Associate Specialist in all Surgical Specialties
1. Associate Specialists are senior hospital doctors and must be regarded and dealt with as such when drawing up job plans. They have professional, all-inclusive contracts and, therefore, are responsible to the Medical Director but for the day-to-day running of the department, the lead consultant and Associate Specialist should agree a job plan. As the majority of Associate Specialists in practice work with limited contact with their named consultant on a day to day basis, run their own clinics, and operating theatres, they, therefore, need to be free to take clinical decisions within the boundaries of accepted professional standards and as delegated to them by their lead consultant.
2. All Associate Specialists whether newly appointed or already in post and with a whole time, maximum part time or part time contract should have job plans agreed with their Trust. Such job plans should include, as a minimum, the following elements:-
(a) The main duties and responsibilities of the post including information on clinical teaching, research and administration elements.
(b) A work programme including fixed commitments of the Associate Specialist.
(c) Planned managed clinical networking.
(d) A requirement to participate in clinical audit and clinical governance under local arrangements in the light of relevant departmental guidance.
(e) Details of out of hours and unsociable hours responsibility including rota commitments, if appropriate.
(f) Budgetary and other management responsibilities where appropriate.
(g) Procedure for appraisal
3. Drawing up of Job Plans
The named/lead consultant may either draw up draft job plans for an Associate Specialist or ask the existing Associate Specialist to draw up their own. Where an Associate Specialist provides services for more than one Trust, the Trust with the greater proportion of the Associate Specialist’s contractual commitment should normally have the lead responsibility for the day-to-day management of the various aspects of the contract. The job plan, including its programme, shall then be agreed between lead consultants and the individual Associate Specialist.
4. Fixed Commitments
For an Associate Specialist on a whole time or maximum part time contract between five and seven notional half days depending upon the intensity of the specialty should normally be allocated in the work programme to fix commitments. Whilst Associate Specialists on other part time contracts, at least half of the notional half days should normally be allocated to fixed commitments. The number of fixed commitments may be varied with agreement of the Associate Specialist and their lead consultant. A fixed commitment, that is outpatient clinics and operating lists, is the commitment which the Associate Specialist must fulfil except by agreement with their lead consultant or in a medical emergency.
5. Associate Specialists are senior hospital doctors and, therefore, should not normally be on a junior on-call rota. If they are asked to share the junior rota then the NHD allocation should be adjusted accordingly.
6. Review of the Job Plan
Each Associate Specialist job plan (including the work programme) should be subject to review each year. This annual review should provide an opportunity for the Associate Specialist and the main consultant to discuss any problems, which may have arisen, and to settle any changes, which need to be made to meet new circumstances or service priorities. It is likely that, in many cases, job plans will need to be amended only occasionally and, even then, will be subject to minimal alterations.
7. Major Changes to Job Plan
In the event of radical changes being proposed to an Associate Specialist’s job plan in order to meet the needs of the service, there should be detailed discussion between the named/lead consultant, the Associate Specialist and the College Advisor. Every effort should be made to ensure that any changes to the job plan allow for the development of existing skills of the Associate Specialist. These should not be detrimental to their job satisfaction.
On Job Training
It must be recognised that this post is not the ‘end of all learning’. Every opportunity should be made available to the Associate Specialists to enable them learn and develop new techniques and to make their job satisfactory and worthwhile.
Guidelines on Calculating a Work Programme for an Associate Specialist
The workload of an Associate Specialist will be influenced by many factors such as local circumstances and areas of special interest. In general, duties will encompass the following:-
1. Outpatients
Adequate time must be allocated to practise surgery to a satisfactory standard and this should include interviewing relatives, teaching students and dictating letters.
2. Ward Rounds
The Associate Specialist should take business and teaching rounds with the juniors.
3. Operating Theatre
An operating theatre list is not necessarily synonymous with an NHD. An all day list may well be more than two NHDs (Notional Half Days).
4. Teaching both Undergraduates and Postgraduates
Adequately experienced and qualified Associate Specialists should participate in both basic and higher surgical training.
5. Special Interests
This may refer to additional operating lists, outpatient clinics, breast screening, endoscopy, clinical measurement, etc.
6. Research
This should not just relate to clinical academic staff but also to Associate Specialists who become involved, say, in research and development initiatives on behalf of the Trust or purchaser.
7. CME and CPD
Associate Specialists’ study leave of 10 days per year or 30 days in 3 years should be fully funded. Attendance at Professional and National and International Meetings, etc.
8. Audit
A regular feature in an Associate Specialist’s workload and may or may not be taken in conjunction with teaching.
9. Management
The time allocated to such work must be included in the work programme.
10. Administration
This will include correspondence, waiting list management, litigation, NHS reports and other tasks requiring secretarial support.
11. Covering Colleagues’ Leave
This usually implies emergency cover only.
12. Travel - part time only
Maximum part time and part time Associate Specialists may include travelling time between home and hospital for up to half an hour each way.
