As a consultant, you are not obliged to work resident on-call unless it is with your explicit agreement. We cover the implications of working resident on-call and things to consider before agreeing to it.
What is 'resident' work?
Being ‘resident’ means you are expected to be present in your place of work for the duration of your on-call period. This might be to cover emergency duties, in case you are needed in person. This differs from usual consultant on-call arrangements where you would be at home when not immediately required for patient care. Many wrongly assume this refers to overnight work, but in fact it applies to any work period in premium time, which is between 7pm and 7am weekdays and any time on Saturday and Sunday (Terms and Conditions – Consultants (England) 2003, s.3, p.6). Further it includes any work which is so busy as to be resident even if not recorded in the job plan as such.
The consultant contract is clear that such resident work will only be performed by mutual agreement between employer and employee (T&C, s.8, p.4).
While consultants are not obliged to work resident on-call, we know that increasing numbers of consultants are working shift patterns, part or all of which may fall during premium time.
Consultants who work long periods consecutively in premium time are likely to use up most of their weekly PAs/sessions very quickly. As such, employers should consider whether these kinds of arrangements are the most effective use of consultant time and resources.
Job planning periods of resident on-call should be done with the recognition that as this is non contractual work the length of PAs during premium time may be negotiated to be shorter than the three hours allowed for non-resident and emergency on-call work. Periods of compensatory rest may also need to be included in job plans as predictable on-call in addition to the hours worked.
Enhanced pay rates are an alternative to shorter PAs, and as the working of these sessions is discretionary on the part of the consultant they are within their rights to seek agreement over either. It may be considered iniquitous for additional waiting list work to be paid at a higher rate than demanding on-call work which is also outside of contractual requirements.
It’s also worth noting that the concept of ‘predictable on-call’ can only exist during plain time. In premium time both resident on-call work or routine work (e.g. planned weekend ward rounds etc.) can only be by agreement (both to undertake the work and rates of remuneration).
Shift or resident working in an emergency
To avoid last minute uncertainty around the arrangements for consultants undertaking unplanned resident work, some LNCs (local negotiating committees) and employers have negotiated specific arrangements with clear policy on remuneration.
A written agreement is essential prior to undertaking resident work. This ensures that all those involved know what is expected of them and how such work will be recognised and paid. For very short-term arrangements, an email request and statement of recognition may be acceptable.
As a minimum, any activity undertaken in premium time should be recognised as such and paid accordingly. Do not assume that an unanswered request for additional pay or changes to an unsigned job plan represent agreement, they do not. If the issue is ongoing do not be afraid to request a job plan review with mediation and appeal as needed.
What you should consider
Where a consultant agrees to be resident, consideration should be given to a number of factors.
How many consultants are on-call
You would need to check if it would be appropriate for a colleague to be on-call at the same time. It should not be assumed that having one consultant covering the work is adequate to cope with the potential workload.
Relevant experience
Do you have recent experience in all aspects of the work you may be required to do. For example, it might be inappropriate for a sub-specialist in gynaecology who has not done obstetrics for a decade to deliver some obstetrics and gynaecology services.
Working hours
The impact resident on-call working may have on your daytime working. You should not be scheduled to work the day after a busy night on-call, particularly if you have been working resident on-call. If you are, you will need to take paid compensatory rest. This may include adding a period of predictable on-call to the job plan the day after a resident on-call shift.
Working time regulations
Unless you have opted out in writing, your working time should not exceed the directive limits and all consultants should be aware that all of a resident’s on-call period counts as working time in the context of the directive.
You are also entitled to 11 hours of continuous rest in any 24 hours.
Acting down and what that means
‘Acting down’ is a phrase commonly used to describe a senior doctor performing the duties of a more junior colleague.
However, a consultant who is covering the work of a junior colleague cannot forget that they are a consultant and they do not have the option of pretending they are working at a lesser level of responsibility than they do normally. Therefore, the consultant is not ‘acting down’ – they are acting appropriately in response to the unusual circumstances they are in.
It should be recognised that they are providing consultant level care and should be remunerated appropriately.
If as a consultant you are asked to provide resident cover because of persistently bad workforce planning beyond your control, tackling the root causes of those problems is the correct long-term approach.
Shift or resident working as a planned arrangement
Some consultants undertake shift work in premium time – this is particularly the case for certain specialties and services, such as paediatrics, emergency departments, intensive care and obstetrics.
BMA's view and position
The BMA’s position is that, where there is a need for a re-arrangement of responsibilities as a result of these pressures, the best way forward is to seek agreement through job planning arrangements to ensure that consultants are properly supported by both facilities and staff.
Some employers may attempt to recruit new consultants to posts which include this work in their job plans. From an employer’s perspective, this may be easier than trying to persuade or induce existing staff to take on these responsibilities.
The BMA consultant committee believes that this not a helpful way of addressing workforce requirements. They are likely to divide the consultant body and create potential tensions if those appointed become aware that their other colleagues are not required to carry out that work.
Where a consultant is considering accepting a post which includes resident on-call cover in the job plan, they should ensure that the contract they are provided with is the standard 2003 consultant contract which allows for consultants to withdraw from resident on call and non-emergency work during premium time.
Consultants are able to decline further resident on-call by giving three months' notice of a wish to exert their contractual right to a job plan without resident on-call arrangements.
Resident on-call guidance for Scotland
The 2004 Scottish consultant terms and conditions of service (para 4.9.1) clearly states that consultants will not, save in exceptional circumstances, undertake resident on call. There is however no definition of ’exceptional circumstances’.
There is no contractual obligation for consultants to undertake resident on call work and no national agreement on the rate payable. Instead, the terms and conditions of service stipulate that employers will negotiate resident on call arrangements with the BMA’s Local Negotiating Committees.
LNCs will have reached a local agreement with the Board on the arrangements that will apply to consultant resident on call, including remuneration, accommodation and catering.
Ensuring safe out of hours working
There are a range of consultant working patterns across different healthcare settings in Scotland. Consultants locally are best placed to determine what constitutes safe working in their particular context.
The practicalities of providing safe consultant working patterns may mean some consultants spending an increased proportion of their time working on-site out of hours.