A Guide to

Job Planning
for Consultant
Urologists

2016

[Link]

British Association of
Urological Surgeons
 BAUS Guide to Job Planning

© 2016 The British Association of Urological Surgeons

The text of this document may be reproduced free of charge in any format or
medium provided it is reproduced accurately and not in a misleading context.
The material must be acknowledged as BAUS copyright and the document title
correctly specified.

BAUS is a registered charity in England and Wales (1127044)

Email: admin@[Link]

Website: [Link]
 Contents 1

Contents
1. Introduction 2

2. Making Job Planning a Success 4

3. Direct Clinical Care 7

4. Supporting Professional Activities (SPAs) 15

5. External Duties (Outside Trust) 19

6. Criteria for Pay Thresholds 21

7. Leave Entitlements 22

8. Annualised Job Planning 24

9. Burnout Among Urologists in the Workplace 25

10. Appendices
Appendix 1 Specimen Consultant Urologist Job Plan 28
(11 PA contract)
Appendix 2 Working out an Annualised Job Plan 29
Appendix 3 Specimen Timetable for a Less Than Full-time 32
Urologist with a Standard or Annualised Job Plan
Appendix 4 Time Allocation and Assigned PAs on an 33
Annualised Contract
Appendix 5 Specimen Timetable and Urologist Annualised 34
Job Plan 10 PAs
Appendix 6 Additional Reading 35
2 BAUS Guide to Job Planning

1 Introduction
It is now 15 years since the document ‘A Quality Urological Service
for Patients in the New Millennium’ with guidelines on workload,
manpower and standards of care in urology was published by BAUS.
Delivery of urological care has been transformed in the interim due to
changes in the socio-political environment allied to advances in medical
care. Examples include the introduction of new technology, the move
away from open surgery, the development of rapid diagnostic services,
increased public expectation and government targets on the timely
delivery of health care.
At present there are approximately 1000 consultant urologists working
in the UK. The UK has one of the lowest rates of consultants per head of
the population in Europe and consultant urologists have a challenging
role delivering expert and timely clinical care.
Careful job planning is crucial to enable consultants to fulfil their role
successfully and support them to deliver high quality safe patient
care. At its most basic, job planning may include routine outpatients,
diagnosis and management of complex cases, operating and
contributing to the efficient running of the urology unit. In addition, all
consultant urologists are expected to participate in quality improvement
initiatives, as outlined in the GMC document ‘Good Medical Practice’. For
consultant urologists working in the UK, this entails a commitment to
contribute to the Healthcare Quality Improvement Partnership (HQIP)
Clinical Outcomes Publication (COP) Programme, which is supported by
BAUS through its various national audits. It also involves spending time
and effort reflecting on, and reviewing, patient care activities so that
quality and safety improve continuously.
Hence, the roles of a consultant urologist are many and diverse;
teaching, training, researching, managerial decision making, running
departments and developing local services. It would not be expected
that all consultants are involved in all these activities at the same time
but rather that they are undertaken across a team of consultants at
specialty/directorate level. The NHS depends on consultants being
involved in the wider management and leadership of the organisations
they work in, and the NHS generally.
 1 - Introduction 3

A successful job plan should facilitate these activities and reflect the
diverse roles that the consultant plays in shaping and developing
services. It should also enable a healthy work-life balance, avoiding
burnout.
This document details the essential components of a successful job plan
and offers guidance on the activity that consultants might deliver on
behalf of their trust, aiming to deliver safe timely care, focusing on the
individual needs of the patient. Much of the source material can be
accessed elsewhere and a comprehensive list of references is detailed in
Appendix 6.

Kieran J. O’Flynn
President, BAUS
4 BAUS Guide to Job Planning

2 Making Job Planning a

Success
2.1 What is a job plan?
Job plans are an annual agreement between the employer and the
consultant setting out:

• the work that is done for the trust, reflecting a balance between
operative work, outpatients and emergency care
• when and where the work is done
• how much time you are expected to be available for work
• what will be delivered for the employer, patients and the employee
• what resources are necessary for the work to be achieved
• what flexibility there is around the above

2.2 What are the hallmarks of a

successful job plan?
Key to a successful job plan is a fit for purpose process. Job planning
should be:

• undertaken in a spirit of collaboration and co-operation

• completed in good time
• reflective of the professionalism of being a doctor
• focused on measurable outcomes that benefit patients
• consistent with the objectives of the NHS, the employing
organisation and the teams and individuals with whom the urologist
will work
 2 - Making Job Planning a Success 5

• clear about the supporting resources the trust will provide to ensure
that objectives can be met
• transparent, fair and honest
• flexible and responsive to changing service needs during each job
plan year
• fully agreed and not imposed
• focused on enhancing outcomes for patients whilst maintaining
service efficiency

It is important that the support offered by non-medical personnel (e.g.

surgical care practitioners, administrative staff, specialist nurses etc) is
shared between all consultants in the department.
Agreement should also be sought on any action(s) the consultant and/or
trust should take to reduce or remove potential organisational or systems
barriers.

