There is a national drive to increase the number of  coronary revascularisation procedures.  Until the existing facilities and manpower are expanded to meet these requirements we are all being asked to do more.  This involves extra operating  (using colleagues lists when they are absent) and operating at weekends. Because running parallel operating theatres is no longer acceptable the former requires consultants to operate on their non-operating days, i.e. increase their number of fixed NHDs.

Many but by no means all Hospital Trusts have agreed remuneration for this extra work.  However all these arrangements are made locally.  There appears to be no agreed national guidelines for these payments, consequently there is considerable variation across the country.

We should not refer to this type of working as cross cover because this may imply simply covering the management of the patients of an absent colleague.  We should use terms that are not at all ambiguous like “extra fixed notional half days (NHD)” and “weekend working”.  This document applies only to work performed in NHS hospitals.

A notional half day is defined in the Terms and Conditions of Service document (paragraph 61) as “the equivalent of a period of 3.5 hours flexibly worked”.  A whole days operating is, therefore, 3 NHDs.  The calculation of the value of a NHD should take into account discretionary points.  A B merit award for this calculation should be regarded as 8 discretionary points.

The BMA Central Consultants and Specialists Committee produced guidelines for remuneration for extra work (ref 296 1996/97).  They suggested that payment should be 3 to 5 NHDs for every NHD worked.  This applies to cover of colleagues fixed “sessions” (NHDs) and not to evening or weekend working.  The BMA supports appropriate rates of pay for work carried out, and can offer assistance to members in the local negotiation of arrangements that would apply to additional work done outside the main contract.

• Remuneration for all operations performed outside the fixed NHD commitments should be described in the individual consultant's job plan.
• The level of remuneration should be nationally agreed.

• Several steps need to be taken and principals will need to be agreed before the aims can be achieved.

• While the BMA and the Terms and Conditions of Service state that a NHD equals 3.5 hours many Trusts appear not to recognise this.  There should be national (government) pressure on Trusts to accept this definition of a NHD.   We agree with the BMA recommendation, which would make all operating days 3 NHDs.

• Every consultant should have a job plan, which should consist of a maximum of 7 fixed NHDs.  Combining this with the points outlined in 1) above will allow job plans to be easily constructed and not open to misinterpretation.

• Not all consultants will want to work extra NHDs (or all the available extra NHDs).  Therefore cross cover for absent colleagues or weekend working has to be optional.

• All NHS consultants are paid the same excluding distinctions and merit awards. The amount paid should therefore be a nationally agreed figure.  It is not unreasonable that the amount for weekend or evening work should be greater than that for extra NHDs taken during the week.  This would also allow this agreement to be applicable to any NHS specialty.

• Any agreement that involves extra operating should be viewed as temporary and will end when the facilities and manpower have expanded to meet the local requirements.