Flexible Working and Training for Doctors and Dentists

Pt. 1, 2007

Anne Hastie, Elisabeth Paice, Elizabeth Boath

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315347646
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This work includes a foreword by Elisabeth Paice. "Flexible Training and Working for Doctors and Dentists" is a real-world, practical guide to the opportunities available for flexible training and working. It explains the current rules and regulations and promotes the 'Improving Working Lives' initiative for NHS workers - a Department of Health priority. It presents a wealth of information, including details on sabbaticals, management roles, maternity and sickness leave, academic life and the GP returner scheme. This straightforward guide will be invaluable to doctors and dentists working in primary and secondary care, medical and dental students and staff, and doctors and dentists in training. Healthcare policy makers and shapers will find it an excellent resource, along with healthcare managers and careers counsellors. "The first book on flexible training and working in medicine and dentistry. The subject matter is highly topical. The proportion of women in medicine and dentistry rises each year, and with it the demand for less than full-time working. This book will prove a useful resource for any doctors or dentists who are contemplating working less than full-time themselves, or who guide or manage others making these choices. Clinical tutors, course organisers and deanery staff will find it invaluable, and unique." - Elisabeth Paice, in her Foreword.

CHAPTER 1

Setting the scene

Anne Hastie

Introduction

Medicine as a career has seen many changes in recent decades for a variety of reasons, some driven by the profession, others by government initiatives as well as external factors. The number of women working in medicine has increased every decade since the introduction of the National Health Service (NHS) in 1948, and it is predicted that women doctors will outnumber men by 2012.¹ Economic factors mean that many more women continue to work after becoming parents and the high divorce rate in the UK has not escaped the medical profession, placing a financial burden on both partners. Men and women are seeking a better work-life balance and the demand for part-time and flexible ways of training and working has been turned into an increasing reality. This has been supported and encouraged by the Department of Health through the ‘Improving Working Lives’ initiative.²

Historical background

Between 1950 and 1973 women were admitted to medical schools on a restricted-quota system. In 1973 the Sex Discrimination Act was introduced so the restricted quotas had to be abolished and by 1992 women had achieved parity in the numbers of medical school entrants. 1990 saw the hours of work for junior hospital doctors reduced to 72 hours a week and the European Working Time Directive³ will reduce this further to 48 hours a week by 2009. However, these hours remain excessive for many women and some men.

Allen^4,5,⁶ extensively researched factors affecting women doctors, which attracted a lot of attention from the medical profession and the Department of Health. The research showed that in 1986 only 3% of women doctors (and no men) were in part-time training posts, although one-third were considering it in the future and there was a definite imbalance between supply and demand for part-time training. At the same time only 4% of women doctors were in part time career posts, although 97% thought there should be greater availability, especially job-sharing opportunities. Allen’s research indicated the need for a radical reassessment of the medical career structure and the way it was structured, with more opportunities for flexible training and working.

Davidson et al.⁷ followed the career destinations of doctors who qualified in 1977 and Lambert and Goldacre⁸ followed those who qualified in 1988. These workers showed that seven years after qualifying in 1988, 53% of women working in general practice and 20% working in hospital specialties worked part-time. Eighteen years after qualifying in 1977 the number of doctors working part-time in general practice was similar, at 51%, but the number of women working part-time in hospital specialties had risen to 42%.

There have been long-standing concerns about medical workforce planning, which is complex and has had a fragmented approach in the past,⁹ and studies have highlighted the need for medical workforce planning to take into account the whole-time equivalent years of work. The number of women doctors shown not to be working is significantly less than in other professions,¹⁰ but the high cost of training means it is worth trying to retain these doctors.

Current trends

Traditional patterns of work are no longer acceptable to many doctors in the medical profession who are looking for a better work-life balance: 48% of doctors (24% male and 74% female) who qualified in 1995 indicated that they might wish to work part-time at some point in their career¹¹ and one of the challenges will be making this a reality. Full-time work is still the norm and this retains a higher status in comparison to some part-time arrangements. However, working patterns are beginning to change, with increasing opportunities to work part-time. Although women are the main gender wanting to work flexibly there is an increasing demand from men, which may have helped contribute towards a greater acceptance of new working patterns.

The NHS Plan,¹² published in 2000, was closely followed by a consultation document, A Health Service of all the Talents: Developing the NHS Workforce,⁹ which identified the need for investment and reform, and the Department of Health acknowledged the need for flexible working environments for doctors at various stages of their careers.¹³ This became part of the consultation brief to develop the NHS workforce,⁹ with an emphasis on flexible training and working in order to make the best use of the wide range of skills and knowledge available. In 2004 responsibility for employment issues and promoting the NHS as an employer was devolved to NHS Employers.

