Transcript Flexible trainees – pros and cons for Trusts

Access 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
What’s Different?
 What happens now…
 Dr Flexible arrives on the first day with no papers…….
OR
 Dr Flexible comes the Trust after having contacted the
Flexible Dean, and has all the signatures and papers,
working through a check list.
Check List
Action
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 / IWL
Manager.
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 year
is up
Date Done
The junior doctor…
 Must collect the signatures – applications should not take longer than 3
months to process.
 They will need to find out who organises the rota patterns – HR / Medical
Staffing / 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 rolling
rotations. …
The clinical tutor
…”education and service elements…..each
component …allocated”
..”funded at the level contracted for educational
purposes”
How to designate this?
work with the doctor to organise the timetable.
Sorting out the rota….
…”identifying total hours of work, which will include
out of hours….”
 The agreement will include an assessment of intensity
banding.
 So, how to do this?
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
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
Week
Mon
Tues
Wed
Thurs
Fri
1
09.0009.00
09.0014.00
09.0017.00
09.0017.00
09.0017.00
2
09.0017.00
09.0009.00
09.0017.00
09.0017.00
09.0017.00
3
09.0017.00
09.0017.00
09.0009.00
09.0017.00
09.0017.00
4
09.0017.00
09.0017.00
09.0017.00
09.0009.00
09.0017.00
5
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0009.00
6
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0017.00
7
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0017.00
Sat
Sun
09.0009.00
09.0009.00
Target
58.00
Just 3 steps….
 Step 1 – look at the full time
pay and how much of that the
flexible is doing
 Step 2 – work out the
supplement
 Step 3 do all the sums
Pay!
The banding flowchart
http://www.nhsemployers.org/PayAndConditions/doctors_in_training_including_gp_registrars.asp
What do part timers do….

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
Part time

only does the nights when
they have done the days
 Band FB
Week
Mon
Tues
Wed
1
09.0009.00
09.0014.00
09.0017.00
2
09.0017.00
09.0009.00
09.0017.00
3
09.0017.00
09.0017.00
09.0009.00
4
09.0017.00
09.0017.00
09.0017.00
5
09.0017.00
09.0017.00
09.0017.00
6
09.0017.00
09.0017.00
09.0017.00
7
09.0017.00
09.0017.00
09.0017.00
Thurs
Fri
Sat
Sun
09.0009.00
09.0009.00
Target
58.00
Future….

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
Part time
 does 70% of all the nights, no
matter whether on for that day or not
 Band FA
1 weekend in 5
Week
Mon
Tues
Wed
1
09.00-09.00
09.00-14.00
09.00-17.00
2
09.00-17.00
09.00- 09.00
09.00-17.00
3
09.00-17.00
09.00-17.00
09.00-09.00
4
09.00-17.00
09.00-17.00
09.00-17.00
5
09.00-17.00
09.00-17.00
09.00-17.00
6
09.00-17.00
09.00-17.00
09.00-17.00
7
09.00-17.00
09.00-17.00
09.00-17.00
8
09.00-17.00
09.00-17.00
09.00-17.00
9
09.00-17.00
09.00-17.00
09.00-17.00
10
09.00-17.00
09.00-17.00
09.00-17.00
Thurs
Fri
Sat
Sun
09.00-09.00
09.00-09.00
09.00-09.00
09.00-09.00
Target
58.00
On full shifts 
Average weekly hours of work New Deal & EWTD
The full time doctors average 50
hours
 Part time 3 ½ days
 does 70% of all the nights
 Band FA 1 weekend in 4
Week
1
Mon
Tues
Wed
Thurs
8-18
8-18
8-18
21-10
21-10
2
3
8-18
8-18
8-18
4
8-18
8-21
8-18
5
8-18
8-18
8-21
6
8-18
8-18
8-18
8-18
Fri
8-21
21-10
Sat
8-21
21-10
35
Night shift of 13 hours
Day shift of 10 hours
long day 13 hours
Prospective cover included?
Sun
Yes
70% of 50 full time hours = 35 is F8
F8 is 80% of FBP
8-21
1 in 4 full shift is a Band FA (O.5)
Supplement is 50% x Basic
21-10
Basic = 0.8 x FBP
Supplement = 0.5 x Basic Pay
0.8 x 0.5 x FBP = 0.40 x FBP
7
8
8-18
Pay = (0.8 + 0.4) x FBP = 1.2 x FBP
Monitoring
 Currently, monitoring against the theoretical pattern for 7
doctors (1 in 7)
with 2 flexis on slot share, checking 6 full timers, and the
slot shares individually*.
 Supernumerary – monitor against their individual pattern.
 When to monitor – just after they start, one off
monitoring…and again every 6 months…..
 With 20% of workforce envisaged as flexible, additional
analysis of monitoring ?
 Software packages / PDAs etc to help
 The normal monitoring mutual obligation applies.
Slot shares
 Dr Slot works 3 days per week
 M, T, W. 30 hours, FB
 1 in 14 weekends
W
ee
k
Mon
Tues
1
09.0009.00
09.0014.00
2
09.0017.00
3
Wed
Th
F
Sat
–.
 Dr Share works for 3½ days a week
 T,W,Th,F. 36½ hours, FB
 1 in 14 weekends…
Tues
Wed
Th
F
1
09.0014.00
09.0017.00
09.0017.00
9-13
09.0017.00
2
09.0009.00
09.0017.00
09.0017.00
9-13
09.0009.00
09.0017.00
3
09.0017.00
09.0009.00
09.0017.00
9-13
09.0017.00
09.0017.00
09.0009.00
4
09.0017.00
09.0017.00
09.0009.00
9-13
4
09.0017.00
09.0017.00
09.0017.00
5
5
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0017.00
09.0009.00
6
09.0017.00
09.0017.00
09.0017.00
6
09.0017.00
09.0017.00
09.0017.00
9-13
7
09.0017.00
09.0017.00
09.0017.00
7
09.0017.00
09.0017.00
09.0017.00
9-13
09.0009.00
Sun
09.0009.00
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
M
Sat
Sun
09.0009.00
09.0009.00
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, etc
 So, what happens to the trainees who are collecting signatures
now?
 The initial banding, worked out before starting, is the level of
pay protection for those starting after the new pay start date.
 Current trainees stay at their current band if it is higher, until
the end of the post or placement ….is this CCST? …or just
until next year?
Final questions
 Is it a good thing to rely on supernumerary trainees for
rota compliance?
 Access to flexible training is resource limited..
 Numbers of flexible trainees will double in the next 3-5
years…aim to increase the numbers over 5 years to 20%
of trainees within all educational contracts… a trust with
50 / 100 / 300 junior doctors….(10, 20, 60)
 Last – does payroll know?