processes can be used.

The job plan will set out the number of PAs for each of the different types of activities above. It will also set out the duties the consultant is expected to perform within those PAs. See the job planning section for more information on job plans.

Reference:

TCS section 4; Job planning for the 2004 consultant contractJob planning for your first consultant post - Scotland (PDF 262K)

 

Balance of activities

The contract sets out that in a 10 PA job plan for a full-time consultant, there will be 7.5 PAs of direct clinical care and 2.5 PAs of supporting professional activities unless otherwise agreed. There is flexibility to agree a different balance of activities. For example, if a consultant has additional responsibilities to carry out, such as being a clinical governance lead, they may reduce their DCC activities to fit this additional work into a 10 PA job.

Alternatively, they may agree to undertake extra PAs in addition to the standard 10 per week. It is recognised that part-time consultants need to devote proportionately more of their time to supporting professional activities, for example, due to the need to participate in continuing professional development to the same extent as their full-time colleagues. The following table sets out the usual balance between DCC PAs and SPAs for part-time consultants.

 

Total number of PAs Number of SPAs

2 or less 

0.5

2.5 - 3.5 

1

4 - 5.5 

1.5

6 - 7.5

2

8 or more

2.5

The SCC’s position, which is supported by the UK Academy of Medical Royal Colleges, is that the vast majority of consultants, new and existing, require at least 2.5 SPAs if they have any teaching, training, research, service development, clinical governance or management responsibilities. If employers offer a different balance between DCC and SPA activities, you should refer to the SCC’s guidance

Reference: TCS paragraphs 4.2.1 and 4.2.2

 

On-call working

Emergency on-call work

The job plan should set out a consultant’s duties and responsibilities in respect of emergency on-call work. Under the contract, emergency work is recognised in three ways.

On-call availability supplement

Consultants on an on-call rota are paid an on-call availability supplement in addition to basic salary, which recognises the inconvenience of being on a rota and the duty to participate in it.

  • The level of supplement depends on the rota frequency and the typical nature of the response:
    Level 1 applies to a consultant who needs to attend a place of work immediately when called, or to undertake analogous interventions (e.g. telemedicine or complex telephone consultations).
  • Level 2 applies to a consultant who can attend a place of work later or respond by non-complex telephone consultations later. (It is possible for a consultant on level 2 availability supplement to agree with their employer not to be contactable immediately for short intervals, provided that there are arrangements for any messages to be taken and for the consultant to be able to respond immediately after the interval in question.)

 

Frequency of rota commitment Value of supplement as a percentage of full-time basic salary
Level 1 Level 2

High frequency: 1 in 1 to 1 in 4

8%

3%  

Medium frequency: 1 in 5 to 1 in 8

5%

2%

Low frequency: 1 in 9 or less frequent

3%

1%

 

Consultants will always be paid the full value of an on-call supplement. If part-time consultants participate in the rota on the same basis and as frequently as their full-time colleagues, they will receive the same percentage supplement on their basic salary. However, if they participate in the rota on a different basis they will receive the percentage supplement that a consultant on an equivalent rota would have received.

For example, if a part-time consultant was on level 1 and worked a one in 10 rota whereas their full-time colleagues worked a one in five, they would receive the low frequency supplement of 3.0 per cent: they would not get half of a 5 per cent supplement.

In calculating the frequency of the rota, it is important to take into account prospective cover rather than taking the frequency to be equivalent to the number of people taking part in the rota. Prospective cover will result in a change in the frequency of the rota commitment and therefore, of the frequency band.

For example, a one in 10 or one in nine rota with prospective cover will be pushed into the medium frequency band, becoming at least a one in eight rota, and a one in five rota will be in the high frequency band, becoming a one in four rota. This is based on the formula: rota after including prospective cover is one in (number on rota x 42/52).

Reference: TCS, paragraphs 4.10.9-4.10.15

 

PA allocation for emergency work

The on-call availability supplement recognises the inconvenience of being available while on call. It does not recognise the work actually done while on call. The contract explicitly takes account of the work done by allocating an appropriate number of PAs within the weekly job plan.

