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Flexible Working in Medicine
: A report by the West Midlands Local Medical Workforce Advisory Group on the issue of flexible working in medicine.

Background
Introduction
Why is flexible working important
Situation in the West Midlands
Results -   Good practice in flexible working
                    Intention to develop a policy
                    Attitudes to flexible working within career grades
                    Demand for flexible working
Conclusions
WM LMWAG's recommendations
Acknowledgements
Examples of Flexible Policies

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Background; This report results from the West Midlands Local Medical Workforce Advisory Group’s concerns about the lack of flexible working opportunities within medical career grades and the implications this has on the present and future workforce.; The aim of this report is to advise Trusts and Health Authorities about the issues surrounding flexible working in medicine, the current situation in Trusts in the West Midlands and areas of good practice.; Introduction
: Flexible working within medicine is a term that encompasses a number of different working practices, including part-time posts, job-sharing, flexi-time, shift work and other patterns of working which may help with family or other commitments outside their career.; The importance of flexible working has been highlighted in the recent NHS Human Resources Strategy, "Working Together – Securing a Quality Workforce for the NHS", which named flexibility as one of the three values that should ‘underpin the management and development of all NHS staff and act as touchstones for any proposed change’. It states:

‘Flexible employment practice is essential to benefit local employers and to get the best from staff who come from a range of backgrounds and have different personal/family circumstances’

The demand for flexible working is increasing, mainly as a result of the number of women entering medicine but also as a result of cultural changes in attitudes to work. Currently over half of all entrants to medical school are women and the number of women entering medicine is expected to rise.; Why is Flexible Working Important?; At present, the majority of doctors wanting to work flexibly are women who are combining a career with raising a family. Without the provision of flexible working, many may be temporarily or permanently lost to the NHS.; Provision of flexible working is not only relevant to the retention of women. The number of people taking early retirement and the overall dropout rate for the NHS is increasing. Without provision of flexible working, a large amount of experience and expertise may be lost prematurely.; Flexible working has also been said to result in employees who bring qualities to the profession such as a reduced level of stress, greater fulfilment, commitment and motivation.; Flexible working may also help with service delivery, reducing locum cover during leave of absence and enabling services to be delivered in alternative ways.; Employment of two part-timers or job-sharers alleviates problem associated with single-handed consultants by providing professional support and cover during leave of absence.; Recruitment is aided by considering employment of flexible doctors. Many doctors who are not currently employed in the NHS would consider rejoining the NHS if flexible working was made available.; Situation in the West Midlands
: The West Midlands Associate Postgraduate Dean has run a very successful flexible training programme which has seen an increase in the number of doctors training flexibly of over 250%, from 40 flexible trainees in 1994 to 94 in 1998. The number of flexible trainees is continuing to rise and many of these flexible trainees will want to continue to work flexibly.; Due to the expected increase in demand for flexible working for career grade flexible positions, the West Midlands Local Medical Workforce Advisory conducted a survey aimed at: -

Establishing which Trusts had flexible working policies applicable to career grade doctors.
Identifying the advantages and disadvantages of flexible working.
Identifying if there has been an increase in demand for flexible career grade positions in the past 2 years.
Identifying how many Trusts have plans to develop flexible working policies.

A questionnaire was sent to the Directors of Human Resources in all 43 Trusts in the West Midlands. Thirty-six Trusts responded (20 acute Trusts and 16 community and mental health Trusts) giving a response rate of 84%. The information below originates from the results of the questionnaire and from personal contacts with Trusts.; Results
: Although only Northern Birmingham Mental Health and the Royal Shrewsbury Hospital stated that they had a specific flexible working policy, 10 Trusts said they either had policies for specific areas of flexible working that were applicable to career grade doctors or had informal arrangements in place. Generally the community and mental health Trusts were more accommodating to flexible working practices and actively encouraged flexible working.; Good Practice in Flexible Working

North Birmingham Mental Health Trust has a flexible working policy for all staff with options for flexi-time, part-time working, job splitting, job sharing, term time only working and sessional working.
The Royal Shrewsbury had a flexible working policy that includes arrangements for reduction from full-time to part-time working.
Birmingham Heartlands has a job share policy and career break policy for between 3 months and 5 years applicable to an employee who has 12 months’ service with the Trust.
Mid Staffordshire General Hospitals have a job share and a special leave policy, and a retainer scheme.
Walsgrave Hospitals has a range of policies applicable to flexible working including policies for job-shares, career breaks and a retirement policy that could allow hours to be reduced before the age of retirement.
Dudley Priority has a career break policy, a paternal leave policy which includes adoption leave and a carer leave policy.
Coventry Healthcare has a job-share and a retainer scheme policy.
Premier Health has a career break policy.
Birmingham Women’s has a special leave policy that incorporates the possibility of flexible working.
Walsall Hospital has a Trust wide flexible working policy that could be applied to doctors which includes a job share policy, retainer scheme, carer leave which is open to all staff. It also has a crèche open 7 days a week from 7am to 9pm.