2.3 How might a job plan be constructed?

The services provided by a consultant fall into 4 broad categories:

• Direct Clinical Care (DCC)

• Supporting Professional Activities (SPAs)
• Additional responsibilities (Trust based)
• External duties (outside Trust)

Consultants remain accountable to their employer for the achievement

of agreed objectives in both DCC and SPA time. While consultants receive
an SPA allowance, this is generally to support CPD and other activities
commensurate to the consultant grade and to the service objectives
of the employer. This gives the employer the right to monitor the
performance of the consultant during SPA time, looking at time spent
and outcomes achieved.
6 BAUS Guide to Job Planning

2.4 When should the job plan be

reviewed?
The job plan should be reviewed on an annual basis. All aspects of the
job plan should be used to consider, amongst other possible issues:

• what factors affect the achievement, or otherwise, of objectives

• adequacy of resources to meet objectives
• any possible changes to duties or responsibilities, or the schedule of
programmed activities
• ways of improving management of workload
• the planning and management of the consultant’s career in the short
and long term
 3 - Direct Clinical Care 7

3 Direct Clinical Care

For consultant urologists, this includes the following:

• outpatient activities
• operating sessions including pre-op and post-op care
• emergency duties (including emergency work carried out during or
arising from on-call)
• clinical diagnostic work, other patient treatment
• multi-disciplinary team meetings about direct patient care
• administration directly related to the above

3.1 Outpatient activities

For most urologists, the majority of their clinical practice is based in
outpatients. The conversion rate from outpatient activity to an inpatient
stay has reduced in recent years with the greater use of outpatient
diagnostics and day case facilities. Increasingly the model for the
provision of outpatient services has shifted with more activity being
delivered on a one-stop basis where the patient is discharged after a
single comprehensive appointment that may include imaging (e.g.
ultrasound and/or CT) and endoscopy. Where such a model is delivered
it is anticipated that 60-70% patients can be safely discharged back to
primary care.
BAUS’ view is that enormous clinics are no longer appropriate. Patients
deserve a full discussion where their concerns can be listened to
and addressed. Recent clarification of the law concerning consent
(Montgomery vs Lanarkshire Health Board, 2015) mandates that, in the
event an intervention or operative procedure is planned, the urologist is
required to share all relevant information with the patient to help him/
her decide whether (or not) to proceed with an intervention or procedure.
Not only must urologists carefully counsel the patient, they must also
document the discussion as part of the consent process, or indeed the
patient’s reluctance to have a procedure performed. This inevitably takes
8 BAUS Guide to Job Planning

time and the proposed clinic templates, which are less onerous than
previously published standards, reflect these changes in practice.

3.2 Weekend working

With increasing pressure towards 7-day working, trusts may request
that urologists provide regular non-emergency Saturday working. At
present this can only be done by mutual agreement. New consultant
appointments by trusts may specify regular Saturday work and an
individual who applies for a post on this basis would demonstrate their
consent to the arrangements. Urologists should seek assurances that the
same level of support and mentoring would be available on Saturdays
as would be available to them, and other consultants in the department,
during Monday to Friday. Without such support (e.g. administrative
support, nursing input, post-operative care, radiology, pathology and
support of medical doctors), a newly appointed consultant would find
it difficult to meet the obligations in the Royal College of Surgeons of
England’s ‘Good Surgical Practice’.
 3 - Direct Clinical Care 9

Table 1 BAUS recommendations for consultant clinical activity, based on 1PA (4 hours in
England, 3.75 hours in Wales), including time for clinical supervision and dictation

Clinical Activity Suggested Comment

no. of patients
per consultant
New outpatients visit -generic 11 Based on consultation time of 20 minutes
per patient with time for administration
Follow-up outpatient visit 15 Based on consultation time of 10-15
generic minutes per patient
Outpatients (combined new 12 Based on 6 new consultations
and review patients) (6x20 minutes) and 6-8 reviews
(6x15 minutes)
New outpatient visit - specialist 30-45 minutes. Number of patients seen
will be dictated by the complexity of the
patients seen, allowing sufficient time for
counselling and consenting
Follow-up outpatient - specialist 15-45 minutes depending on nature of
the problem
Outpatients (one-stop) 7-8 To include provision of flexible cystoscopy,
imaging, TRUS and consent as applicable
Haematuria clinic 6-8 To include flexible cystoscopy
(new patients only)
TRUS clinic 5-6 40-50 minutes per patient. Need to allow
sufficient time for confirmation of consent
and provision of antibiotic prophylaxis
Urodynamic clinic 4-5 40-50 minutes per patient
ESWL (am/pm session) 3-6 40-50 minutes depending on
complexity of patient
Flexible cystoscopy 8-10 25-30 minutes. Need to allow sufficient
time for confirmation of consent
Flexible cystoscopy and botox 4-6 40-60 minutes. Need to allow sufficient
time for confirmation of consent
Multidisciplinary team meeting General allocation 0.5-1PA direct clinical
(oncology, stones, reconstruction etc) care depending on time
Theatre For an all day list (8 hours/2PAs) an
allocation of 2.5 PAs is desirable to cover
pre- and post-op ward rounds
10 BAUS Guide to Job Planning

3.3 Emergency work

Survey evidence shows that urological emergencies account for
approximately 20-25% of all surgical admissions. BAUS believes that
consultant urologists should have reduced clinical commitments when
on call, particularly in the morning, to allow all emergency admissions
to be reviewed daily by the on-call consultant. There should be no
scheduled private practice whilst on call. In larger units with a high
emergency workload, and in the setting of an increasingly consultant led
service, BAUS’ view is that the urology team should be completely free of
elective commitments to cover emergencies.
Emergency work will fall into two main categories:

i. Predictable emergency work: this is emergency work that takes

place at regular and predictable times, often as a consequence of a
period of on-call work e.g. daily weekend ward rounds. This should
be programmed into the working week as scheduled programmed
activity (PA);
ii. Unpredictable emergency work arising from on-call duties: this is
work done whilst on call and associated directly with the consultant’s
on-call duties e.g. recall to hospital to see urgent admissions or
operate on an emergency basis. It will also include offering telephone
advice to colleagues and remotely reviewing imaging and test
results.

