Health Department Human Resources Directorate

: PCS(DD)2003/2 abcdefghijklm Health Department Human Resources Directorate Dear Colleague TERMS AND CONDITIONS OF SERVICE FOR HOSPITAL MEDICAL AND DENTAL STAFF AND DOCTORS IN PUBLIC HEALTH MEDICINE AND THE COMMUNITY HEALTH SERVICE IN SCOTLAND Summary 1. This circular notifies employers of the introduction of merged terms and conditions of service for hospital medical and dental staff and doctors in public health medicine and the community health service. Action 2. Employers are required to: Note that the merged terms and conditions for service for hospital medical and dental staff, and doctors in public health medicine and the community health came into effect from 1 April 2003; Alert all employees to the new merged terms and conditions of service handbook; Note that the merged terms and conditions of service do not cover community dentists and practitioners in dental public health who will continue to be covered by their own terms and conditions of service; Invite and consider applications from remaining Clinical and Senior Clinical Medical Officers, and any doctors providing sessional community health services under the annex to the existing public/community health TCS (such as sessional family planning doctors) to regrade to Staff Grade or Associate Specialist as appropriate. Guidance on appointments procedures for such transfers/regradings is attached at Annex B. 25 April 2003 Addresses For action Chief Executives, NHS Trusts, Boards and Special Health Boards Chief Executive, Common Services Agency Chief Executive, State Hospitals Board for Scotland Chief Executive, NHS Education for Scotland For information Members of the Scottish Partnership Forum and HR Forum Enquiries to: Ms L McWilliams Directorate of Human Resources GFR St Andrew s House EDINBURGH EH1 3DG Tel: 0131-244 2327Fax: 0131-244 2837 Louise.mcwilliams@scotland.gsi.gov. uk BB0019APR2003

Note that these terms and conditions simply reflect the merging of existing texts for hospital medical and dental staff and doctors in public health medicine and the community health service and are not the outcome of any re-negotiation between the Department and the BMA. 3. Details of what is required are set out below in the attached annexes and appendix. 4. Employers should not amend or re-issue contracts as a result of the merger. The continuity of employment of practitioners, whether or not there is a move to a new grade, is not affected by this merger. Enquiries 5. Employees should direct their personal enquiries to their employing NHS Boards, Special Health Board or NHSScotland Trusts. 6. Employers are asked to make their own arrangements for obtaining any additional copies of this circular. This circular can also be viewed on http://www.show.scot.nhs.uk/sehd/pcs.asp. Yours sincerely MICHAEL PALMER Assistant Director of Human Resources (Policy) BB0019APR2003

abcdefgh NATIONAL HEALTH SERVICE, SCOTLAND APPROVAL OF REMUNERATION AND CONDITIONS OF SERVICE Scottish Ministers, in exercise of the powers conferred on them by regulations 2 and 3 of the National Health Service (Remuneration and Conditions of Service) (Scotland) Regulations 1991 and section 105(7) of, and paragraph 5 of Schedule 1 and paragraph 7 of Schedule 5 to, the National Health Service (Scotland) Act 1978 hereby approve the agreement of the Joint Negotiating Committee for Hospital Medical and Dental Staff and the Joint Negotiating Body for Doctors in Public Health Medicine and the Community Health Service as set out in the revised Handbook of the Terms and Conditions of Service for Hospital Medical and Dental Staff and Doctors in Public Health Medicine and the Community Health Service. This approval has effect from 1 April 2003. MICHAEL PALMER Assistant Director Human Resources (Policy) Scottish Executive Health Department St Andrew s House EDINBURGH EH1 3DG 25 April 2003

