Medical & Dental staff

Schedule 9 - Guidance on Section 16 for Senior Academic GPs

1. The guidance set out in this Annex applies to senior academic GPs as defined in the introduction to the terms and conditions.

2. Within this definition two broad sub groupings exist: those who are employed by HEIs or other organisations and provide direct clinical care through an honorary contract as part of an integrated job plan and those who work part time within an HEI and part time as either an independent contractor or salaried GP providing direct clinical services under the new General Medical Services (nGMS) contract.

3. The terms and conditions covering the senior academic GP's honorary NHS contract are set out in the main section of this document. Part 1 of this Annex offers additional guidance on these. Part 2 offers further guidance relevant to those senior academic GPs who work under the nGMS contract.

Index:

• Part 1: Senior Academic General Practitioners who old subtantive HEI contracts and honorary NHS contracts
• Audit and postgraduate education
• The job of the Senior Academic General Practitioner with an honorary NHS contract
• The balance between Academic and Clinical Service Activities
• Balance of activities within the integrated job plan: Summary of variations
• Pay, pensions and leave entitlement
• Joint appointing procedures
• Starting salary
• Disciplinary and grievance procedures
• Part 2: Senior Academic General Practitioners who have a part time University contract and uindertake their clinical duties as independent contractors or salaried GPs under the nGMS contract

Part 1: Senior Academic General Practitioners who hold substantive HEI contracts and honorary NHS contracts

Audit and postgraduate education

4. Audit and postgraduate education, other than where it is of direct benefit only to the University, will normally be carried out as part of the weekly clinical programmed activities covered by the senior academic GP's honorary contract.

The Job of the Senior Academic General Practitioner with an honorary NHS contract

5. The special nature of the senior academic GP's job derives from its two major components, academic and clinical, which are of equal importance and together make up the integrated workload. This integrated commitment - requiring the senior academic GP to give equal priority to University and NHS activity - distinguishes the senior academic GP from the NHS GP.

6. The academic and clinical workloads, although subject to assessments as set out in paragraph 1.3 of the terms and conditions, will be brought together as the integrated workload and incorporated within an integrated job plan (see Section 2 of the terms and conditions). This approach is consistent with the Follett Review which states in a number of places (e.g. paragraphs 53, 62, 67) that the clinical academic post is a "single job" and elsewhere that "all aspects of a clinical academic's work are of benefit to the NHS" (paragraph 68). In this context, these comments also apply to senior academic GP posts as these also contain academic and clinical elements of equal importance. Further, the Review recommends (paragraph 42) that "the two contracts should be consistent and cross referring, and should be given equal weight". For senior academic GPs, this recommendation will necessitate maintaining a proper balance between academic activity and direct and indirect clinical duties within the integrated job plan.

7. It is important that, in introducing these terms and conditions to senior academic GPs, the current academic commitment provided by the senior academic GP and required by the University Employer is maintained. Because of the nature of the academic aspects of the integrated workload, this commitment cannot be quantified appropriately in terms of programmed activities, nor are the concepts of Plain Time and Premium Time (Section 4 of the 2004 Scottish Consultant Contract) or additional capacity (paragraph 6.1) in relation to private practice or fee paying work, relevant to it.

8. It is recognised that, with few exceptions, the commitment of senior academic GPs to academic activities equates to significantly more than the University's pro-rata share of 10 core programmed activities. This extra (and at times unsocial) commitment to the University will be recognised by the offer of extra equivalent programmed activities as set out in paragraphs 1.10 - 1.13 of the terms and conditions. A senior academic GP is under no obligation to accept the offer of extra academic activities and may restrict his/her academic activities to the equivalent of 5, or fewer, programmed activities (see also paragraphs 1.10 and 1.13). There will be no detriment to pay progression in such circumstances.