3.4 On-call availability

As an absolute minimum, all emergency surgical admissions must be
discussed and documented with the responsible consultant urologist
within 12 hours of admission. Where practicable, BAUS supports a daily
consultant-supervised ward round/review, 7 days a week, to support
ongoing decision making and to review the management plans and
results.
While most urological admissions are not taken to theatre, BAUS’ view
is that the patient must be seen by the on-call consultant urologist
within a maximum of 24 hours from admission, 7 days a week. Local
 3 - Direct Clinical Care 11

arrangements should be agreed for appropriate escalation of clinical

involvement according to changes in clinical condition.
Urologists who need to attend their trust after 12am (midnight) should
not be expected to attend for regular day time work on the following
morning. On the rare occasion that the consultant has to work through
the night, he/she should not be expected to work the following day. It
is accepted that, in addition to providing on-call cover at their base
hospital, urologists may also be required to provide advice to a number of
units across the network. Under such circumstances, local arrangements
will need to be made so that cover can be provided in the event the
consultant urologist is busy on a different site.
A BAUS audit of emergency provision by urologists demonstrated that
in teaching hospitals 25% of urologists are free of other duties and 85%
are supported by a properly constituted mid-grade rota. In larger DGHs
(population >350000), only 15% are free from other duties and only 55%
have mid-grade support. For smaller DGHs, only 5% are free of other
duties and only 15% have mid-grade cover. Many urologists support
emergency care in smaller hospitals, with support from a ‘hospital at
night team’ or FY1/FY2 cover. The provision of consultant urological cover
in smaller DGHs is likely to become increasingly problematic for those
consultants covering on a 1:4 basis or less, and innovative solutions will
need to be identified to address the problem.

3.5 Acting down

The term ‘acting down’ is used to refer to situations where, as the result
of an emergency or crisis, a consultant is required to undertake duties
which would normally be performed by a non-consultant member of
medical staff. It does not apply to duties that a consultant undertakes as
part of his or her normal workload but which could also be undertaken by
a non-consultant member of staff.
Acting down places an increased burden on consultants and should be
the exception rather than the rule. All efforts should be made to avoid
it through, for example, effective management of absences (including
holidays and sickness) and absence cover for non-consultant career
grades by comparable staff.
12 BAUS Guide to Job Planning

Consultants are not contractually obliged to act down or to be

compulsorily resident on-call to cover the duties of non-consultant staff.
In general, consultants are only requested to act down when there is a
critical shortage of non-consultant staff and the only alternative would
be to close the department. NHS Employers does not endorse any one
approach and trust arrangements will be a matter for local discussion
and agreement with the affected urologists.

3.6 Patient administration

All consultant urologists will need dedicated time to review referrals,
outcomes from MDTs, results from investigations, queries from GPs and
consultant colleagues, and dictate and sign off correspondence. This
work is directly related to patient care and would normally attract an
allowance of 1 PA, although an extra allowance should be allocated when
the administrative burden is high.

3.7 On-call availability supplement

Most consultant urologists are required to participate in an on-call rota;
the clinician will be paid a supplement in addition to basic salary, in
recognition of his or her availability to work during on-call periods. The
availability supplement will be paid at the appropriate rate set out in
Table 2 below.
Table 2 Frequency of rota commitment and availability supplement
Frequency of Value of availability supplement
rota commitment as a percentage of full-time
basic salary for Category A duties

1 in 1 to 1 in 4 8.0%

1 in 5 to 1 in 8 5.0%

1 in 9 or less 3.0%
 3 - Direct Clinical Care 13

The level of supplement will depend on both:

• the contribution of the consultant to the on-call rota, and

• the category of the consultant’s on-call duties

Less than full-time consultants, whose contribution when on call is the

same as that of full-time consultants on the same rota, should receive the
appropriate percentage of the equivalent full-time salary.
While the employing trust will determine the category of the urologists
on-call duties i.e. Category A or B, it is BAUS’ strong view that Category A
should apply to almost all urologists. The consultant is typically required
to review emergency admissions and return immediately to the hospital
when called or has to undertake interventions with a similar level of
complexity to those that would normally be carried out on site, e.g. any
emergency operative procedure.

