7-day working will save thousands of lives. 7-day working will save no lives. 7-day working is unaffordable. 7-day working is a must which will increase efficiency. Seldom has an NHS workforce issue been more contentious. The BMA has placed full page ads in newspapers to make its points. So what are the realities behind the myths, asks Nick Chronias from DAC Beachcroft.
Agenda for Change
The position for the great majority of NHS staff who are engaged under Agenda for Change is simple: there are specific provisions and payments for working 24/7. The principle of round the clock working, including shift working, is clearly established. That means that those staff covered by it can clearly be required to work at any time of the day or night under their employment contracts. Culturally there is generally an acceptance that this is the case for those providing care. However, there is clearly a cost implication given the unsocial hours payments due for evening and weekend working.
Junior and staff grade doctors
Again, 7 day working flexibility is built into the standard junior doctor contract with the options for them to work full shifts, partial shifts and 24 hour shifts. On call means on site on call. As you will all know, there are then pay band supplements depending on the working hours/pattern of the junior doctor.
Whilst not the same, there are terms requiring staff grades to work 7 days too.
So far, so good. So where's the problem? Everyone can be required to work 24/7. Not quite. The national consultant contract (replicated by virtually every FT and Trust in England) tells a different story. It provides for non-premium hours of 07.00 – 17.00 Monday to Friday. It states there shall be no non-emergency work outside non premium time unless otherwise specifically agreed. Outside those duties, off site on call arrangements apply. There is no reference to shift working or other forms of 24/7 working. It is often forgotten that the consultant contract also states: ‘You and your clinical manager may agree, as part of your Job Plan, other arrangements for flexible scheduling of commitments over an agreed period of time’. This would allow job plans to cover Saturdays and Sundays but in our experience, this provision is simply not used. So, our most senior clinician terms are out of step with those for other clinical staff.
So what's the solution?
As you will all know, negotiations between NHS Employers and the BMA to amend the consultant contract (particularly to better facilitate 7-day working) remain inconclusive. This has caused the Secretary of State for Health to say he will introduce legislation allowing him to impose contracts on new consultants including a 7-day working requirement. He has stated that he will do this if there is no progress in the NHS Employers/BMA negotiations by the end of September.
But are Trusts and FTs powerless to grasp this issue themselves? The answer is ‘no’. For new consultants there is no legal bar to seeking to make amendments to the template consultant contract, particularly to address the premium time issue. A very small number of FTs have done so. Others have been discouraged from doing so by employee relations issues. That still leaves an issue for existing consultants where such a change would need their consent.
The question for all trusts and FTs grappling with the need to have consultants available to truly deliver a 7-day service is whether to pursue their own changes or await a national solution, whether through negotiation or government imposition. Either way, this issue is not disappearing.
Nick Chronias, Partner, Employment & Pensions Team in London, DAC Beachcroft