9. In relation to the offer of an extra academic programmed activity outlined in paragraph 1.10, this may be withheld only in circumstances where there is clear evidence that the activity and commitment of a senior academic GP fall below the equivalent of 5 plus 1 weekly academic programmed activities. It would be anticipated that this circumstance would have been clearly highlighted in previous appraisals and job planning rounds and that sufficient time and resources for remedial action to be taken would have been made available. The Transparency Review demonstrated that these instances would be exceptional. Any such instances would be subject to the provisions of the appeals procedure outlined in paragraphs 4.1 to 4.13. In the case of a senior academic GP for whom the offer of an extra academic programmed activity had previously been withheld, the extra academic programmed activity would again be offered if and when the reasons for withholding it ceased to apply.

10. The UK Government initiated Transparency Review, implemented in Scotland by the Scottish Higher Education Funding Council, provides a mechanism for measuring the integrated workload of senior academic GPs and there is an expectation that the aggregated outcome of locally agreed integrated job plans across a medical school/NHS Board system will be consistent with its findings.

The Balance between Academic and Clinical Service Activities

11. For full-time senior academic GPs the integrated job plan will normally comprise the equivalent of 6 (5 core and 1 extra) weekly academic programmed activity equivalents and 5 weekly clinical service programmed activities (with the option of 1 extra weekly clinical service programmed activity by agreement of all interested parties - see paragraph 1.12). These norms can only be varied with the agreement of all interested parties. Other than in the case of a senior academic GP working part-time, the core commitment to academic and clinical service work will be set at the equivalent of 10 weekly programmed activities overall. Normally, no more than 2 extra weekly programmed activities will be offered under the combined substantive and honorary contracts, and thus the integrated job plan maximum will normally not exceed the equivalent of 12 programmed activities.

12. The job plan of a senior academic GP contracted for the equivalent of 10 weekly programmed activities or less will be made up exclusively of core academic activity equivalents and core programmed clinical service activities.

13. Where the NHS Employer, University Employer and senior academic GP agree that the clinical workload of that senior academic GP is equal to 6 or 7 weekly programmed activities, the senior academic GP will be offered one or two weekly clinical extra programmed activities in the job plan to reflect the agreed level of commitment to clinical service. Where this extra clinical activity is not recognised by the offer of an appropriate number of clinical extra programmed activities, the clinical workload should be adjusted to reflect the number of weekly clinical programmed activities agreed in the job plan.

14. Where, exceptionally, a senior academic GP undertakes more than 7 (i.e. 5 core and 2 extra) weekly clinical service programmed activities by agreement, this will be achieved by increasing the core clinical service commitment to a level above 5 weekly programmed activities, with a pro-rata reduction in the core commitment to academic activities.

15. Where a senior academic GP undertakes more than the equivalent of 6 (i.e. 5 core and 1 extra) weekly academic programmed activities, this will normally be achieved by first increasing the number of extra academic programmed activities to a maximum equivalent to 2 weekly programmed activities, with any further increase achieved by adding core academic activity equivalents and reducing pro-rata the core commitment to clinical service programmed activities to keep within the integrated weekly job plan maximum normally equivalent to 12 programmed activities.

16. A university School/RI, or specialist clinical group within a School/RI, may undertake to provide a defined amount of clinical service in a particular specialty. Such an arrangement has advantages for the NHS and University in terms of flexibility and continuity of service provision and in all circumstances should be formally considered by the University Employer and NHS Employer working together. As the Follett Review makes clear (paragraph 70) such arrangements are consistent with individual job planning and accountability. This can be achieved by means of a service level agreement between the relevant NHS body (usually the Medical Director/Director of Public Health) and the university (usually the Head of College of MVLS) and implemented via individual job plans for senior academic GPs under their honorary NHS contracts.

17. Examples of substantive university managerial and administrative roles (see paragraph 1.11) which may, at the discretion of the University Employer, require more than the equivalent of 6 (i.e. 5 core and 1 extra) weekly academic programmed activities include, but are not limited to:

• Head of College/ Head of School/RI
• Phase Convenor / Specialty Convenor

Balance of activities within the integrated job plan: Summary of variations

Notes: Examples of variations in the balance between academic and clinical service commitments within the integrated job plan expressed as programmed activities (PAs):

• Variation 1. The norm for a senior academic GP with a full-time contract and no extra clinical service programmed activities (see paragraphs 1.8-1.10 of the terms and conditions)
• Variation 2. As for (1) with one extra clinical service weekly programmed activity (see paragraph 1.12 of the terms and conditions)
• Variation 3. As for (1) with two extra clinical service weekly programmed activities (see paragraph 1.13 of the terms and conditions)
• Variation 4. Senior academic GP with a substantive university managerial role (see paragraph 1.11 of the terms and conditions)
• Variation 5. Senior academic GP contracted for the equivalent of 10 weekly programmed activities or less (see guidance above)

Exceptionally, a senior academic GP may, by agreement, be contracted for more than the normal maxima of 2 extra programmed activities and 12 programmed activities in total.