abcdefgh DIRECTION NATIONAL HEALTH SERVICE, SCOTLAND APPROVAL OF REMUNERATION AND CONDITIONS OF SERVICE Scottish Ministers, in exercise of the powers conferred on them by regulations 2 and 3 of the National Health Service (Remuneration and Conditions of Service) (Scotland) Regulations 1991 and section 105(7) of, and paragraph 5 of Schedule 1 and paragraph 7 of Schedule 5 to, the National Health Service (Scotland) Act 1978 hereby give NHS Trusts and Boards and the Common Services Agency the following direction. The revised terms of service for hospital medical and dental staff and doctors in public health medicine and the community health service shall come into effect on 1 April 2003 and senior clinical medical officers and clinical medical officers shall be assimilated into the mainstream structure for hospital medical practitioners as specified in the arrangements which were approved by Scottish Ministers on 1 April 2003 in Annex B of PCS (DD) 2003/2. MICHAEL PALMER Assistant Director Human Resources (Policy) Scottish Executive Health Department St Andrew s House EDINBURGH EH1 3DG 25 April 2003

AGREEMENT ANNEX A 1. The Joint Negotiating Body for Doctors in Public Health Medicine and the Community Health Service and the Joint Negotiating Committees for Hospital Medical Staff (Seniors and Juniors) have approved the merger and associated amendments to the terms and conditions of service. AMENDMENTS 2. This issue includes all amendments to Terms and Conditions of Service promulgated as at 1 April 2003. Some additional changes have been necessary as a result of the merger. A summary of the changes is attached at the Appendix. 3. Employers should not amend or re-issue contracts as a result of the merger. The continuity of employment of practitioners, whether or not there is a move to a new grade, is not affected by this merger.

APPENDIX This re-issue replaces the two handbooks with a single set of terms and conditions of service and incorporates the following changes to the Hospital Medical and Dental Terms and Conditions of Service (Scotland) issued in October 1994. (i) (ii) all amendments to the Terms and Conditions of Service promulgated as at 1 April 2003; a number of changes to the references defining the scope of the handbook to include doctors in Public Health Medicine and the Community Health Service. The main amendments are as follows:- 1. The phrase "Hospital Medical and Dental Staff" has been changed to "Hospital Medical and Dental Staff and Doctors in Public Health Medicine and the Community Health Service" throughout. 2. Where "hospital" referred to an employer, this has been replaced with the term "employing authority". 3. Where "hospital referred to a place of work, this has been replaced with the phrase "hospital or other place of work". 4. Terms and conditions of service for Specialist Registrar (SpR) grade have been included (paragraphs 10, 65, 71, 110,111,130,196,205,251c, 284c and 285e). References to Registrars and Senior Registrars have been retained as a number of practitioners in these grades are still employed in the NHS. 5. Introduction, paragraph vii The term "clinical" should be taken to include hospital medical and dental work and work in Public Health Medicine and the community health service. 6. Paragraph 2: Rates of Pay New Paragraph: Payments relating to sessional employment and item of service fees in the community health service are set out in the supplement to these terms and conditions of service. 7. Paragraph 4b: Closed Grades New paragraph: 4.b Entry to the career grades of Clinical and Senior Clinical Medical Officer is closed. The terms of service of these practitioners are, unless otherwise specified, those of Associate Specialists (or, in the case of practitioners who do not fulfil the conditions of paragraphs 5.a - d below, those of Staff Grade practitioners). Employers are required to invite and consider applications from remaining Clinical and Senior Clinical Medical Officers, and any doctors providing sessional community

