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Cardiology Management: UK On-Call Remuneration

Have we got it right?

With the number of Cardiac Units offering a primary angioplasty service increasing, the thorny question of on-call payments has been raised a number of times by colleagues. Where there was no previous on-call service offered, or no local agreement for on-call payment arrangements in place prior to switching to Agenda for Change (AFC) terms and conditions four years ago, any on-call activity is to be paid as per AFC provisions. The problem with this is that AFC on-call payments are several steps backwards from what most UK Radiographers are used to receiving for on-call activity. Also, if there was no Cardiac on-call service in operation prior to a primary angioplasty service being introduced, it is unlikely that staff have an obligation to provide such a service written into their job contracts. What then would be an ideal on-call remuneration package to ensure staff are prepared to undertake these duties? Also, how is it possible to allow such payments under the current AFC umbrella?

Several years ago a number of Radiology Departments shifted on-call payments for Radiographers from the old Whitley terms and conditions, which paid staff on a per call-out basis, to a fixed rate payment. This largely happened when the right of employers to insist Radiographic staff worked out of hours duties expired from the old Whitley terms and conditions around 10 years ago. This shift in payment structure was particularly true in places with a busy Accident and Emergency workload. This meant staff knew what they were going to get paid to undertake the out of hours duties regardless of how busy they were, and Manager’s could accurately budget for such payments. It also meant that staff could negotiate a fixed payment that made it attractive enough to make it worth doing the duty.

When considering what payment out of hour’s duties should attract, it is worth considering three things.

  • Firstly what financial reward do staff currently receive to undertake other additional duties, for example private work, bank work, and waiting list initiative work?
  • Secondly, what do work groups in other industries receive to undertake work outside normal working hours?
  • Finally is whatever finally decided upon as financial reward for additional out of hours duties going to be attractive enough for staff to make it worth while doing it, given the disruption it can cause to life outside work?

Currently Allied Health Professional (AHP) staff working in the NHS receive £45 per hour for any private work they do outside their normal contracted hours. In addition to this, waiting list initiative work done by Allied Health Professionals at the Trust where I work is paid at £50 per hour, as it is in many other Trusts. In both cases, this work tends to be done either after 5:00pm, or on weekends, but not normally in the middle of the night, unlike a measurable portion of Catheter Lab on-call activity which is. Bank rates vary significantly from Trust to Trust depending on the nature of the duty being covered. However, a Sunday bank in A&E covered by a band 7 Radiographer (9:00am – 5:00pm) costs the Trust where I work £38:25 per hour, of which the Radiographer gets £27:28 per hour. This is through Reed, the preferred NHS provider for bank and agency staff.

For those who have ever had to call a tradesman in London out for a domestic emergency, the next set of figures will come as no surprise. Looking on the React Fast website (www.reactfast.co.uk), if you need to call out a locksmith as an emergency (1-2 hour response) to replace a front door lock having lost house keys, they quote a discounted rate of £99.90 per hour, or for any part of any hour (based on a SE London postcode). They do say that in 80% of jobs are completed within one hour. A plumber will cost a mere £71 per hour during normal working hours through the same website.

Pimlico Plumbers (www.pimlicoplumbers.com) offer a range of tradesmen for domestic emergencies. A general tradesman will cost £130 per hour between 6:00pm – 12:00am Monday to Friday, and from 7:00am – 12:00am Saturday. On Sunday 7:00am – 12:00am it will cost you £140 per hour. Between midnight and 7:00am Monday through Sunday the charge is £170 per hour. A Corgi registered Engineer costs an additional £10 per hour across all the charges already mentioned, and drain jetting costs £200, £230, and £250 respectively. All charges exclude value added tax (currently 15%), and there is a minimum charge of one hour for any work done.

A little cheaper for tradesman were One Central (www.onecentral.net). An Electrician or Plumber will cost you £95 per hour Saturday between 8:00am and 6:00pm, or £110 per hour on Sunday 8:00am – 6:00pm. A Gas Engineer will be £105 on Saturday and £120 on Sunday 8:00am – 6:00pm. Once again, this excludes value added tax, and there is a minimum charge of one hour for any work done. I could go on, but if you google “emergency tradesman London”, you can look for yourself (in some cases you will need to ring for a quote, the three I mention you can check on-line without phoning).

