>> Service Provision Guidelines

Draft Model Job Plan for a consultant dermatologist working in a District General Hospital

The standard contract for a consultant working full time within the NHS will consist of 10 Programmed Activities (PAs). These will be divided into 7.5 PAs related to direct patient care, and 2.5 related to supporting activities. The 7.5 PAs devoted to patient care should include time spent in outpatient clinics (including surgical sessions), time allocated to the supervision of the care of patients attending for day-care, and having treatments or investigations such as phototherapy or patch testing, as well as regular ward rounds and review of ward referrals from hospital based colleagues. Direct clinical care also includes time spent on administrative tasks that directly relate to patient care. This includes tasks such as screening and prioritising referral letters, reviewing and acting upon laboratory results, communicating about patients with colleagues in writing or by telephone or e-mail. Demonstration of the justification for the content of a job plan will need to be provided by the work diary of the individual.

Essential Non-clinical elements of job plan. PAs
Audit/research/CPD, Clinical Governance, Non-clinical admin,, Teaching 2.5
Clinical Elements of job plan
Clinics, Surgery, Supervising eg day unit treatments, patch tests, phototherapy,lasers, histopathology review, ward work 5-6
Administration related to direct clinical care and travelling time This will consist of time allowed within clinics, as well as additional PAs as identified by the analysis of your diary
Total 7.5
Overall Total 10

The balance between formal clinics, ward work and supervisory activity will vary. Direct patient contact time must be balanced by appropriate clinical administration time. Numbers in clinics should be adjusted to ensure completion within 4 hours including teaching and immediate clinical administration. Additional administrative responsibilities will require further time drawn from the 7.5 PAs allocated to patient care. Work for National bodies should be acknowledged and programmed. They may require a negotiated reduction in the clinical elements of the annual job plan. The arrangements for on call will vary with local policies, but it is likely that most consultants will be given a category B availability supplement. Those working part-time will still be required to complete the full complement of supporting activities, so no significant reduction in the 2.5 PAs allocated for this should be made.

We draw your attention to the following paragraph from the BMA document on job planning:

"Any agreed hours that you work above your basic commitment will be paid. In order to make best use of this contract, it is vital that you use this opportunity to claim for extra work. The first thing to do, therefore, is to demonstrate the number of hours that you are working for the NHS. If this is in excess of 10 PAs, then you need to be able to show this to your clinical manager so that you can get paid for the additional work. This should be done at the first job planning meeting. If you are working above 40 hours, then the trust should pay you for this extra work. If you do not get paid for these hours, do not work them."

Analysis of your work diary may indicate that your work-load is in excess of 10 PAs.
If this is the case, you can:
i) reduce numbers of clinics, or
ii) reduce numbers of patients in clinics, or
iii) be paid more

Job Planning in Teaching Hospitals.
Teaching Hospital Consultants will need additional time for teaching and supervision of research. This will have to reduce the clinical elements of the job plan.

Dr M J Goodfield
Honorary Secretary
British Association of Dermatologists

November 2003