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Full recommendations

The aim of these recommendations is to support doctors who want to remain in the NHS workforce until their mid to late 60s, and make this option more attractive to doctors who are considering when to retire.

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Changes need to be effected at 3 levels: Individual, Departmental (which involves the Clinical Director and employer), and National, which requires action by NHS policy makers and the RCOG.

The recommendations apply to doctors across all O&G roles.

1. National (Government / NHS / RCOG)

Government

  • Reform pension allowance issues. This reform should include the removal of the tapered annual allowance.

 

NHS

  • Ensure that flexible working patterns/portfolio careers are available to all staff who wish to choose them (NHS 2019).
  • Promote the option of career breaks (NHS employer’s handbook).
  • Place an onus on Trusts to value staff wellbeing by demonstrating the actions they’re taking to support staff.
  • Appoint “flexible working” champions in every Trust, not only for trainees but also to promote less than full time (LTFT) work for all staff who wish to adopt this pattern.

 

RCOG

  • Adapt the job plan approval process to incorporate LTFT templates, include examples of what is working well in some Trusts.
  • Create a page on the RCOG website for Clinical Directors and members covering the options for doctors nearing retirement, such as reducing sessions, reducing/stopping on call, and retire and return options.
  • Establish a support network for those working LTFT.
  • Work closely with the GMC and other Royal Colleges to review the appraisal process for older doctors to make it more relevant and straightforward. For example, irrelevant mandatory learning should be reduced (RCP recommendation 2019). It remains important that those practising clinically must be able to demonstrate their competence.

2. Departmental (Clinical Director/employing NHS Trust)

Job planning

At every annual job planning meeting a discussion should take place about the development and future evolution of an individual’s job plan. This could include the acquisition of new interests (e.g. new skills, management, education, mentorship) which are required by the department and fit with those of other staff.

 

Long term planning for the department

A long-term model for the department should be developed, with the help of HR, to evolve all job plans over time to enable senior doctors to reduce or stop out of hours work whilst maintaining the required service and being fair to all members of the department which may require compromise.

The following seeks to demonstrate an individual’s career progression and why the department needs to have a long term plan to allow evolution of each doctor’s career over time whilst maintaining the service.

New consultants

  • Learning roles
  • Building confidence
  • Developing leadership skills
  • Greater share of resident on call

Mid-career consultants

  • Consolidating clinical skills
  • Leading change
  • Stop resident on call

Senior consultants

  • Provide stability
  • Transfer knowledge
  • Minimal on call

Flexibility

  • Flexibility with job planning is needed, including the option of working less than fulltime (LTFT). There should be the opportunity for job shares or LTFT working at the time of appointment or when an existing doctor wishes to reduce sessions and could job share with a newly appointed or existing consultant. Although job sharing can be expensive for the Trust it is cheaper than recruiting agency locums. Another form of job sharing would be for one person to work full-time for six months and then swap with their ‘job share’. This would enable doctors to pursue other interests (e.g. work abroad or undertake research) without leaving the department.
  • Promote and facilitate career breaks. Develop a department policy to share the opportunities fairly between staff and have arrangements in place to backfill the work. A career break might be unpaid or ‘earned’ by doing a little extra work each week to go towards time off (RCP recommendation 2019).
  • Increase flexibility of working, both by location and time. This could be by facilitating administration and supporting professional activities from home and would require secure IT systems to access the Trust’s patient notes and test results.

 

On call

  • Departments should develop systems to allow senior staff (around age 55yrs onwards) to stop night work if they wish, whilst contributing to an equal share of other less popular work such as working on call at weekends or twilight shifts.
  • In some units, the younger doctors may need to work on the resident on call rota for a number of years but then move on to non-resident on call and later take up daytime/evening out-of-hours sessions only, or stop all out of hours work.

 

Department culture

  • It is essential to improve the culture within departments and Trusts so that doctors feel happy at work and do not feel undermined. Better communication within the consultant body should be developed. There must be fairness, transparency, options for change in job plans within a department, and team discussions about taking annual leave. Social activities are important for staff communication and morale.
  • Some staff develop long term medical conditions. Departments and Trusts must recognise this, ensure good occupational health and make necessary alterations in the job plan.

 

Administration

  • Reduce the administrative burdens on senior doctors – or allocate more time for these. Electronic systems have created more work and this must be recognised. Some tasks can be shifted to administrative staff, and there should be improved team working and efficient systems for routine tasks such as checking results.

 

3. Individual

  • Acknowledge the clinical needs of your patient population and the needs of your colleagues but don’t be afraid to ask for change
  • If you wish to reduce your work, make a plan and discuss it with your colleagues and at your annual job planning meeting
  • Offer to do more of the ‘unattractive’ sessions in return for reducing night time working
  • Offer to mentor newly appointed colleagues e.g. for major gynaecological surgery. They will appreciate the support and opportunity to operate, it will also ensure succession planning
  • Get advice on working LTFT from your Trust champion (if available - see above)
  • Consider reducing sessions within the department’s overall plan or job sharing
  • You might consider applying for a new post at a Trust with less workload or an advertised special interest. Smaller units need staff with plenty of general experience
  • Evolve your work interests over time towards less acute work and more support and mentoring
  • Employ a financial advisor who has knowledge of medical pension arrangements