Guidance on resident on-call work for consultants
December 2007
This advice applies to consultants working in England under the 2003 contract, although the principles involved are similar for other consultant contracts.
Consultants may be asked to cover an absent resident, either through short term unavailability or a planned removal of a trainee rota.
The 2003 terms and conditions of service are quite clear on the matter:
“Where unusually a consultant is asked to be resident at the hospital or other place of work during his or her on-call period, appropriate arrangements may be agreed locally. A consultant will only be resident during an on-call period by mutual agreement.” (Sch. 8, Para. 4)
Consultants, then, are not obliged to provide a resident on-call service. This is why there is no ‘rate for the job’ in the contract. Where the consultant agrees to provide the cover they should negotiate locally on the terms for this work. The Local Negotiating Committee (LNC) may have reached an understanding with the trust over what these terms should be and the consultant should check with a member of the LNC for details. Common arrangements involve multiples of the normal PA rate with or without time off following the resident shift. Disagreements arise where this compensation is not explicitly agreed beforehand.
Consultants should consider what impact resident on-call working might have on their daytime working – depending on the work intensity, it may be appropriate for daytime commitments to be cancelled. Unless the consultant has opted out in writing, their working time should not exceed the Working Time Directive limits and consultants should be aware that all of a resident on-call period counts as working time in the context of the Directive.
Consultants should avoid providing resident cover where the reason is poor manpower planning by the trust. Such an approach could result in a continuance of the original problem. If a consultant agrees to provide the cover under any circumstance, explicit agreement about the duration of the agreement should be made.
Where a consultant agrees to do work at resident level, consideration should be given as to whether it would be appropriate for a colleague to be on call at the same time. Consultants should also consider whether they have sufficiently recent experience in all aspects of the work they may be required to do e.g. it might be inappropriate for a subspecialist in gynaecology who has not done obstetrics for a decade to act as a middle grade in O&G.
Where a consultant is considering accepting a consultant post which includes resident on-call cover in the job plan, they should consider very carefully the nature of the long term commitment they are making. Any changes made cannot be varied at a later date without mutual agreement. Members are strongly advised to seek BMA advice before going ahead with any such change.
Most consultants work for employers whose core business is to provide 24/7 specialist health care for their local populations, and consultants have a contractual responsibility to make certain that mechanisms exist to diagnose and manage new patients, and continue care for existing patients, during the entire out of hours period. As such most consultants take part in on call rotas. Consultants typically work from home while on call, with other grades of doctor being resident in the hospital. This guidance gives advice on the contractual and pragmatic position when you or your employers propose that you work as a resident consultant.
Consultants may from time to time be asked to provide resident on-call cover by their employer. There could be a variety of reasons for this: a trust may be seeking to take a trainee doctor off a resident on-call commitment because the trainee’s hours are exceeding the European Working Time Directive limit; this is likely to result in a long term need for alternative resident on call arrangements.
Another reason may be that sickness may have led to a gap in the service; this is likely to result in a short term need for an alternative resident on-call arrangement. Consultants who are asked to provide resident on-call cover should consider the reasons they are being asked to do so, whether it is likely that the cover will be a on a short term basis or not and their willingness provide such cover. Once the consultant has established the reason for the request, they should seek further advice from the BMA. An agreed written agreement is essential: it ensures that all those involved know what is expected of them. For very short term arrangements an email request and statement of recognition could be acceptable.
Where a consultant is considering accepting a consultant post which includes resident on-call cover in the job plan, they should consider very carefully the nature of the long term commitment they are making. Any consultant considering agreeing a change to their contract should seek advice from the BMA before doing so.
Consultant cover for highly acute areas
It is relatively expensive to use a consultant for round-the-clock cover regardless of appropriateness as this would consume large parts of their contracted direct clinical care.
