Flexible trainees – pros and cons for Trusts

Access to less than full time working –improvements and concernsAccess to less than full time working –improvements and concerns

•Jayn Ammantoola

Chair, National Association of Medical Personnel Specialists

Medical Personnel Specialist

Flexis – pros ‘n’ cons……..

…Differences…Differences

What’s Different?What’s Different?

What happens now…

Dr Flexible arrives on the first day with no papers…….

Dr Flexible comes the Trust after having contacted theFlexible Dean, and has all the signatures and papers,working through a check list.

Check ListCheck List

Action

Date Done

Dr contacts the Flexible Training Office at the Deanery to discuss eligibility

Flexible form is posted to the doctor

Dr discusses placement with the programme Director (SpR) and Supervising Consultant,

Draw up training programme and work plan

Dr gets Royal College educational approval, STC / University approval (SpR)

Doctors’ Hours Team looks at the provisional timetable / pattern and calculates band

The Trust may ask for further local signatures – Directorate Finance / HR Director / IWLManager.

Recruitment documents are attached to show that the recruitment was in open competition(SHO)

Form is sent to the Flexible Training Office

A signed copy of the form is sent back to the Dr.

A copy is given to Medical Staffing for the file, Dr starts work at the Trust, signs onto payroll

After 6 weeks, Dr is monitored to check the provisional band

Repeat this check list – either 3 months before the next Trust, or 3 months before the yearis up

The junior doctor…The junior doctor…

Must collect the signatures – applications should not take longer than 3months to process.

They will need to find out who organises the rota patterns – HR / MedicalStaffing / Directorate;

 - and get the papers to them in advance.

Consultant needs to talk to Dr.

Timely return to work after maternity leave…….and 6 monthly rollingrotations. …

The clinical tutorThe clinical tutor

…”education and service elements…..eachcomponent …allocated”

..”funded at the level contracted for educationalpurposes”

How to designate this?

work with the doctor to organise the timetable.

Sorting out the rota….Sorting out the rota….

…”identifying total hours of work, which will includeout of hours….”

The agreement will include an assessment of intensitybanding.

So, how to do this?

What do the full timers do….What do the full timers do….

 7 doctors doing a 1 in 7

non resident on call

 Band 2B

 Hybrid - Full shift and on call

Week

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

09.00-09.00

09.00-14.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

Average weekly hours of duty New Deal

63.14

Target

72.00

Average weekly hours of work New Deal

50.10

Target

56.00

Average total rest weekday on call

11.00

Average total rest weekends on call

12.00

Prospective cover included?

Yes

Average weekly hours EWTD

48.22

Target

58.00

Just 3 steps….Just 3 steps….

Step 1 – look at the full timepay and how much of that theflexible is doing

Step 2 – work out thesupplement

Step 3 do all the sums

Pay!

The banding flowchartThe banding flowchart

http://www.nhsemployers.org/PayAndConditions/doctors_in_training_including_gp_registrars.asp

What do part timers do….What do part timers do….

 Part time

 only does the nights whenthey have done the days

Band FB

Average weekly hours of duty New Deal

41.46

Target

72.00

Average weekly hours of work New Deal

32.17

Target

56.00

Average total rest weekday on call

11.00

Average total rest weekends on call

12.00

Prospective cover included?

Yes

Average weekly hours EWTD

30.56

Target

58.00

Week

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

09.00-09.00

09.00-14.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

Future….Future….

 Part time

does 70% of all the nights, nomatter whether on for that day or not

Band FA 1 weekend in 5

Average weekly hours of duty New Deal

42.37

Target

72.00

Average weekly hours of work New Deal

33.28

Target

56.00

Average total rest weekday on call

11.00

Average total rest weekends on call

12.00

Prospective cover included?

Yes

Average weekly hours EWTD

32.12

Target

58.00

Week

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

09.00-09.00

09.00-14.00

09.00-17.00

09.00- 09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

On full shifts -On full shifts -

 The full time doctors average 50hours

Part time 3 ½ days

does 70% of all the nights

Band FA 1 weekend in 4

Week

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

8-18

21-10

8-18

8-21

8-18

8-21

8-18

8-21

8-18

21-10

8-18

Average weekly hours of work New Deal & EWTD

Night shift of 13 hours

Day shift of 10 hours

long day 13 hours

Prospective cover included?

Yes

70% of 50 full time hours = 35 is F8

F8 is 80% of FBP

1 in 4 full shift is a Band FA (O.5)

Supplement is 50% x Basic

Basic = 0.8 x FBP

Supplement = 0.5 x Basic Pay

0.8 x 0.5 x FBP = 0.40 x FBP

Pay = (0.8 + 0.4) x FBP = 1.2 x FBP

MonitoringMonitoring

Currently, monitoring against the theoretical pattern for 7doctors (1 in 7)with 2 flexis on slot share, checking 6 full timers, and theslot shares individually*.

Supernumerary – monitor against their individual pattern.

When to monitor – just after they start, one offmonitoring…and again every 6 months…..

With 20% of workforce envisaged as flexible, additionalanalysis of monitoring ?

Software packages / PDAs etc to help

The normal monitoring mutual obligation applies.

Slot sharesSlot shares –.

Dr Slot works 3 days per week

M, T, W. 30 hours, FB

1 in 14 weekends

Dr Share works for 3½ days a week

T,W,Th,F. 36½ hours, FB

1 in 14 weekends…

Week

Mon

Tues

Wed

Sat

Sun

09.00-09.00

09.00-14.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

09.00-09.00

09.00-17.00

Tues

Wed

Sat

Sun

09.00-14.00

09.00-17.00

9-13

09.00-09.00

09.00-17.00

9-13

09.00-17.00

09.00-09.00

09.00-17.00

9-13

09.00-17.00

09.00-09.00

9-13

09.00-17.00

09.00-09.00

09.00-17.00

9-13

09.00-09.00

09.00-17.00

9-13

60% of 50 hours full time = 30 hours = F7 so Basic pay is 0.7 x FBP

Supplement for ON call = 1 in 14 with cover = FB, so that is 40% of F7,

Which is 0.4 x 0.7 = 0.28

Pay = (0.7+0.28) x FBP = 0.98 x FBP

70% of 50 hours = 35 hours = F8, so basic is 0.8 x FBP

Supplement is 40% of F8

Which is 0.4 x 0.8 = 0.32

Pay = (0.8 + 0.32) x FBP = 1.12 x FBP

Pay protection, etcPay protection, etc

So, what happens to the trainees who are collecting signaturesnow?

The initial banding, worked out before starting, is the level ofpay protection for those starting after the new pay start date.

Current trainees stay at their current band if it is higher, untilthe end of the post or placement ….is this CCST? …or justuntil next year?

Final questionsFinal questions

Is it a good thing to rely on supernumerary trainees forrota compliance?

Access to flexible training is resource limited..

Numbers of flexible trainees will double in the next 3-5years…aim to increase the numbers over 5 years to 20%of trainees within all educational contracts… a trust with50 / 100 / 300 junior doctors….(10, 20, 60)

Last – does payroll know?