3.8 Additional /extra programmed

activities
Schedule 6 of the current consultant contract (2003) deals with extra
programmed activities and spare professional capacity. Consultant
urologists wishing to undertake private practice, and who wish to remain
eligible for pay progression, are required to offer up the first portion of
any spare professional capacity (up to a maximum of 1 PA per week).
Where a consultant intends to undertake such work, the employing
organisation may (but is not obliged to) offer the consultant the
opportunity to carry out up to 1 extra PA per week on top of the standard
commitment set out in their contract of employment. In practice, many
trusts are happy to do so, recognising that they get extra work from the
consultant with little extra cost.
Schedule 6.2 of the terms and conditions of the current consultant
contract sets out the provisions regarding offers to consultants and the
periods of notice required. There is flexibility to agree a fixed number of
extra PAs to be undertaken as required over the course of the year and
trusts may find this provision particularly helpful in that arrangements
can be tailored to reflect varying service needs.
14 BAUS Guide to Job Planning

One approach, for example, is to assess on a departmental basis how

many extra PAs are likely to be required during the course of a year to
temporarily increase capacity, for example for waiting list work, to cover
clinics and lists, or to cover a vacancy.
 4 - Supporting Professional Activities 15

4 Supporting Professional
Activities (SPAs)
4.1 Categories of SPAs
The consultant contract (2003) defined categories of PAs. Within a full-
time framework of 10 PAs, the contract states that a full-time consultant
surgeon would normally devote on average 7.5 PAs per week to DCC
and 2.5 to SPAs. However, over the past decade, many new consultant
appointments have been made with a reduction in the number of SPAs
and many urologists have found their SPA time reduced.
SPAs may include:

• continuing professional development (CPD)

• job planning
• appraisal
• participation in training
• medical education
• formal teaching
• audit (including the BAUS audits)
• research
• clinical management
• local clinical governance activities

CPD activities encompass clinical, personal, professional and academic

activities. BAUS strongly supports the value of SPAs to ensure urologists
have time to maintain and develop their skills, undertake CPD and
contribute to the BAUS audits. Urologists are expected to gather evidence
of audit and outcomes to support annual appraisal and revalidation.
16 BAUS Guide to Job Planning

BAUS concurs with the Academy of Medical Royal Colleges estimate that
1.5 SPAs per week is the minimum time required for a consultant to meet
the needs for CPD for revalidation purposes. However, any job plan with
only 1.5 SPAs leaves no time for teaching, undergraduate examination,
research, trainee supervision, managerial input or clinical governance
work outside of audit of personal practice. For these reasons, BAUS
recommends the inclusion of a minimum of 2.5 SPAs in a 10 PA contract,
enabling a consultant urologist to fulfil these commitments.
Expectations in relation to SPA allocation should be detailed in the job
plan. Those consultants with less than full-time contracts will need to
devote proportionately more of their time to supporting professional
activities as they will have the same need as full-time colleagues to
participate in continuing professional development.
Additional SPA time should be linked to the employing organisation’s
objectives, such as research, clinical management or specific medical
education roles. Added SPAs should be evidenced by a commitment to
training, teaching, research, governance etc. Individual urologists should
be prepared to justify, through the job planning process, that their
allocated SPA time is appropriate, or to negotiate for additional time as
required. Table 3 illustrates some examples.
 4 - Supporting Professional Activities 17

Table 3 Suggested SPA allocations for additional Trust roles

Activity Role Duties Allocation (SPA)
Education Specialty tutor (trainees Oversee job planning, educational 0.5
and non-consultant development and yearly appraisal
hospital doctors)
Assigned educational Conduct PBAs, CEXs and CBDs 0.125-0.25
supervisor (per trainee) Conduct interim and final review
for ARCP
Surgical tutor (RCS) Support core surgical training 1
and education within the hospital
setting
Undergraduate tutor Range from occasional teaching 0.25-1
(urology) events to co-ordinating
student experience on
a urology attachment
Audit and Unit governance lead Oversee review of adverse incidents, 0.5-1

clinical complaints, risk register and SUIs
governance
Appraiser Reading, critiquing, conducting 0.5-1
and writing up appraisal (depending
on number
of appraisals)
or 4-6 hours
per appraisal
Audit Overseeing and supporting unit 0.25-0.5
strategy for audits and COP
publications
Management Clinical director Developing and overseeing a 1-2
(depending on size complex range of strategic,
of department) operational and clinical
responsibilities
Clinical lead Delivering strategic, operational 1-2
and clinical responsibilities
Rota co-ordinator Developing a fair and equitable 0.25-0.5
rota for consultant and junior
colleagues
Junior doctors’ leads May be responsible for day to 0.5-1
day placement of junior doctors to
meet both educational needs and
department requirements
Research e.g. NIHR funded studies Recruitment to national trials 1-2
18 BAUS Guide to Job Planning

4.2 Additional responsibilities (Trust based)

These are special responsibilities agreed between a consultant and the
employing organisation which cannot be absorbed within the time that would
normally be set aside for SPAs. These activities will not be undertaken by the
generality of consultants in the employing organisation.
Roles may include (the list is not exhaustive):

• Medical director
• Clinical director or lead clinician
• Clinical audit lead
• Clinical governance lead
• Undergraduate dean
• Postgraduate dean
• Clinical tutor
• Regional adviser
 5 - External Duties (Outside Trust) 19

5 External Duties (Outside Trust)

In addition to DCC activity and SPAs, urologists often take on extra
responsibilities outside the trust. Examples include (the list is not exhaustive):

• Medical Royal College work, including RCS England Invited Review

Mechanism (IRM)
• Departments of Health
• BAUS work, including Trustees, Sections, Council
• Intercollegiate Board of Urology
• National Institute of Health Research (NIHR)
• National Institute for Health and Clinical Excellence (NICE)
• Regional Cancer Boards etc