If Agenda for Change terms and conditions did not exist, I would suggest that staff doing on-call activity from home should be on an hourly rate of £50, with at least one hour’s payment guaranteed per day on call in-lieu of carrying the bleep. Under the old Whitley terms and conditions, staff receive a rather derisory sum of money for actually being on-call (less than £10), which does not reflect the inconvenience of doing so. The one hour minimum payment would offset this. For any work then done over and above the one hour, staff would receive £50 per hour. This is still far less that getting a tradesman of any sort to come out after normal working hours (or indeed during normal working hours). It is the same hourly rate that some staff are currently paid to undertake waiting list initiative work, but the on-call involves far more unsociable and unpredictable hours, which has a much bigger impact on life outside work. Incidentally these payments would apply to all Catheter Lab support staff that cover on-call (i.e. Nurses and Cardiac Technicians and Radiographers). This is in-line with recommendations made in the evaluation of the National Infarct Angioplasty Project recently published by the National Institute for Health Research.

There is scope under AFC conditions to pay retention premiums, and this is where I feel employers could link retention payments to on-call activity. It is possible to be awarded up to 30% of your basic salary with such payments, which would give employers enough leeway to pay enough by way of a retention bonus to reward on-call activity at the rate suggested. The counter argument to this is that it sets a precedent. I accept it would, however there are very few staff groups left who still cover out of hour’s activity by way of on-call, rather than some sort of shift system. For those that do, especially where recruitment and retention of staff to who are being asked to do so is problematic, one could also make a similar case. The argument of “setting a precedent” only becomes relevant if the payments I am suggesting are unreasonable, and clearly I do not believe they are given the irregular hours, skill level of staff involved, and the disruption caused to life outside work.

A lot of work has been done around the problems of staffing Catheter Lab’s with Nurses, Cardiac Technicians, and Radiographers. Generic working, devolving down tasks to less skilled staff, and reducing overall staff numbers considered essential to run lab’s are just some of the things that have been looked at. In my experience, it is often the out of hours commitment, and lack of suitable remuneration for that commitment, that drives staff away from Catheter Lab working. More money for out of hours activity may well seem like a blunt instrument, but it is one that has proved very effective in both recruiting and retaining Radiographic staff previously.

Where I work we had big recruitment and retention problems (as did most other London Trusts) eight years ago. This led to the on-call service in Radiology being severely stretched with a bare minimum of staff covering out of hours duties. A new fixed payment on-call system was introduced which was financially very attractive, which saw both recruitment and retention of fulltime staff improve dramatically, taking a lot of the pressure off cover of out of hours duties. Due to the Catheter Lab out of hours here being covered by Radiographers from Radiology, I have managed to step back from on-call duties about a year ago, meaning I have no personal conflict of interest in the rates of remuneration I am suggesting for out of hours activity. I must say as someone who had done irregular hours and shift patterns for 23 years prior to that, the improvement in the work life balance was far greater for me than I could have ever imagined.

If payments for out of hours duties are not dramatically improved from the Agenda for Change conditions (or indeed old Whitley for those still on them) I can see staff either declining the option of doing such duties if not contractually obliged to do so, or requesting a change in their work contracts to remove and compulsion to cover on call duties. Any employer threatening to terminate contracts for those making such a request could find themselves with no staff fairly quickly if the situation gets any worse.

Two things that could happen which would prove costly to the NHS if I am right. We could go back to the days where the NHS became more reliant on agency staff to cover key staff in specialist areas (at an inflated cost), which in turn creates problems recruiting fulltime staff. Furthermore, it is possible that the very staff who are disenfranchised by the current terms and conditions, could form their own limited liability companies (either individually or collectively) and contract their services back to the NHS setting out their own terms and conditions for providing an out of hours service. I fear neither of these scenarios will benefit the NHS.

For those staff already involved offering a primary angioplasty service, all will recognise the advantage such a service offers both the patient (by way of outcome), and us all as tax payers, by way of cost savings realised by treating patients in this fashion. It is a truly rewarding experience providing a service that is so beneficial to patients. Ultimately, it would seem a shame if the ability to sustain a 24/7 primary angioplasty service was ever compromised by failing to reward staff in an appropriate fashion for providing such an important service.

 

Author:

Greg Cruickshank
Superintendent Radiographer, Cardiac Catheter Suite
Kings College Hospital NHS Trust
London, UK

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