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Survey on the regrading of Clinical Medical Officers (CMOs) and Senior CMOs

January 2006

Introduction
With the merger of terms and conditions for doctors in Public Health Medicine and Community Health with hospital grades in 2002, it was agreed that senior/clinical medical officers (S/CMOs) wishing to regrade to the equivalent post of the associate specialist grade/staff grade respectively would be able to apply through their employing trust and the regrading process would be a smooth transition with a review due in April 2006.

Although a large number of S/CMOs have successfully regraded, some very smoothly, others with varying degrees of difficulty, mainly through their employers, there are still a significant number of S/CMOs who have not regraded. The Community Health Services Joint Committee has been made aware of anecdotal cases but also evidence where employing trusts have been very obstructive. In order to gather further information on the current situation, a survey was undertaken of clinical medical officers and senior clinical medical officers across the United Kingdom.

A questionnaire was sent to S/CMOs (BMA members and non-members) across the United Kingdom. A total of 456 completed responses were received, which is a response rate of 28%. This report presents the findings of the survey.

Results
Characteristics of respondents
A quarter of respondents are currently working as senior clinical medical officers and a fifth (19%) are currently working as clinical medical officers (table 1). The remainder of respondents are currently working in the staff grade, associate specialist grade or a mix of positions. Respondents are distributed across the United Kingdom (figure 1). Respondents are more likely to be female (84%) than male (16%). They are also more likely to be in the older age groups (50-59 and 65+ age groups) (figure 2).

Whilst almost half of respondents (47%) have regraded to the staff grade or associate specialist grade and a further fifth (20%) intend to soon (figure 3). A third (33%) or respondents report that they have not regraded and of those, 51% do not intend to and 49% have not decided yet. Of those respondents who have already regraded (n=206), most have done so in the last year or two (table 2). Most have regraded to the associate specialist grade (64%), although around a third (36%) regraded to the staff grade (figure 4).

Almost a fifth of respondents (18%) report that they either do not intend to regrade to either the staff grade or associate specialist grade or have yet to decide. In many cases, respondents are nearing retirement age and do not forsee any advantage in regrading. Others enjoy the flexibility that their current S/CMO position affords them. Several respondents are currently working on a part-time or sessional basis and do not perceive there to be any advantage to regrading. In other cases, regrading to the staff grade or associate specialist grade would mean reduced income. In a few cases, respondents report that they have received no information or advice and have not been offered the opportunity to regrade.

Of those respondents who are intending to apply for regrading (n=90), a range of reasons have been given for the delay. Whilst one in ten are waiting to see how the regrading was working in their practice, 5% have been delayed by a dispute in their back pay. However, the majority of respondents (80%) report that their regrading has been delayed by their trust. In many cases (n=73) no reason has been given by the trust for the delay and the regrading of some respondents has been delayed by up to 3 years from the initial application.

In other cases (n=38), reasons have been given by the trust for delaying regrading of S/CMOs and these include financial constraints, whereby the trust claims to have inadequate fund to cover regrading or disputes over salary and pay scales; administrative delays and the amount of paperwork involved; the length of time taken to prepare the job description and/or job plan; disputes over hours, job plans or job descriptions; lack of appropriate staff. Many respondents report that the trust is ‘dragging its feet’, whilst others report that the trust is being obstructive and difficult. In some cases, trusts appear to be uninformed about the regrading process and are unsure as to how to proceed. In several cases, applications for regrading have been ignored or rejected by the PCT. Some respondents report that the trust has told them that they are too busy dealing with the new consultant contract to address issues of regrading S/CMOs.

Table 1: Current position of survey respondents

	Frequency	Percent
Clinical Medical Officer	86	19
Senior Clinical Medical Officer	125	27.6
Staff Grade	73	16.1
Associate Specialist	130	28.7
Other*	39	8.6
Total	453	100
No reply	3

* other includes a mix of positions such as GP/CMO or SCMO/clinical assistant

Figure 1: Distribution of respondents across the UK

Figure 2: Age range of respondents (%)

Figure 3: Whether regraded to either staff grade or the associate specialist grade

Table 2: Date of regrading

	Frequency	Percent
Before 2000	14	7
2000	4	2
2001	7	3.5
2002	17	8.5
2003	43	21.5
2004	64	32
2005	51	25.5
Total	200
No reply	6

Figure 4: Grade regraded to (%)

Communication with members
Hard copy letter is the preferred method of communication about developments on S/CMO and SASC contract issues, followed by e-mail (table 3). Similarly, hard copy guidance notes is the preferred method of receiving general advice and guidance from the BMA, followed by e-mail (table 4)

Table 3: Preferred method of communication about developments on S/CMO and SASC contract issues

	Frequency	Percent
BMA website	16	3.8
Email	103	24.7
Hard copy letter	289	69.3
Medical press	9	2.2
Total	417
No reply	39

Table 4: Preferred method of receiving general advice and guidance from the BMA

	Frequency	Percent
BMA website	30	7.2
Email	104	24.9
CD-ROM	6	1.4
Hard copy guidance notes	277	66.4
Total	417
No reply	39