Most of these types of work are not remunerated and consultants will need
to work with their managers to determine what allocation of time may be
appropriate. Trusts are not obliged to give a consultant in excess of 10 days per
year (30 days per 3-year cycle) for study/professional leave, although some will
choose to do so, recognising the wider benefits for the NHS. Where the work is
regular, it should be set out and scheduled. Where it is irregular, an allocation of
PAs can be agreed or there could be a substitution for other activities. The clinical
director can approve up to 12 PAs of leave per annum to undertake external
duties. Above this threshold, approval should be sought from the medical director.
Where external duties beyond 12 PAs per year are carried out for another body
(e.g. deanery/LETB/Departments of Health), agreement to substitute this activity
for DCC activity is unlikely unless the full cost of the PA is recoverable from the
other body. If the consultant and clinical director agree the consultant’s clinical
workload should remain the same, then additional PAs for DCC may be offered.
Any potential commitment to external duties is likely to impact on the service
provided at trust level and this should be discussed with colleagues and
management before applying for the post so that:

• the impact on service can be assessed and managed

• any potential benefits to the organisation can be identified
• there is fairness and transparency between team members at the outset
20 BAUS Guide to Job Planning

Opportunities to contribute in this way are likely to arise and vary during
the course of a consultant urologist’s career recognising that individuals
may wish to take up additional responsibilities at different stages in their
careers. Consultants and employers should agree outcomes for these activities
and arrangements for reporting back to the employer and inclusion in the
consultant’s appraisal/revalidation folder.
 6 - Criteria for Pay Thresholds 21

6 Criteria for Pay Thresholds

Following the annual job plan review, the clinical manager who has
conducted the review will report the outcome, via the medical director, to
the chief executive. The report will be copied to the urologist, and to the
chief executive of any other NHS organisation with which the consultant
holds a contract of employment. For the purposes of decisions on pay
thresholds, the report will set out whether the consultant has:

• made every reasonable effort to meet the time and service

commitments in the job plan
• participated satisfactorily in the appraisal process
• participated satisfactorily in reviewing the job plan and setting
personal objectives
• met the personal objectives in the job plan, or where this is not
achieved for reasons beyond the consultant’s control, made every
reasonable effort to do so
• worked towards any changes identified in the last job plan review
as being necessary to support achievement of the employing
organisation’s objectives
• taken up any offer to undertake additional PAs that the employing
organisation has made to the consultant in accordance with Schedule
6 of the consultant contract (2003)
• met the standards of conduct governing the relationship between
private practice and NHS commitments set out in Schedule 9 of the
consultant contract (2003)
22 BAUS Guide to Job Planning

7 Leave Entitlements
7.1 Annual leave
A week’s annual leave for a full time consultant is 5 days or 10 PAs. If the
urologist has time out of the system during the week, he/she should not
pro rata the week’s annual leave.
The easiest way is to annualise the PA allocation for leave – 2 PAs per
day of annual leave (for a consultant more than 7 years in post) = 64
PAs leave per annum. For time off that is less than a week, allocate the
same number of PAs that a consultant would work in that day – e.g. 3 PA
theatre day = 3 PAs of leave. This does not take into account the non-
timetabled activity so a working week would always be equivalent to the
number of PAs are worked in that given week, according to the job plan.
Consultants are entitled to annual leave at the following rates per year,
exclusive of public holidays and extra statutory days:
Table 4 Annual leave entitlement against number of years of completed
service as a consultant

Up to seven years 30 days

Seven or more years 32 days

The leave entitlements of consultants in regular appointment are

additional to 8 public holidays and 2 statutory holidays or days in lieu
thereof. The 2 statutory days may, by local agreement, be converted to a
period of annual leave.
In addition a consultant who, in the course of his or her duty, was
required to be present in hospital or other place of work between the
hours of midnight and 9am on statutory or public holidays should
receive a day off in lieu.
 7 - Leave Entitlements 23

7.2 Professional and study leave

This includes:

• study, usually but not exclusively or necessarily on a course or

programme, for CPD
• research
• teaching and assessment e.g. SAC in Urology etc
• examining or taking examinations eg undergraduate, MRCS,
FRCS(Urol) etc
• visiting clinics and attending professional conferences for CPD
• training

The recommended standard for consultants is leave with pay and

expenses within a maximum of 30 days (including off-duty days falling
within the period of leave) in any period of 3 years for professional
purposes within the United Kingdom.
24 BAUS Guide to Job Planning

8 Annualised Job Planning

Many consultants (those with senior managerial responsibility, single
parents, clinical academics etc) do not have a working/domestic pattern
that lends itself to preparing a job plan based on weekly activities. Both
the consultant and the employing trust/health board (where applicable)
may be best served by adopting a job plan that is wholly or partially
annualised. A major advantage of an annualised job plan is that it
will enable the trust to have a clear understanding of the activities a
consultant will deliver on a yearly basis. Based on the numbers shown
in the right hand columns of Appendix 4 (page 33), the yearly capacity
of a unit to deliver urological services can be calculated along with the
associated costs. In turn, this can inform the trust in its discussion with
commissioners about the capacity and demands on the service.
Annualised job plans are likely to have some weekly fixed sessions and,
in addition, will include the major responsibilities the individual will
be expected to take on over the coming year and usually the relative
amounts of time spent on each activity. The principles of job planning
remain unchanged. The job plan should be a prospective document that
sets out the requirements of the organisation and the priorities for the
individual to meet those requirements. Like all other job plans it should
include the objectives for the consultant, or team of consultants, and the
support the organisation agrees to provide.
All, or part, of a job plan may need to be agreed on an annualised basis for
the following reasons (the list is not exhaustive):