South Warwickshire Combined has had three consultants work flexibly towards retirement.
Hereford Hospitals has split a single handed Haematology consultant post into two seven session posts.

Specific extracts of policies from four Trusts are attached as Appendix 1.

Intention to develop a policy

Two Trusts were currently developing flexible working policies and another Trust was developing a career break policy. A further 7 Trusts are investigating their current arrangements on family friendly policies or are considering developing a flexible working policy. Of the Trusts with no specific flexible working policy, 14 Trusts (39%) had no intentions of developing a flexible working policy. The reasons for not developing a flexible working policy included

the informal arrangements in place worked well,

there was no demand,

time constraints meant it was a low priority and

the policies already developed were sufficient.

Attitudes to flexible working within career grades

Most Trusts said that there were benefits in flexible working with only two Trusts indicating there were no benefits in having flexible working. Recruitment and retention of both people and skills were seen by most Trusts as the main benefits of flexible working although several Trusts indicated that employing a flexible doctor is only considered when recruitment difficulties arise. It was also seen as of particular benefit to female doctors as it would enable and encourage them to continue in their chosen career and increase the number of females in certain specialties resulting in a balanced workforce.

The main problems indicated were with flexible working in the acute specialties, where flexible working can create problems for continuity of care and arrangements for out of hours cover.

Traditional ways of working also contributed to many problems of introducing flexible working, with a lack of acceptance of peers and the arrangements of existing practices e.g. teaching, hand-overs, meetings. The problems of sustained demands placed on clinicians for non-clinical activities, which have a greater impact on the part-time doctors was seen as a barrier, as was the additional cost of employing part-time workers. Although many Trusts said that they have had requests for flexible working towards retirement, the affect on the pension that is based on the last three years of employment, is a barrier for a reduction of hours within the existing contract. When asked if there were any barriers in employing flexible career grades, 10/12 (83%) community and mental health Trusts stated that there were no barriers in employing flexible workers compared to only 3/16 (19%) acute Trusts.

Demand for Flexible Working

The demand for flexible working in career grades in the past 2 years has increased in 7 (35%) of the 20 acute Trusts and 2(13%) of the 16 of the community and mental health Trusts.

Conclusions

In the West Midlands it appears that there have been many positive steps to encourage an environment of flexible working, with the development of policies that allow flexible working and in the intentions of Trusts to develop policies. However, in practice there are still many factors which hinder flexible working in career grades and development of policies may not be reflected in the number of doctors actually working flexibly as a result of these barriers. Some of these are inherent to working in medicine such as out of hours cover and continuity of care, and are a reflection of the traditional attitude of some medical professionals and a reluctance to change.

The mental health specialties have traditionally attracted flexible doctors due to the nature of the workload, this being reflected in the attitudes of community and mental health Trusts to flexible working and the small number of Trusts seeing an increase in the demand for flexible working. The rise in demand for flexible working in the acute Trusts is possibly a reflection of the rise in female doctors and a reflection of cultural change to attitudes to working arrangements.

WM LMWAGs Recommendations

There are inevitable difficulties with flexible working in medicine but the demand for flexible working will increase, as will the need to improve recruitment and retention of staff. Development of flexible working arrangements is key to Trusts commitment to the human resources strategy ‘Working Together’. The WM LMWAG recommends that Trusts should:

1. Consider developing a flexible working policy even if informal arrangements are already in place. This will confirm commitment to flexible working to staff and create an environment where flexible working is seen positively.

2. Consider the implications of flexible working as part of the Trust’s medical workforce plan.

3. Consider options for flexible working within current service arrangements and the benefits of using flexible working in service developments.

4. Consider advertising strategies to encourage flexible working. Advertising jobs in ways
that encourages flexible working may result in a greater pool for recruitment and higher quality candidates.

Acknowledgements

The West Midlands Local Medical Workforce Advisory Group wishes to thank all Trusts that responded to the questionnaire and Janine Clarke from Birmingham Heartlands Hospital and Janet Hamer from City Hospital for their advise.

Susan Hamilton
June 1999

Appendix 1: flexible working policies
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