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Further considerations
Any extension of working hours should take into account the European Working Time Directive. The CCSC’s guidance on this can be accessed here:
http://www.bma.org.uk/ap.nsf/Content/EWTDsenior
Whether a consultant is willing to carry out this work is largely a personal decision based on a number of factors – those already mentioned but also taking into account family and other commitments. The key to making this work is proper consideration of what any agreement might mean in terms of its impact on the consultant’s work-life balance, how necessary it is to the service and whether the terms reached are agreeable.
Scotland
The following paragraph in the TCS for consultants employed in Scotland covers resident on-call:
4.9.1 Consultants will not, save in exceptional circumstances, undertake resident on-call. However, the employer will agree with the local negotiating committee (LNC) for medical and dental staff the arrangements in respect of resident on-call, including remuneration, paid time off in lieu, accommodation and catering. Where it is agreed between the consultant and employer that he/she will undertake resident on-call duty, these arrangements agreed with the LNC will apply.
Wales
Consultants in Wales should refer to the following paragraph in their TCS:
Para 3.8 of the Welsh Consultant Contract:-
In exceptional circumstances where the Consultant is requested and agrees to be immediately available, i.e. "resident on call", this will be remunerated at three times the sessional payment at Point 6 of the Consultant salary Scale, excluding commitment awards and clinical excellence awards. In such circumstances, there will be an agreed compensatory rest period the following day."
Appendix 1
The following model agreement for LNCs to use where consultants are working resident on-call. Consultants may wish to adapt the agreement as appropriate.
Consultant resident on call agreement
Agreement between [NHS Board Name] and The BMA Medical and Dental Staff Local Negotiating Committee
1. Introduction
This policy is entered into between [NHS Board name] and the BMA LNC to implement paragraph 4.9.1 of the new consultant contract effective from 1 April 2004.
2. Principles
The principles governing these arrangements are:-
2.1 Consultants will only undertake resident on call by mutual agreement. Where a consultant withholds agreement, the employer cannot require a resident on call commitment to be worked, and this matter cannot be taken to appeal. In this event, there will be no detriment to progression through seniority points or any other matter. Where the employer withholds agreement, the provisions below do not apply.
2.2 A consultant is ‘Resident on Call’ when he/she is required and agrees to be at his/her principal place of work (or other agreed employer-designated NHS establishment) on a continuous basis and available to respond to emergencies within the period 8.pm to 8.am on any day of the week or 8.am to 8.pm Saturday and/or Sunday.
2.3 An Agreement reached between a consultant and the NHS Board under this policy will be formally recorded on Appendix R1 (format to be designed by local agreement) and the job plan agreed between the consultant and the employer will be amended accordingly.
3. Resident On-Call Payments
3.1 In circumstances where [NHS Board Name] and a consultant agree that Resident On Call will be undertaken as per Section 2 above a separate contract for this purpose will be entered into (See Appendix R2 – format to be designed by local agreement). Any indefinite arrangements made under this Agreement will be subject to a notice of termination period of three months.
3.2 Such work will be paid at three times the hourly rate appropriate to point 20 of the seniority scale set out in Appendix 3 of the consultant terms and conditions of service effective from 1 April 2004, or alternatively and by agreement with the employer:
- paid at twice the hourly rate appropriate to point 20 of the seniority scale set out in Appendix 3 of the terms and conditions for the new consultant contract and equivalent time off in lieu; or
- paid at the hourly rate appropriate to point 20 of the seniority scale set out in Appendix 3 and twice the equivalent time off in lieu.
3.4 Payments for Resident On Call will be considered as additional to the basic salary and will not be superannuable.
4. Standards of Residential Accommodation and Catering
4.1 Any consultant undertaking Resident On-Call work under this policy will be guaranteed an agreed minimum acceptable standard of on call accommodation and catering which is in accordance with NHS Circular HDL (2001) 50.
agreed on………………………………………………………
date……………………………………………………………..
Signed/Designation:
(for [NHS Board name])……………………….……………………………
Signed/Designation:
(for the BMA LNC)…………………………………………………………..