Case studies

Background

 

St George’s Healthcare NHS Trust has over 360 consultants. The Trust runs services at St George's Hospital in Tooting, one of the biggest NHS hospitals in the country, as well as the Wolfson Rehabilitation Centre in Wimbledon.

Since the introduction of the new consultant’s contract in 2003 the Trust had not seen much benefit from the new contract and the job planning process. Previous attempts at job planning had not been consistent across the trust, and it had been difficult to get an accurate overview of the services being delivered. In October 2006, the trust undertook an independent review of possible job planning solutions. They chose Zircadian’s web-based solution MyJobPlan. By 2008 the Trust had a 100% job plan submission rate.

 

Budgeting

 

General Manager Lila Pilling is responsible for the first sign-off of consultants’ job plans for five surgical specialties. She has approximately 50 consultants with whom she must produce job plans in liaison with care group leads. The key outcome of job planning for Lila is that each consultant’s job plan equates to the number of PAs they are allocated in the pay budget. However, the process also exists to recognise any service developments and additional work the consultants have taken on. Although they are each recruited to a job plan with a baseline number of PAs, they can record up to one additional PA for extra activities. This allows Lila to monitor how much extra required work is going on within the group. This can result in a business case for an additional consultant, or if a small amount of extra required work is being carried out then it may be agreed through job planning that the existing consultant(s) will be allocated an additional PA or however many are necessary. Once this has gone into budget-setting and additional funding has been secured they can then be paid for that extra work. In this respect, by accurately calculating the PAs worked, MyJobPlan allows both careful budgeting and efficient business planning.

 

Aligning consultant activity with trust objectives

 

The electronic job planning process enables the Trust to identify exactly what work is being carried out, and align consultant activity with trust objectives. The MyJobPlan system makes the process transparent, clearly highlighting discrepancies between the service plan and the job plans. Lila points out:

“MyJobPlan also helps highlight other activities which previously I would never even have known consultants were doing. It is vital that we are made aware if consultants are working in excess of their agreed PAs without any reference to budgets or planning, and without any discussion or agreement.”

St George’s always makes clear that if a consultant wishes to change their contract they must negotiate with their general manager and care group lead, and clearly set out on a business planning model why they wish to increase their activity.

 

Double-counting

Double-counting is a significant issue that has been largely eradicated at St George’s by use of the MyJobPlan software. An example of double-counting that was frequently missed before the implementation of the system was in the area of medical teaching. Often, consultants will enter hours of teaching separately to a clinic, whereas those activities actually happen concurrently. Consultants teaching during clinics are essentially doing both activities at the same time and within the same PA. MyJobPlan clearly shows if consultants are double-counting for the same time period. Lila estimates that this aspect of MyJobPlan could save the department over 5 PAs per week across 50 consultants.

 

Rescheduling of SPA time

 

A further benefit of MyJobPlan is that it allows the Trust to see clearly where SPA activity should be rescheduled from premium time to normal time. This kind of shift, along with an overall hours reduction is something that the Trust has applied in three or four cases, saving approximately 16 hours, or 4 PAs, per week.

 

Workforce planning and capacity

 

Speaking about other benefits to productivity Lila mentions that MyJobPlan flags up any discrepancy between expected length of an activity against the actual length recorded in a job plan. This has been particularly useful in the case of afternoon dentistry clinics at St George’s in which dentists do not work the expected amount of PA time. Once the issue was highlighted by MyJobPlan, discussion revealed that although the dentists are happy to work the full clinic length, the Trust currently cannot provide dental nursing past 5pm, so clinics must stop thirty minutes before their scheduled end to allow for nurses to clear up and leave on time. As a result, Lila has initiated a recruitment process for more dental nurses so that the consultants can extend their clinics to the correct amount of time. Lila says:

“In this respect MyJobPlan has really helped, and will have a significant effect on the capacity in afternoon dentistry clinics in this Trust as of April next year. I’ll probably get another four or five hours of activity a day. Previously, in order to check the length of a clinic I would have had to look at PAs and check through each individual template, but because it’s now on MyJobPlan, if it’s outside of the norm it’s flagged up immediately in red and I can see it straight away.”

 

Service line reporting and additional funding/income

 

There is now increased emphasis on service-line reporting and recognising income from other areas such as training, and Lila anticipates that MyJobPlan will be immensely helpful in these areas. This is especially with regard to undergraduate teaching and SIFT funding. Medical Service Increment for Teaching (SIFT) funding is paid via the SHA to NHS organizations. It supports additional costs incurred in providing clinical placements for medical undergraduates in England. The way SIFT funding is allocated is changing and it will be tariff-based. In future the Trust will only be paid if this work is also entered into the medical school online diary. Therefore when consultants record undergraduate teaching in their job plans using the MyJobPlan system, they are encouraged to also record it in the medical school online diary at the same time. In this way the electronic job planning process is prompting use of the diary, and this data collection is vital in helping and defending the Trust’s income position.

 

Customisation

 

A key to St George’s success with job planning is the level to which they have customised the MyJobPlan system to provide a greater and more helpful level of detail to the job planning process. It is possible for any trust to tailor the clinical and non-clinical language within the system, to most meaningfully reflect the work being carried out. For example, rather than having an activity for a particular department generically named ‘Outpatient Clinic’, St George’s chooses to make this much more specific by splitting the activity, for example into: ‘Outpatient Clinic (gastro) - junior staff with separate patients to supervise’ and ‘Outpatient Clinic (gastro) - no separate junior staff’. This kind of specification within the system is easily achieved in communication with Zircadian’s support team, and leads to a more detailed job plan. This in turn enables the production of far more accurate and useful activity reports once the job plans are complete. In this way MyJobPlan can be finely tuned to the specific requirements of a trust, thereby providing a highly effective tool for medical workforce management.

Uniquely, St George’s has also uploaded a separate job planning framework document for each specialty, to be accessed within the MyJobPlan system, rather than one generic framework document for the entire Trust. This means consultants receive only the guidance which is strictly relevant to their specialty / care group, and helps ensure that they job plan correctly.

 

Best practice

 

Since its implementation of the MyJobPlan system, St George’s has hosted visits from other NHS Trusts in order to share its progress in the area of electronic job planning, and is becoming known as a beacon of best practice. Lila says:

“MyJobPlan gives me much greater clarity on what doctors are doing. It helps me bring the doctors’ job plans back into budget by removing inconsistencies, and has helped me increase income by raising productivity and decreasing the demand for extra PA’s. We have been happy to discuss our processes, challenges and successes with our NHS colleagues so that they might also find a way to experience benefits from job planning.”

April 2010