health services under the annex to the existing public/community health TCS (such as sessional family planning doctors) to regrade as Staff Grade or Associate Specialist as appropriate. Guidance on appointments procedures for such transfers/regrading is attached at Annex B. It is expected that such transfers/regradings should have been completed by 1 April 2006, at which time this process will be reviewed. 8. Paragraphs 20 to 22: Controls on Hours, Payment These paragraphs have been amended to incorporate changes as a result of the new junior doctors' contract which came into effect on 1 December 2000 (see HDL (2000) 17). 9. Paragraph 20 a. iii: Controls on hours This paragraph will henceforth apply to trainees in public health medicine, who have until now worked on on-call rotas based around working a week at a time on-call. For a transitional period of two years from 1 September 2002 trainees in public health medicine may, in consultation with organisers of training schemes in public health medicine, choose to continue to work for a week at a time on-call, provided that the average weekly hours of work do not exceed 48 and they can expect to receive 11 hours continuous rest between 9pm and 8am on at least 75% of nights when on-call. Practitioners undertaking a week on call meeting the above criteria shall not be entitled to Band 3. 10 Paragraph 25: Emergency Rota Allowance Paragraph inserted from TCS for doctors in PMH/CHS 25a.Where a doctor in public health medicine and the community health service (other than a public health physician or trainee in public health medicine) who has the appropriate experience and training, deputises for a public health physician who acts as designated medical officer in regard to his or her responsibilities for communicable diseases and food poisoning on the 24 hour rota, he or she shall each half year receive an allowance at the rate given in Appendix I. Each week should be regarded as consisting of 9 duties, i.e. 7 nights plus the days of Saturday and Sunday. Statutory and general national holidays should be treated in the same way as Saturdays and Sundays. The allowance should be assessed and paid at the end of each half-year ending 30 June and 31 December. The allowance is superannuable. b. Where a clinical or senior clinical medical officer is on a 24 hour rota for work at a designated customs air port or for a constituted port health authority, he or she shall receive an allowance, at the same rate as that payable under sub-paragraph (a) above, except in the circumstances specified in sub-paragraph (c) below. c. If such a doctor is on a rota which requires him or her to simultaneously to be on duty for environmental health and for port health work (as defined in (b) above) and he or she is eligible for an allowance under sub-paragraph (a) above, only one such allowance will be payable, at 150 percent of the rate set out in Appendix I, in respect of each duty during which he or she was on-call for both rotas.

d. A doctor who receives an allowance under sub-paragraph (b) or (c) above may also receive an allowance under sub-paragraph (a) for nights when he or she is on-call for environmental health only but not port health. e. A doctor may retain any existing personal terms and conditions relating to port health if these are more favourable on a marked time basis unless section 35(2) of the NHS (Scotland) Act 1972 applies. 11. Paragraphs 39a & 39b: Payment of Fees: Doctors in Public Health Medicine and the Community Health Service - inserted from TCS for doctors in PHN/CHS 39a. A doctor in public health medicine and the community health service employed under these terms and conditions of service may, unless it would, in the opinion of the employing authority, interfere with the proper discharge of his or her normal duties and provided it does not form part of his or her normal duties, undertake and receive payment for work other than that referred to in paragraph 39.b., including services to a local or public authority of a kind not provided by an NHS Board under the collaborative arrangements, such as: i. work as a medical referee (or deputy) to a cremation authority and signing confirmatory cremation certificates; ii. iii. iv. medical examination in relation to staff health schemes of local authorities and fire and police authorities and to driving licences; lectures to other than NHS staff; medical advice in a specialised field of communicable disease control, eg. Membership of a Departmental panel for an infectious disease; v. work for water authorities, including medical examinations in relation to staff health schemes; vi. vii. viii. ix. attendance as a witness in court (other than in the course of an officer's normal duties); medical examinations and reports for commercial purposes eg. certificates of hygiene on goods to be exported or reports for insurance companies; advice to organisations (including NHS employing authorities), other than the doctor's employing authority, on matters which the doctor is acknowledged to be an expert; examinations and recommendations under Part II of the Mental Health Act 1983 and under Part V of the Mental Health (Scotland) Act 1984. 39b. A doctor in public health medicine and the community health service employed under these terms and conditions of service, whether whole-time or part-time, shall not accept a fee from a local or public authority or from an NHS employing authority for

