Paul Edwards
Primary Care Training and Development Consultant
A former practice manager, Paul is passionate about working in primary care. He joined the NHS as a general management trainee in 1991. Paul’s other preoccupations are spending time with his 18-month-old son, preparing to climb Mont Blanc in July, and getting married in August
Agenda for Change (AfC) is the most radical review of NHS terms and conditions since the conception of the NHS in 1948. The system aims for all 1.4 million employees to have completed the process by October 2006. It is almost certainly one of the largest reviews of terms and conditions in history.
Due to its independent contractor status, general practice is not obliged to embrace AfC. Certainly the costs of the new terms and conditions have discouraged many practices that have considered it. Nonetheless, practice managers should consider the frameworks of AfC, as they offer a huge potential for recruitment and selection and redefining job descriptions.
AfC factors
AfC uses 16 easy-to-understand factors to analyse jobs. These factors range from communication skills to knowledge, physical effort and working conditions.
Each factor has a range of levels against which to assess the job. All jobs score at least the minimum level in each of the 16 factors. These levels have a preassigned score. The scores for each factor are added together, and the total for the job defines which pay band an employee should be placed in.
This process is valuable for primary care. Withstanding the pay band option (for it is only an option to consider in primary care and not an obligation), the ability to define an individual’s responsibilities in such a clearly defined way is very useful. When writing job descriptions, these factors can be used to give a truly accurate representation of all aspects of the job.
Practices have been told quite firmly that cherry-picking aspects of AfC is a nonstarter. However, given the independent contractor status, practices can utilise whichever aspects of the system they wish.
Life becomes easier given that AfC job factor outlines are already available on the internet for many primary care jobs. There are descriptions for reception and administrative jobs, two practice manager jobs and many nursing jobs. This reduces the work commitment for the practice manager considerably (see Resources for a weblink to post outlines).
AfC pay bands
There seems to be a strong consistency about the pay bands. I asked 12 managers individually to assess one of their practice receptionists against the factors. Each manager assigned a level to each of the 16 factors, and then scored those levels to give a total value for the job. There were many variations in the levels for the factors; all receptionists having different priorities and responsibilities.
Reassuringly, 11 out of the 12 managers scored their receptionists in the same pay band, without prior knowledge as to what the pay band scores were. This demonstrates the ease of use of AfC and also recognises that different employees, although sharing a common job title, will have different elements to their job. The overall value of the job though remains consistent.
Knowledge and Skills Framework
The Knowledge and Skills Framework (KSF) is a process also being adopted by the NHS. A continued professional development (CPD) tool, the KSF gives clear guidance on how an individual can improve their skills. Whereas AfC looks at a description of the job, the KSF looks at the knowledge and skills required to fulfil that job. The process complements AfC.
The KSF has a series of dimensions. Six of these are deemed to be core dimensions and are relevant to all employees. The remaining 24 dimensions are specific, and only those relevant to the job are used. As a guide, no more than 12 dimensions are ever used to describe the knowledge and skills for the job. Once again, each dimension has four levels, enabling employees and managers to find the most appropriate competencies for the individual.
The great advantage of the KSF is that it enables employers to define the required knowledge and skills of a fully competent employee. Individuals are set meaningful development plans, and managers can easily appraise performance. For the first time, a fully transparent CPD process is available to practices for staff of all professions.
The KSF also recognises that individuals will not gain competency immediately and therefore can also be used to set goals for the first year as part of induction. Employees will therefore have a full picture of their development requirements. As job demands increase, the competencies can be redefined, ensuring post-holders remain “modern”.
Payment and competency
AfC and KSF overlap when it comes to pay. A “gateway” occurs as employees reach a certain (predefined) annual increment. The employee must demonstrate competence and, if competence cannot be proven, the increment is not paid. This is a crucial tool for practices wishing to control the quality of the employee and the pay that the employee is remunerated.
An employee who does not meet the competency can be offered further support. If the employee ultimately does not meet the required level, then dismissal on the grounds of incompetence is an option. Managers have frequently stated that it is very hard to remove those who do not meet the mark.
Working measures without penalties
To summarise, general practice can utilise AfC and KSF without having to incur the financial penalties that the NHS is currently facing. Managers will have a range of measures to aid in all aspects of personnel management (recruitment and selection, induction, professional development, pay if required, disciplinary) that have been approved nationally and are designed specifically for health employees. All managers owe it to themselves to have a look at the information available and work out how best to adapt it into general practice.