• where a consultant has a significant managerial role (e.g. a full time

medical director)
• clinical variation
• social or domestic circumstances
• clinical academics

As an example - an individual and the organisation may agree that during

28 weeks of school term time, an individual works an 11 PA job plan. In
the remaining weeks only 8 PAs are worked, with the total amount being
averaged over the year to derive a 10 PA job plan. A description of working
out an annualised job plan is detailed in Appendix 2 (pages 29-31).
 9 - Burnout 25

9 Burnout Among Urologists

in the Workplace
9.1 Rates of burnout in urologists and
causative factors
The traditional characterisation of a consultant urologist/surgeon would
include intense ambition, high intelligence, focus and organisation
at work, and perfectionism. Such an achiever would be expected to
thrive on stress rather than suffer burnout. Occupational burnout or
job burnout is characterized by exhaustion, lack of enthusiasm and
motivation, feelings of ineffectiveness, and also may have the dimension
of frustration or cynicism. All these factors may contribute to reduced
efficiency in the workplace. People experiencing burnout often do not
see any hope of positive change in their situations. While clinicians are
usually aware of being under a lot of stress, they do not always notice
burnout when it happens. The same admirable personality traits of
perfectionism and diligence actually predispose, rather than protect
against, burnout.

In 2015, the British Association of Urological Surgeons and the Irish

Society of Urology published their collaborative study in the BJUI
revealing rates of self-reported burnout and causative factors among
urologists. The study used an internationally accepted and reproducible
research tool, the Maslach Burnout Inventory, which measures emotional
exhaustion, depersonalisation and loss of personal achievement. Key
findings from the cross sectional survey of 575 urologists were:

• 52% of respondents had high levels of emotional exhaustion and

levels of depersonalisation

• 26% had moderate or high (29%) levels of emotional exhaustion

• 23% had moderate or high (27%) levels of depersonalisation

• 28% had moderate or high (31%) levels of loss of personal achievement

26 BAUS Guide to Job Planning

Self-reported burnout was more common in certain subgroups.

Consultants reported higher levels than trainees, particularly those
consultants under 44 years of age. Ethnicity was not a factor. While
gender was not a factor overall, higher levels of emotional exhaustion
were reported among females. Posts with responsibility or leadership
were an adverse factor, whereas those with research commitments
reported lower levels of burnout.
The top three reported stressors included:

• excessive administrative workload

• overall excessive work volume
• lack of institutional resources

The least three potential stressors reported included operating stress,

clinical decision making and appointment status. It appears the old
adage that a surgeon is happiest when left to operate in theatre applies.
8% of urologists reported seeking professional help for burnout and
7% had taken time off work. 1 1% reported taking prescription drugs to
cope with burnout/depression/anxiety at work. A further 18% reported
taking non-prescription drugs/alcohol to cope, more commonly amongst
trainees (28%) than consultants (13%).
When asked, 80% of urologists considered medical staff should be
evaluated in their workplace for symptoms of burnout. 60% reported
they would avail themselves of workplace counselling if it was provided.
60% reported they would be happy to discuss burnout with their
medical colleagues.
From a sociological viewpoint it may be uncomfortable to accept that
consultant surgeons can suffer burnout but the findings do not surprise
those in occupational health. Comparable rates are seen in non-medical
high level positions. It is therefore important that the risk of workplace
stress and burnout is now recognised and, where potential causes of
breakdown are identified, these should be addressed and if possible
avoided. It is also encouraging that urologists themselves feel there
should be ongoing assessment for signs of burnout and they are willing
to seek help in that eventuality. With the recent changes in pension
arrangements, modern day consultants will be expected to work until
 9 - Burnout 27

66-68 years of age or will face being penalised with their pension
arrangements should they choose to retire early. Consultants in the latter
stages of their careers are unlikely to have the same mental or physical
reserves as their younger colleagues and new working arrangements
will need to be developed to safeguard both the consultant staff and the
service.

9.2 What help is currently available?

For any urologist suffering symptoms or signs that may be related to
workplace stress, or in a burnout situation, there are agencies which
offer help although services may vary in different locations. Hospital
occupational health and GP services are available to all. Some trusts
offer a specialist service for doctors in distress. Discussion with work
colleagues can be most helpful. Advice may also be sought through the
surgical Royal Colleges or the BMA Counselling Service (telephone: 0330
123 1245) which is staffed by professional telephone counsellors 24 hours a
day, 7 days a week.
28 BAUS Guide to Job Planning

10 Appendices
Appendix 1 Specimen Consultant Urologist
Job Plan
Based on an 11 PA contract with 1 extra PA of DCC activity, enabling the consultant to
do private practice with 1:6 on call
Day Location Time Work Category Number of PAs
Monday 8am-9am CPD SPA 0.25
9am-1pm Flexi cystoscopy clinic DCC 1
1pm-3pm Patient related admin DCC 0.5
3pm-5pm Teaching SPA 0.5
Tuesday 8am-12pm One stop clinic DCC 1
12.30pm-1.30pm Audit SPA 0.25
1.30pm-5.30pm Urodynamic clinic DCC 1
Wednesday 8am–12pm Private practice
2pm-6pm OPD DCC 1
Thursday 7.30am-8.30am Pre-op ward round DCC 0.25
8.30am-5.30pm Theatre DCC 2
5.30pm-6.30pm Management SPA 0.25
Friday 9am-10am Ward round DCC 0.25
10am-12pm Patient related admin DCC 0.5
12pm-1pm Journal club SPA 0.25
1.30pm-5.30pm MDT DCC 1
Predictable Ward round on-call DCC 0.75
emergency on-call
Unpredictable Emergency patient DCC 0.25
emergency on-call admissions
Telephone
consultations/advice
Total DCC 9.5
11 PA
SPA 1.5
 10 - Appendices 29