For many consultants, there will be a predictable amount of emergency work arising from on-call duties (operating lists, ward rounds, administration etc). The consultant and the employer should monitor the number of hours worked over the period of the rota and calculate the average number of PAs of emergency work done per week. Prospective cover should be factored into the calculation (see below).

There is no limit on the amount of predictable on-call work that can be allocated to DCC PAs.

Some emergency work will also be unpredictable and the same approach to calculating average weekly PAs spent in this type of activity should be taken. Diary evidence will be key to calculating the PA allocation fairly. Allocations for unpredictable on-call work should not exceed a maximum of two PAs per week. If unpredictable on-call work exceeds this level, this will be addressed through job planning. In exceptional circumstances, where the employer and the consultant agree that additional work beyond two PAs is necessary, this excess work will be recognised through additional arrangements locally.

The allocation of emergency PAs should be reviewed and adjusted as necessary at the annual job plan review, or whenever the consultant or the employer believes that emergency workload has changed.  

Definitions of emergency work (as set out in the TCS)

  • Predictable emergency work
    This is emergency work that takes place at regular and predictable times, often as a consequence of a period of on-call work (e.g. post-take ward rounds). This should be programmed into the working week as scheduled PAs.
  • Unpredictable emergency work
    This is work done while on call and associated directly with the consultant’s on-call duties (e.g. recall to hospital to operate on an emergency basis).
Reference: TCS, paragraphs 4.10.1- 4.10.8

 

Cover for leave

Agreement should be reached with the employer in advance through the job planning process about the circumstances in which consultants will provide cover for colleagues on leave. Any extra PAs resulting from cover will be by agreement between the consultant and employer. Where cover by consultant colleagues is not available, the employer, not the consultant, is responsible for the engagement of a locum, or other arrangement.

If a consultant covers colleagues’ on-call duties when they are away on study leave, annual leave and public holidays, this prospective cover should be taken into account when assessing workload for both predictable and unpredictable emergency work. With six weeks annual leave, on average two weeks study leave and public holidays, consultants are likely to be covering nearly 10 weeks of each colleague’s duties. This may mean a consultant’s average out-of-hours workload is up to 24 per cent greater in the week and 18 per cent greater at weekends than that measured when nobody is on leave. In reality, consultants can do 52 weeks of on-call work in 42 weeks at the hospital.

A consultant is under no obligation to provide prospective cover other than annual and study leave and public holidays since the extent of such a commitment cannot be predicted.

Cover for leave is an area where many Local Negotiating Committees (LNCs) have reached local agreements with employers.

Reference: TCS, paragraphs 7.7.1-7.7.2

 

Resident on call

Resident on call by consultants is an extremely wasteful way of providing cover and the contract clearly states that consultants will not, save in exceptional circumstances, undertake resident on call. There is no obligation in the contract for them to do so.  However in some specialties (eg. Paediatric ICU, labour ward work), this may be necessary. LNCs will have reached a local agreement with the employer on the arrangements that will apply to consultant resident on call, including remuneration, accommodation and catering. The SCC believes that pay for resident on call should be substantially higher than standard or premium time rates.

Reference: TCS, paragraph 4.9.1

 

Duty to be contactable

It is a requirement that while on call, the consultant must be contactable.

However, it is possible for a consultant on level 2 availability supplement to agree with their employer not to be contactable immediately for short intervals, provided that there are arrangements for any messages to be taken and for the consultant to be able to respond immediately after the interval in question.

Reference:  TCS, paragraph 4.10.11

 

Private practice and on-call work

Except in an emergency, private work should not be undertaken while on call and a consultant will have to make alternative arrangements to provide cover if emergency treatment for private patients regularly impacts on NHS commitments.

Reference:  TCS, appendix 8, paragraphs 2.3-2.8

 

Extra PAs

A consultant may agree with the employer to work more than the standard 10 PAs for a full-time consultant. There is no obligation on the consultant to work more than 10 PAs (but note the potential impact on pay progression below) and there is equally no obligation on the employer to offer more than 10 PAs. Where a consultant agrees to work extra PAs, these are payable at a rate of 10 per cent of basic pay, plus any discretionary points held. This is capped at eight discretionary points where a distinction award is held.