Pay, pensions and leave entitlement

18. All elements of a senior academic GP's salary will be paid through the University Employer (or other substantive employer), irrespective of the primary source (or sources) of funding.

19. Senior academic GPs' pay will be uplifted in line with uplifts agreed for consultant clinical academics.

Joint appointing procedures

20. To comply with the recommendations of the Follett Review (paragraphs 31-38), appointment to senior academic GP posts should be made by a procedure jointly agreed by the University Employer and the NHS Employer.

Starting salary

21. In determining the starting salary of a senior academic GP, the University Employer will, in addition to considering the factors referred to in Section 5.1 of these terms and conditions, apply academic criteria. These may include:

• length of time in academic training (research and /or teaching) posts; 
• possession of postgraduate research and /or teaching degrees; 
• awards, prizes and other evidence of academic recognition; 
• academic outputs (e.g. publications); 
• national/international standing.

Disciplinary and grievance procedures

22. As recommended by the Follett Review (paragraph 63), the University Employer and the NHS Employer should jointly prepare a formal agreement on the procedures for the management of poor performance and for disciplinary action to be followed for senior academic GPs. As a minimum these should: ensure joint working from the outset (i.e. from the moment when a problem or potential problem is identified); specify which employer is to take the lead; ensure suitable cross membership of disciplinary bodies; be expeditious.

23. The responsibility for investigating and managing matters related to poor performance, discipline or grievance will normally follow the lines of accountability as set out in paragraph 2.1 of these terms and conditions, i.e. the University Employer will lead on matters arising under the substantive contract and the NHS Employer will lead on matters arising under the honorary contract.

24. The development by the universities of a new model statute will provide an opportunity to co-ordinate and cross-reference these principles as they are incorporated into the separate procedures.

Part 2: Senior Academic General Practitioners who have a part time University contract and undertake their clinical duties as independent contractors or salaried GPs under the nGMS contract

25. Whilst the duties of a senior academic GP post which exists within the framework of a substantive HEI contract, an honorary NHS contract and direct clinical care duties within a GP practice can be considered to constitute a single post and are thus covered by the recommendations of the Follett Review, senior academic GPs who work within a GP practice under the nGMS contract are, for the purposes of job planning, considered to have two separate posts.

26. In view of the above, HEIs are not required to enter into joint job planning arrangements with GP practices where senior academic GPs work as independent contractors or salaried GPs under the nGMS contract. HEIs will, however, be expected to bear the conclusions of the Follett Review in mind in conducting job appraisals for these employees. In addition, senior academic GPs who fall into this category will be expected to work in partnership with their HEI employer and to keep the Head of College, or other nominated individual within the University, informed of their general practice commitments. As with senior academic GPs described in Part 1, it is acknowledged that the academic and clinical components of the integrated workload of senior academic GPs undertaking independent clinical practice under the nGMS contract are of equal weight and all aspects of the integrated workload are of benefit to the NHS.

27. In addition, senior academic GPs working under the nGMS contract should keep their HEI employer informed of any aspect of their general practice work which might have a bearing on their substantive HEI contract. In particular, any issue highlighted in the final written record of the annual review held between the Health Board and the GP which may have a bearing on his/her work for the HEI employer or any notification made to the Health Board under section 403 of the nGMS contract should be reported to his/her HEI employer.

28. The Head of College, or other nominated person within the HEI, will consider what action, if any, needs to be taken in relation to such information. Failure to keep the employing HEI informed of such information may be considered a disciplinary offence and progressed through the HEI's disciplinary procedures.