Staff Grade Doctors in all Surgical Specialties
1. A staff grade doctor is responsible to a named consultant within the boundaries agreed with their named consultant and accepted professional standards. Staff doctors need to be free to take clinical decisions. Under the recommended form of contract for a staff grade doctor, the named consultant and the staff grade doctor are responsible for agreeing the staff grade doctor’s duties. A job plan and its integral work programme should be part of every such contract.
2. All staff grade doctors, whether newly appointed or already in post and whether full time or part time should have job plans agreed with their Trust. Such job plans should include, as a minimum, the following elements:-
a) The main duties and responsibilities of the post including information on clinical, teaching, research and administrative elements.
(b) A work programme including fixed sessions of the staff grade doctor.
(c) A requirement to participate in clinical audit and clinical governance under the local arrangements in the light of relevant departmental guidance.
(d) Details of out of hours and unsocial hours responsibilities including rota commitments where appropriate.
(e) Management responsibilities where appropriate
(f) Procedure for appraisal.
3. Job plans should include certain general provisions such as that the staff grade doctors would be expected to observe the policies and procedures of Trusts drawn up in consultant with the profession where they involve clinical matters, for example, admissions procedures.
4. A staff grade doctor responds to service needs and is contracted to work for fixed time sessions. However, within these sessions the staff grade doctor should be permitted reasonable time away from patients for refreshments or rest.
5. Drawing up of Job Plans
The named/lead consultant may either draw up draft job plans for a staff grade doctor or ask the staff grade doctor to draw up their own. Where a staff grade doctor provides services for more than one Trust, the Trust with the greater proportion of the staff grade doctor’s contractual commitment should normally have the lead responsibility for the day to day management of the various aspects of the contract. The job plan including its work programme shall then be agreed between the named/lead consultant and the individual staff grade doctor.
6. Fixed Commitments
For a staff grade doctor on a full time contract between five and seven fixed sessions, depending on the intensity of the specialty should normally be allocated in the work programme to fixed commitment. For staff grade doctors on part time contracts at least half of the sessions should normally be allocated to fixed commitments. The number of fixed sessions may be varied with the agreement of the staff grade doctor and their named consultant. A fixed commitment that is outpatient clinics, operating lists, and multi-disciplinary ward rounds is a commitment, which a staff grade doctor must fulfil except by agreement with their named/lead consultant or in a medical emergency.
7. Review of the Job Plan
Each Staff Grade doctor’s job plan (including the work programme) should be subject to review each year. This annual review should provide an opportunity for the Staff Grade doctor and the main consultant to discuss any problems, which may have arisen, and to settle any changes, which need to be made to meet new circumstances or service priorities. It is likely that, in many cases, job plans will need to be amended only occasionally and, even then, will be subject to minimal alterations.
8. Major Changes to Job Plan
In the event of radical changes being proposed to a staff grade doctor’s job plan in order to meet the needs of the service there should be detailed discussions between the named consultant and the staff grade doctor concerned prior to the changes being introduced so that the changes to the job plan can be negotiated and agreed. Every effort should be made to ensure that any changes to the job plan allow for the development of the existing skills of the staff grade doctor.
On Job Training
It must be recognised that this post is not the ‘end of all learning’. Every opportunity should be made available to the Associate Specialists to enable them learn and develop new techniques and to make their job satisfactory and worthwhile.
Guidelines on Calculating a Work Programme for a Staff Grade
The workload of a Staff Grade doctor will be influenced by many factors such as local circumstances and areas of special interest. In general, duties will encompass the following:-
1. Outpatients
Adequate time must be allowed to practise surgery to a satisfactory standard and this should include interviewing relatives, teaching students and dictating letters.
2. Ward Rounds
The Staff Grade doctor should take business and teaching rounds with the juniors, depending on their experience and training.
3. Operating Theatre
Sufficient sessions should be allocated to the Staff Grade doctor work programme.
4. Teaching both Undergraduates and Postgraduates
Adequately experienced and qualified Staff Grade doctors should participate in both basic and higher surgical training.
5. Special Interests
This may refer to additional operating lists, outpatient clinics, breast screening, endoscopy, clinical measurement, etc.
6. Research
This should not just relate to clinical academic staff but also to Staff Grade doctors who become involved, say, in research and development initiatives on behalf of the Trust or purchaser.
7. CME and CPD
Staff Grade doctors’ study leave of 10 days per year or 30 days in 3 years should be fully funded. They should be allowed to attend professional and national meetings, etc.
8. Audit
A regular feature in the Staff Grade doctor’s workload and may or may not be taken in conjunction with teaching.
9. Management
The time allocated to such work must be included in the work programme.
10. Administration
This will include correspondence, waiting list management, litigation, NHS reports and other tasks requiring secretarial support.
11. Covering Colleagues’ Leave
This usually implies emergency cover only.
12. Travel - part time only
Maximum part time and part time Staff Grade doctors may include travelling time between home and hospital for up to half an hour each way.
Paper jointly produced by Mr Mohib Khan, Mr A K Choudhary and Mr Syed Kazm.