The Postgraduate Medical Education and Training Board (PMETB) took over the statutory responsibility for approving postgraduate medical education and training from the Specialist Training Authority (STA) and the Joint Committee on Postgraduate Training for General Practice (JCPTGP) on 30 September 2005. New regulations will allow the PMETB to be more flexible in the type of training and experience that can be approved in order to allow doctors to be eligible to become consultants or GPs.

Career counselling

The importance of career counselling before choosing to enter medical training, and throughout undergraduate and postgraduate training, has been increasingly acknowledged, although many doctors still make career decisions by a process of elimination.¹⁴ There is a need to develop career counselling, including tools appropriate to medicine. However, counselling also needs to be available throughout doctors’ working careers and into retirement.

Modernising medical careers

In 2003 the Department of Health¹⁵ first published details of modernising medical careers in response to a proposal from the Chief Medical Officer to review the house officer grade.¹⁶ This modernisation has resulted in a reorganisation of postgraduate training for doctors, with the following main changes.

• The introduction of a two-year foundation programme to replace the Pre-registration House Officer (PRHO) and first Senior House Officer (SHO) years.
• The development of a ‘run-through’ grade for specialty training, including general practice.

A more flexible approach will be required to fit in with the European Working Time Directive and the demography of those entering medical school. There also needs to be the opportunity to change specialty training.

New contracts

New contracts are now in place for hospital consultants and general practitioners (GPs) after considerable negotiation between the profession and the Department of Health. The new 2003 consultant contract is the only contract available to new consultants, although some consultants already in post chose to stay on the previous contract. The new contract is based on a full-time week of 10 four-hour programmed activities, and doctors can choose to work part-time in consultation with their employing trust. Each consultant has a job plan, which is meant to take into account the full range of services they provide, including management and teaching.¹⁷ It is hoped the new contract will allow more flexible working arrangements and improve part-time opportunities. Employers are able to offer annual contracts so consultants can vary the programmed activities they work each week to fit with personal commitments.

In 2004 there was also the introduction of a new contract for general practice,¹⁸ which replaced the previous 1990 contract. GPs are now paid for essential (core) services and quality care for chronic disease. In addition, they can contract to provide enhanced services, which are negotiated locally. Enhanced services include the development of practitioners with special interest (PwSIs), which has enabled doctors who did significant amounts of training in another specialty and GPs who have developed additional skills to be paid for providing their expertise.

Practices receive a global sum, which represents practice income and not individual GPs’ income as was the case under the 1990 contract. This enables practices to be more flexible in the way GPs are employed in their practice, for example as partners or salaried GPs. As a result there are increasing numbers of GPs working in salaried posts, many of whom are part-time.

New schemes to promote flexible training and working

The ‘Improving Working Lives’ initiative included new policies to allow doctors to have career breaks or periods outside full-time work. It was also seen as a retention initiative, resulting in improvements in the service to patients. The Flexible Career Scheme (FCS) provided central funding for hospital doctors and GPs who wanted to work less than half-time or for doctors planning to return to medicine. The scheme was available for doctors at all stages of their careers, including those who would have retired otherwise.

‘Shifting the Balance of Power’ is the name given by the government to a programme designed to move decision-making in the NHS to local levels, where services are delivered to patients. This programme has resulted in the increasing devolvement of central funding to strategic health authorities (SHAs), to primary care trusts (PCTs) and to deaneries. In the financial year 2005/2006 funding for the FCS became cash-limited and was devolved to SHAs and PCTs, which will significantly restrict access to the scheme in future years. Deaneries will need to prioritise eligibility to join the scheme, taking into account the needs of patients and the NHS as well as individual doctors.

Flexible training was first introduced in the 1970s in order to retain doctors who would otherwise have left the profession. New flexible training arrangements for hospital doctors were introduced in June 2005^19,20 to reflect the increasing demand for part-time training. Salaries are proportional to work actually done, with the aim of making flexible trainees mainstream rather than supernumerary by slot-sharin...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• About the editor
• Contributor
• Introduction
• CHAPTER 1 Setting the scene
• CHAPTER 2 Flexible training in secondary care
• CHAPTER 3 Flexible training for general practice
• CHAPTER 4 Flexible working and training for dentists
• CHAPTER 5 Flexible working as a consultant
• CHAPTER 6 New GPs
• CHAPTER 7 Part-time partners and sessional GPs
• CHAPTER 8 Practitioners with a special interest
• CHAPTER 9 The Flexible Career Scheme in secondary care
• CHAPTER 10 The GP Flexible Career and Retainer Schemes
• CHAPTER 11 The GP Returner Scheme
• CHAPTER 12 Academic medicine and dentistry
• CHAPTER 13 Teaching and training
• CHAPTER 14 The portfolio general practitioner
• CHAPTER 15 Sabbaticals
• CHAPTER 16 Leadership, management and the flexible career
• CHAPTER 17 Illness and disability
• CHAPTER 18 Pensions, maternity leave and other benefits
• Index