Appendix 2 Working Out an Annualised

Job Plan
The trust has a commitment to deliver elective and emergency urological
services 52 weeks of the year. Most trusts recognise that consultants will
work for 42 weeks of the year allowing for 6 weeks (30+ days, depending
on seniority) annual leave, 2 weeks (10 days) professional/study leave
and sundry bank holidays etc. Hence the cost to the trust of providing a
designated session (PA) 52 weeks of the year is 52÷42 = 1.23.
Figure 1 Job plan for a consultant on a 1:8 with a 10 PA annualised job plan
and no elective duties when on call

52 weeks

Consultant
42 weeks
working year

Routine
35.5 weeks
clinical work

On call 6 weeks

Key:
block of 4 weeks

For a consultant on a 10 PA contract, 420 PAs of activity will need to be

provided by the consultant annually. The precise nature of the PAs will
depend on the requirements of the trust, frequency of on call and the
services (clinical, managerial, educational etc) provided by the consultant.
30 BAUS Guide to Job Planning

Figure 2 Number of PAs of activity to be delivered based on type of contract

Contract Annual number of PAs to be delivered
based on 42 week working year

12PA 504

11PA 462

10PA 420

9PA 378

8PA 336

7PA 294

6PA 252

For a consultant working in an 8 consultant unit, where all consultants

take part in a dedicated on call rota, with no routine duties, each
consultant will perform on call duties 6.5 weeks of the year, free of
elective care. In a year:

• 35.5 weeks will be spent on routine activity

• 6.5 weeks will be spent on emergency care

Two elements need to be factored into provision of emergency care,
namely routine clinical activity (ward rounds, urgent clinic reviews etc)
and unpredictable activity in which a PA would be 3 hours (‘premium
time’ - which for consultants is currently the hours between 7pm and
7am and all day Saturday and Sunday). For urology it is estimated that,
when on call, there are 3 hours of unpredictable activity per day ie 21
hours or 7 PAs per week. When the consultant is on call, they are unlikely
to be providing routine outpatient care and this is reflected in the
reduced allocation of annualised PAs for a routine clinical session from
1PA to 0.845PAs. This is shown on the next page.
 10 - Appendices 31

A consultant on a 1:8 rota will be engaged in routine clinical activity (i.e.

not on call) for 35.5 weeks of the year. Annualised over a working year,
each PA of activity can be calculated as follows - (35.5÷42) x1 = 0.845. As an
example, a consultant doing a regular Tuesday clinic between 9am and
1pm will be working 0.845 PAs on an annual basis.
The two right hand columns in
1 PA - 1 routine clinic Appendix 4 (page 33) show the
42 weeks per year true cost to the trust (in PAs) of
providing elective and emergency
care each week and on a yearly basis.
This allows a trust to calculate its
capacity to deliver outpatient care
and the associated consultant costs.
For a urology unit to see 8000 new
patients per year, based on a one
0.155 PA - No routine stop model with 8 new patients per
clinic when on call clinic, 1000 single consultants’ clinics
6.5 weeks per year (PAs) would need to be provided,
recognising that a consultant on a 1:8
0.845 PA - 1 routine
rota, with no elective commitments
clinic 35.5 weeks per
when on call, doing 2 new clinics per
year
week, would be providing a total of 71
PAs and would see 568 patients.
With respect to emergency care, a trust would need to make provision for
827 PAs of DCC per year (52 weeks). This would allow for predictable on-
call (ward rounds etc), unpredictable care (emergency review and theatre)
and the provision of emergency/review clinics 5 days per week.
32 BAUS Guide to Job Planning

Appendix 3 Specimen Timetable for a Less

Than Full-time Urologist with
a Standard or Annualised Job
Plan.*
Based on a consultant doing a 1:12 on call with 6 PAs per week
Day Time Work PAs Number of annualised
PA (based on 37.7 weeks
routine work) and no
routine work on call

Monday AM OPD 1 0.897

PM Flexible cystoscopy 1 0.897

Tuesday AM One stop clinic 1 0.897

PM Revalidation / governance /
AES /teaching 1 0.897

On call (1:12) 0.5 0.5

Wednesday All day Week 1

Operating list (with pre-op 2.5 2.24
and post-op round)

Week 2
Admin/ward rounds etc am 1 0.897

TRUS/urodynamics pm 1 0.897

Total 6.25 5.95

PAs (average)