A separate contract should be agreed with the employer for any extra PAs. This should set out what work is to be done in the extra PAs; this will mean that if the consultant or the employer decides to terminate the separate contract, it will be clear what work is to be dropped.

 

Private practice and extra PAs

There is no obligation for a consultant to undertake PAs in excess of the standard 10 per week for a full-time consultant, but one of the criteria for achieving progression through seniority points is that consultants should accept an extra paid PA in the NHS, if offered, before doing private work. See the private practice section for further details.

Reference: TCS, appendix 2, model contract for EPAs; TCS, section 4.4

 

Premium time and work done out of hours

The contract recognises work done at certain times of the week, defined as work undertaken outside of the hours of 8.00am to 8.00pm, Monday to Friday, and on public holidays, as ‘premium time’ or “out of hours work”. Non-emergency work cannot be scheduled during these times without the agreement of the consultant and there should be no detriment to pay progression or any other matter if a consultant refuses to undertake non-emergency work in premium time.

An employer cannot require a consultant to undertake scheduled work outside 8.00am to 8.00pm, Monday to Friday and 9.00am to 1.00pm on Saturdays, or on public holidays. However there are acute specialties where some “out of hours” work by consultants is necessary, so prospective appointees do need to be realistic about this possibility. If a doctor accepts a consultant post with scheduled work out of hours included in the agreed job plan (for example, on-site working overnight for three nights each month), then the doctor cannot unilaterally withdraw from undertaking this work since this would breach the contract.

The contract states that no more than 3 PAs per week should be out of hours other than in exceptional circumstances. During premium time the length of a PA is reduced to three hours (rather than four) or, by agreement, the rate of pay for a four-hour PA increases to ‘time-and-a-third’.

Reference: TCS, paragraphs 4.8.1-4.8.6

 

Location of work

It is generally expected that PAs will be undertaken at the location agreed in the job plan, which must be set out in the consultant’s individual contract. 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 elements of SPA time can be scheduled flexibly and undertaken off-site.

Reference:TCS, paragraphs 3.2.9-3.2.13Travelling time

 

Travelling time

Travelling time to and from the usual place of work is not regarded as working time.  Travelling time between the principal place of work and other work sites is working time and should be included within the category of work (e.g. DCC, SPA) for which the journey is necessary. Travel to and from work for NHS emergencies also counts as working time.

Reference: TCS, paragraph 4.7.1Workload assessment

 

Workload assessment

Where a consultant believes that their average workload exceeds the amount of work for which the consultant has contracted as PAs agreed in the job plan, the consultant can request an interim job plan review, which the employer will set up within one month of the request.

In such cases, the consultant will complete a diary measuring workload over an agreed period. The completed diary, along with any other appropriate supporting documentation provided by the consultant and/or the employer, will form the basis of determining the consultant’s workload. Where this demonstrates that workload does exceed contracted PAs, the job plan will be adjusted in one of the following ways:

  • The consultant and employer may agree that the consultant will continue the same level of activity and contract for a number of extra PAs which equate to the hours worked; or
  • The consultant and employer may agree a reduction in hours worked to equate to the number of PAs contracted in the previously agreed job plan; or
  • The consultant and employer may agree a combination of a) and b) so that the PAs contracted in the revised agreed job plan (including any extra PAs) equate to the consultant’s new working hours.

Where it is agreed to contract for extra PAs as in a) above, the effective date for their payment will be the date on which the consultant first brought the matter to the employer’s attention by requesting an interim job plan review. Where the employer agrees to reduce actual workload as in b) or c) above, this must be achieved within three months of the date of the interim job plan review. Time off in lieu will be accrued from the date of the interim job plan review.

If agreement cannot be reached, the mediation and appeals processes will apply.

Where an employer has concerns that the workload does not match the job plan, then they can ask the consultant to complete a diary or other supporting documentation, but if the consultant believes that this is an unreasonable request, then the consultant may refer back to the mediation and appeals processes.

Reference: TCS, section 4.6