Consultant job plans – the basics
A consultant job plan is an annual, prospective
agreement between the employer and the
consultant, and should be based around
the terms and conditions of the Consultant
Contract agreed in 2003 and subsequently
updated in England (2018), Scotland
(2007), Wales (2011) and Northern Ireland
(2013). Broadly speaking, the principles are
common in all the home nations although
the implementation may differ slightly
between countries. The job plan should set
out everything that a consultant does in a
typical working week, including any private or
independent practice, ensuring that no activity
is double counted. Specifically it should set
out what work is done for the NHS, when
and where that work is done, how much time
the consultant is expected to be available
for work, what flexibility there is around that,
what objectives are to be achieved by the
consultant and what resources the employer
should provide to support these.
The typical full-time consultant job plan is based on working
an average of 40 hours per week in England, Scotland and
Northern Ireland and is nominally comprised of ten blocks
of programmed activities (PAs) of four hours each; in Wales
it is based on an average of 37.5 hours per week in blocks
of 3-4 hours. PAs are generally classed as those related to
direct clinical care (DCC) and those related to supporting
professional activities (SPA). In some circumstances other
(temporary) PAs may be included for additional programmed
activities (APA, or EPA in Scotland), and less commonly for
additional NHS (HSC in Northern Ireland) responsibilities or
external duties. The job plan should not usually exceed a total
of 12 PAs. Annualised job plans may allow working in excess
of 12PAs in some weeks as long as the annualised average is
no more than 12 per week. Increasingly electronic job plans
are being used; these offer increased transparency and avoid
double counting of activities, and should follow the principles
agreed in the 2003 consultant contract.
DCC PAs include predictable and unpredictable work
performed while on call and include activities shown in Box 1
(this list is not exhaustive). SPAs are divided into core activities
necessary for CPD, job planning, mandatory training, appraisal
and revalidation, and others including research, teaching,
and training (Box 2; again this list is not exhaustive). It is very
helpful if tariffs are agreed centrally with the employer for
involvement in educational and clinical supervision, personal
appraisal and appraisal of colleagues, and undergraduate
teaching (e.g. educational supervisor 0.25 SPA per week
per trainee, appraiser 0.25 SPA per week). The wording in
the model consultant contract is that job plans ‘will typically
include an average of 7.5 PAs per week of direct clinical care
and 2.5 PAs of supporting professional activities’. Recently,
however, consultant job plans have been produced with a
different DCC:SPA split, often 8:2, but sometimes 8.5:1.5 or
9:1. The Academy of Royal Medical Colleges, Association of Anaesthetists, Royal College of Anaesthetists and BMA
consider that 1.5 SPA is the minimum required to allow a
consultant to keep up to date and undertake mandatory CPD
and activities to permit appraisal and revalidation. Where a job
plan has fewer than 1.5 SPAs, there should be opportunity for
the consultant to make the case for increased SPA recognition
at job planning which should occur at least annually (and
often within 3-6 months of a consultant’s initial appointment).
A survey of anaesthetists working in Scotland and appointed
within the previous ten years found 74% had 1 or 1.5 SPA
at the time of appointment - this dropped to 33% after job
plan discussions. Additional or Extra PAs may be agreed for
clinical and non-clinical activities. These APAs or EPAs are
temporary, should be reviewed annually, and currently are not
pensionable.
Additional NHS or HSC responsibilities may also be
recognised; these are special responsibilities not undertaken
by most consultants and are duties performed on behalf of the
employer or government that are beyond the typical range
of SPAs. These include medical leadership/clinical director
roles, senior roles in governance, lead roles in appraisal,
regional adviser, and undergraduate or postgraduate dean
roles. External duties may be recognised separately; these are
not done directly for the NHS employer but are often in the
broader interests of the NHS, and may be related to work for
Royal Colleges (and the Association of Anaesthetists), GMC,
governmental roles, CQC and involvement in consultant
appointment committees.
In addition to PAs, payment (calculated as a percentage of
basic salary) is made for on-call availability. The amount ranges
from 1% to 8% and depends on the frequency of on-call
rota and the typical nature of the response (such as whether
immediate return to work is required or not).
Job plans should be reviewed annually – such reviews
should encompass the whole range of the consultant’s work,
including clinical duties and SPA. Further details may be found
in the supporting information listed below.
David Ray
Consultant in Anaesthesia and Critical Care
Royal Infirmary of Edinburgh
Supporting information
BMA - Consultant Contract (updated 7 December 2018). There are separate
sections for each of the four home nations.
Job planning for your first consultant post. Guidance from the Scottish Consultants Committee, BMA Scotland (2014).
(Available by following links in the BMA URL in reference above)
A best practice guide for consultant job planning. NHS Improvement (updated 19 July 2017). https://improvement.nhs.uk/
resources/best-practice-guide-consultant-job-planning/
Ray D, Aitken H. Supporting professional activities and job planning – a survey of consultant anaesthetists working in Scotland.
Anaesthesia News 2017; 361: 16-8
Box 1. Typical DCC activities
- Operating theatre sessions
- Outpatient activities
- Ward rounds
- Emergency duties
- Administration directly related to patient care
- On call duties
- MDT meetings and preparation for these
Box 2. Typical Supporting
Professional Activities (SPA)
Core:
- Continuing professional development
- Job planning
- Mandatory training
- Appraisal and revalidation
Other:
- Teaching & training, undergraduate and
postgraduate
- Research
- Management of doctors in training
- Audit
- Contribution to service management
& planning
- Clinical governance activities