*A consultant wishing to work a 6PA week might prefer to work a standard 42

week year delivering care on a weekly basis. Alternatively, the consultant and
the trust may be better served by a contract that reflects the constraints and
demands on the service and/or family and domestic considerations. On an
annualised contract the consultant would deliver 252 PAs of care during a 42
week working year across the spectrum of urological care.
Activity Time PAs Total number of Trust requirements
allocation allocated PAs per annum per week Per year (PAs)
(working 42 weeks (52 week year)
a year)
Outpatient 4 hour session 0.845 PA 35.49 PAs (52X1)/42= 1.23x52=
session 1.23 PAs 63.96 PAs
Urodynamics/ 4 hour session 0.845 PA 35.49 PAs (52x1)/42= 1.23x52=
Appendix 4
flexi/TRUS 1.23 PAs 63.96 PAs
Administration/ 1.5PA 1.5 PA 63 PAs 1.5 PAs 1.5x52=
ward round/ (allocation) 78 PAs
meeting patients
MDT 0.5PA (allocation) 0.5 PA 21 PAs 0.5 PA 0.5 x52=
26 PAs
Undergraduate 2 hours (0.5 PA) (0.5x16)/42 = 7.98 PAs
teaching 16 weeks per year 0.19 PA
SPA (audit, 1.5 PA (allocation) 1.5 PA 63 PAs 1.5 PA 1.5x52=
governance, 78 PAs
training etc)
Theatre list 9 hours 2.625 PAs 110.25 PAs (52x2.625)/42= 3.25x52=
+1.5 hours 3.25 PAs 169 PAs
pre- and post-op
On-call (based on 1:8)
Predictable on-call 2 hours, 7 days 0.5x6.5/42= 3.36 PAs 0.5x7= 3.5x52=
(ward round etc) per on call week 0.08 PA 3.5 PAs 182 PAs
Emergency clinic 0.75 (3 hours) (3.73x6.5) /42= 24.36 PAs 0.75x5 days= 3.75x52=
(3 hours) 0.58PA 3.75 PAs 195 PAs
Time Allocation and Assigned
PAs on an Annualised Contract

Unpredictable 7x3=21 (7x6.5)/42= 45.36 PAs 7x52/42= 8.66x52=

10 - Appendices

on-call hours/week 1.08PAs 8.66 PAs 450.3 PAs

(3 hours per day) or 7PA
33

Total 362.72 PAs

 34
Day Time Work Category Number of
annualised PAs
Monday AM OPD DCC 0.845
PM Private practice
Tuesday AM One stop clinic/urodynamic clinic DCC 0.845
PM Operating list (16.5 weeks/year) DCC 0.392 (16.5/42)
Appendix 5
Wednesday All day Operating list (2.5 PAs) DCC 2.113
Thursday AM MDT (stone/oncology) meeting DCC 0.5
PM Research SPA 0.845
BAUS Guide to Job Planning

Friday AM Clinical governance SPA 1

Benign firm weekly meeting
care and 6.5 weeks of emergency care

PM Clinic (18 weeks/year) DCC 0.42 (18/42)

Total 4.615
Annualised Job Plan
Annualised clinical sessions DCC 4.615
Admin/ward rounds etc DCC 1.5
Urgent access sessions DCC 1
On-call DCC 0.875
Clinical meetings (MDT) DCC 0.5
Research SPA 0.875
Revalidation/governance etc SPA 1
Assigned educational supervisor to 4 SPA o.5
Annualised Job Plan 10 PAs

trainees; FRCS(Urol) examiner, MB

examiner/medical student teaching

Total 10.865
Based on a consultant doing a 1:8 on call with 35.5 weeks devoted to routine clinical

Rounded Total 10.5

Specimen Timetable and Urologist
 10 - Appendices 35

Appendix 6 Additional Reading

GMC. Good Medical Practice. Published 25 March 2013. Came into effect 22
April 2013.
[Link]

NHS Employers. Consultant Contract [Terms and Conditions –

Consultants (England) 2003]
[Link]
Pay%20and%20reward/Consultant_Contract_V9_Revised_Terms_and_
Conditions_300813_bt.pdfConsultant

The Academy of Medical Royal Colleges. Advice on SPAs in Consultant Job

Planning. AOMRC, 8 February 2010.
[Link]
Statement_2010-02-08_Advice_on_SPAs.pdf

The Royal College of Surgeons of England. Emergency Surgery: Standards

for unscheduled care. Guidance for providers, commissioners and service
planners. February 2011.
[Link]
docs/emergency-surgery-standards-for-unscheduled-care/

BMA. Information on job planning – including detailed guides on

job planning (via the link below). Includes A Guide to Consultant Job
Planning (July 2011).
[Link]

Medical Protection Society. New Judgment on Patient Consent. 20 March

2015.
[Link]
news/2015/03/20/new-judgment-on-patient-consent

The Supreme Court. Judgement: Montgomery (Appellant) v Lanarkshire

Health Board (Respondent) (Scotland). 11 March 2015.
[Link]
[Link]
36 BAUS Guide to Job Planning

Position Statement on the Management of Emergency Surgery at the

General, Paediatric and Urological Surgery Interface. Association of
Surgeons of Great Britain and Ireland, British Association of Paediatric
Surgeons, British Association of Urological Surgeons, SAC in General
Surgery, SAC in Paediatric Surgery, SAC in Urology. 2015.
[Link]

ISCP Core Surgical Training. 2015.

[Link]
aspx?enc=vVY4XFLbRSZIHhnkUDQyVoJGVh3MGYxzpE0YSpfvy0k=

‘Rates of Self-reported ‘burnout’ and causative factors amongst urologists

in Ireland and the UK; a comparative cross sectional study’. O’Kelly, Fardod
et al. BJUI Int, 2016; 117 (Issue 2):363-372.

[Link]. Burnout Prevention and Recovery. Signs, symptoms and

coping strategies for mental exhaustion.
[Link]
 British Association of
Urological Surgeons

Email: admin@[Link]
Website: [Link]

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