A toolkit for flexible working

Flexible working offers an alternative to leaving the NHS. Opportunities for physicians to work flexibly and examples of flexible ways of working are provided below.

We need to recognise that the medical workforce is changing demographically and wants to work differently. The traditional route of full-time clinical training with direct progression to a consultant post is not the right model for all.

Systems and behaviours that mainly support this traditional training route and working pattern stifle recruitment, return to work and retention. Opportunities for variety in the types of work undertaken in senior positions are needed, as is the ability to decrease, increase, stop and return to that work.

It is essential that we continue to grow the medical workforce to address gaps in certain specialties and regions and to deliver our vision for flexible working and training for doctors at all stages of their career

Interim NHS People Plan [1]

Flexible working can take a variety of forms:

  • training, or working, less than full time (LTFT)
  • taking breaks from the traditional training route to work in a variety of settings to create a portfolio career
  • working full time, but not 5 long days, Monday to Friday
  • working a different pattern in term time compared with school holidays
  • working out of hours to earn a paid sabbatical
  • working in other areas, such as research, management and education
  • retiring and returning.

Examples of flexible working

  1. Working less than full time

Dr A is an infectious diseases consultant who works full time delivering inpatient care for 10 weeks and works 7 programmed activities (PAs / 4-hour blocks) for 33 weeks delivering an outpatient parenteral antibiotic therapy (OPAT) service, a weekly clinic, and the clinical and education lead roles. During the 33 weeks, other than a weekly clinic and multidisciplinary team meeting, there are no other scheduled weekly commitments. Instead, their hours are worked out over a year. For example: the 1 PA for education lead is not programmed in as a set 4 hours every week. The hours are annualised, totalling 168 hours a year.

  2. A portfolio approach

Dr B is a nephrology specialty doctor. They have had a portfolio career, completing their foundation training and core medical training via alternative certificates during and in between treatment of a cancer. They now work 2.5 days in medical education and 1 day clinical, and are in remission.

  3. Working full time, but mixing shift lengths and timings

Dr C works 11 PAs as 2 long days, 2 short days, one evening clinic and one out-of-hours shift in acute medicine. One PA is for clinical lead, 3 are supporting professional activities (SPAs) including being audit lead and 7 are direct clinical care (DCC) PAs. Their DCC shifts on acute medicine are worked out on an annualised basis according to whether they are in hours, or after 7pm, and a weekend. This means that they are able to be flexible with days off during the week. Dr C has been able to undertake a part-time MBA as a result.

  4. Job sharing

Dr D and Dr E work in acute and respiratory medicine, 6 PAs a week each. Importantly, they have 0.25 PAs a week for handover, forced cc’d emails, so they are both aware of everything, and quarterly future vision meetings to discuss their plans, including forward planning to swap to consecutive days in acute weeks.

  5. A flexible department

Team F is a haematology/oncology team in a district general hospital, with the following team:
> Oncology
two x 0.6 full-time equivalent consultants
- two full-time consultants
- one flexible full-time consultant.

> Haematology
- 14 LTFT consultants, who work flexible PAs, if they are not in a clinic, or meeting.

They have a clinical lead who is not a member of the department and oversees annualised job planning using Allocate software. They have a fixed period of time when job planning occurs with the directors of operations, specialty manager and chief of service.

  6. Working in different roles during the week

Dr G works 6 PAs; 3 clinical and 3 research.

  7. Working in a non-traditional way

Dr H works part time for the NHS, an online virtual hospital, the Care Quality Commission (CQC) and the GMC, after retiring aged 55 from their clinical substantive post. In a typical month they work 2 PAs face to face for the NHS in outpatient clinics. A further 8 PAs are undertaken remotely using a secure virtual private network (VPN) to access electronic patient records, order and review investigations and inpatient / general practice communication. Up to 2 days per month are spent as a Professional and Linguistics Assessment Board (PLAB) examiner for the GMC or as a specialist adviser for the CQC. They spend 2 PAs per month undertaking continuing professional development (CPD) / SPAs.

  8. Working flexibly in response to ill health

Following a musculoskeletal injury which meant they were unable to travel to work, Dr H arranged to run their NHS outpatient clinic via telephone from home.

  9. Choosing to retire and return

Dr I is a 60-year-old gastroenterology consultant who works in different roles. They wound down and then retired and returned. They work 6 PAs (0.6 full-time equivalent).

Reference

  1. NHS. Interim NHS People Plan. NHS: 2019. www.longtermplan.nhs.uk/wp-content/uploads/2019/05/Interim-NHS-People-Plan_ June2019.pdf (Accessed 11 December 2019)