President's view: Spread of the annualisation bug

HR departments are increasingly catching doctors out with sleights of hand that can bring annualised hours by stealth. It pays to remain vigilant, says President Ross Welch

Frustration is rising across the Consultant workforce as the NHS efficiency drive and financial squeeze is felt in every aspect of our work.

In this environment it is necessary to remain vigilant to the methods through which managers are seeking to reduce their spending, more often than not at the expense of clinical staff.

Skirmishes are increasingly taking place around annualised contracts – for some a practical and mutually agreed choice, but in a growing number of cases a forcible one where hospital doctors are losing out.

Part or fully annualised contracts were established in the 2003 consultants contract, intended for certain specific situations – for example a consultant wishing to spend as much time as possible during the school holidays at home and delivering their direct clinical care during term time.

It also allowed employers and consultants to match variations in demand with available resources, but was to be subject to a number of principles – including that the decision to annualise must be by mutual agreement.

Indeed NHS Employers’ own guidance advises among other points that the job planning process must be “undertaken in a spirit of collaboration and co-operation,” and be “consistent with the objectives of the NHS, the organisation, teams and individuals.”It should be “transparent, fair and honest,” and “fully agreed and not imposed.”

All the guiding principles are designed for fairness and transparency within the annual process of job plan and contract negotiation, while focused on patient need.

But things have changed since then – and not usually in favour of doctors.

Amid current NHS resource pressures, cases where scheduled work does not happen for reasons outside the consultant’s control are becoming commonplace – lists cancelled at less than 24 hours’ notice because of lack of bed availability, black alerts, strikes or lack of required equipment or facilities, let alone Norovirus outbreaks.

These situations, which are now almost everyday events across the NHS, have seen hospital management seeking to deploy their senior and most experienced workforce more “efficiently” or perhaps, more honestly, simply wanting to recoup some of these lost sessions. Consultants who have fulfilled their non-annualised contract by being available have nevertheless found themselves facing managers demanding the time be rescheduled.

At the end of the job plan year, during discussions for the following year, some consultants are being told, despite not having previously agreed an annualised contract, that they have underprovided in the previous year and that the underprovision has to be added to the coming year’s work or repaid.

Funnily enough, when the shoe is on the other foot – where consultants have agreed fully or partly annualised job plans and have completed their sessions early – they seem rarely to be asked to down tools and sit idle until the next year begins. Neither are they offered pay for continuing to work their timetable and overproviding, which would actually increase throughput and efficiency. If they are offered additional remuneration to overprovide, this is often in ad hoc ways and at ad hoc rates of payment.

Across the country Local Negotiating Committees (LNCs) have been asked to agree local principles and practices to work around this national problem. In some hospitals, for instance, it has been agreed that if a session will not be available perhaps six weeks ahead, consultants will agree to reprovide that session flexibly within a year, but, if less than 48 hours’ notice is available, the session will be deemed to have been provided.

Unsurprisingly these issues have led to trusts trying to move more and more consultants onto annualised contracts.
NHS Employers, on its job planning web pages, urges NHS organisations “to review how job planning can be used to drive improvements and quality of patient care. Some trusts are looking at new IT tools, some at annualisation, others at team or departmental job planning amongst other initiatives.”

Many consultants are working in trusts that are using all of these techniques to entangle the unwary.

In particular, new IT systems can have hidden pitfalls, including moving people onto an annualised plan by stealth via the way in which sessions are recorded – and certainly without the mutual agreement detailed in the 2003 principles.

Some have programmed in a standard number of weeks across the workforce for the job plan year, which goes against another of the principles of individual job planning.

Consultants may not be aware of their trust’s approach until faced with a demand for repayment of sessions or, worse still, demands to return pay.

It is clear that many individuals may benefit from the annualisation of some or part of their job plan.

The key message, though, is beware what you agree. Understand your job plan and the software used. Document very clearly at annual review whether all or any part of next year’s job plan is annualised.

If so, what happens when a list does not go ahead because of bed problems, what notice is acceptable for management to demand reprovision, and what happens at the year’s end when they think you have underprovided or you think you have overprovided. In many cases your LNC should have clear guidance.

Only then can it be clearly evidenced that the process has been mutually agreed and properly documented.

Remember that, since annualisation is an option, if your job plan doesn’t say it is annualised then it isn’t. And remember, too, that HCSA National Officers are always there to help as your last line of defence.