the provision of advice or services of a kind which an NHS Board provides under the arrangements for collaboration between NHS Boards and local and public authorities in accordance with Section 15 of the National Health Service (Scotland) Act 1978, including: i. advice and service relating to social services, education and environmental health (including control of communicable disease); ii. advice in relation to staff health schemes of local authorities and driving licences (but see paragraph 39.a.ii); iii. advice to an NHS employing authority other than under paragraph 39.a.iv. or viii. 12. Paragraph 44: Clinical and Senior Medical Officers: Additional Work Paragraph inserted from TCS for doctors in PHM/CHS: 44. An employing authority may permit a full-time senior medical officer (public health medicine), senior clinical medical officer or clinical medical officer to undertake additional work remunerated on a sessional basis, provided the authority is satisfied that this does not conflict with the performance of his or her normal duties. In the case of SCMOs such work may represent managerial duties or highly specialist professional responsibilities. 13. Paragraphs 50 & 51: Chief Officers of NHS Boards Amended paragraphs inserted from TCS for doctors in PHN/CHS: 50a. A chief officer of an NHS Board shall receive a supplement within the range set out in Appendix I, depending on the band within which his or her posts falls and the weight of the post as assessed by his or her employing authority. "Chief Officer" means a director of public health or chief administrative medical officer. The definition of the relevant bands for NHS Boards is set out below: Band B - Band C - Band D Director of Public Health population 450,000 and over Director of Public Health population 250,000-449,999 Director of Public Health population 50,000-249,999 Island NHS Boards Population under 50,000 b. Supplements shall be an element of remuneration and shall be superannuable. c. Population shall be reviewed annually at 1 April. The relevant population for this purpose shall be the Registrar General's estimate of the home population for the employing authority at the previous 30 June.

i. If the home population for the employing authority increases to a higher population band for one year only, this shall have no effect on the minimum supplement. If the rise to a higher population band is confirmed by the next year's estimate, a review of the supplement payable should be completed within 6 months. Payment of any increased supplement following such a review shall be made with retrospective effect from 1 April of the previous year. ii. If the home population for the employing authority falls to a lower population band for one year only, this shall have no effect on the minimum supplement. If the fall in population is confirmed by the next year's estimate, a review of the supplement payable should be completed within 6 months. Where this would result in a reduction in the value of the supplement, an officer shall retain the cash value of his or her existing supplement for so long as that remains more favourable.. 51.a For so long as it is more favourable, a chief officer may opt to retain the cash value of his or her existing supplement, including any incremental progression, until such time as the value of the supplement is overtaken by the value of the supplement payable under the provisions of paragraph 50.a. b. The incremental supplements for 1991-92, together with the supplement to DPHs of NHSBoards designated for teaching and the lead allowance are set out in Appendix I. They will not be subject to revaluation. 14. Paragraph 132b: Counting of Previous Service - General Practitioners Paragraph inserted from TCS for doctors in PHM/CHS: 132b. On entry to a post under these terms and conditions of service a general practitioner who has been vocationally trained and has 4 years experience as a principal in general practice, or a general practitioner who has at least 8 years postregistration experience including at least 5 years as a principal in general practice, shall have entitlement to protection either of his or her superannuable income in her or her last complete year of practice uprated by the factor determined for the purpose of regulations 71(2)(a) of the National Health Service Superannuation Regulations 1980 (SI 1980 No 362) or at the current rate of the second incremental point of the consultant scale, whichever is the lower. 15. Paragraph 133 Promotion Increase To read as follows: 133a Subject to sub-paragraph b. below, where practitioners have been paid in their previous regular appointment at a rate of salary higher than or equal to the rate at which they woud (were it not for this provision) be paid on taking up their new appointment, then their starting salary in the new appointment shall be fixed at the point in the scale above that previous rate, or at the maximum if that previous rate were higher. b. Where the previous appointment was a part-time medical or dental officer under paragraph 94 or 105, sub-paragraph a. shall apply only where that appointment has been held for twelve months or more.

c. Where a practitioner in their previous appointment has been paid on one of Points 3, 4 or 5 of the Senior House Officer scale for a period of 5 months or more in their last appointment prior to promotion to Specialist Registrar their starting salary shall be determined as under sub-paragraph a. above and they shall retain their existing incremental date. 16. Paragraph 125: Service outside NHS Hospitals Amended to "grade outside the NHS hospitals, public health and community health services". 17. Paragraph 135f: Protection During Training: Interpretation Paragraph inserted from TCS for doctors in PHM/CHS: 135f. for doctors in public health medicine and the community health service, a practitioner entitled to protection under paragraph 132 shall receive the appropriate training grade salary plus the supplement or his or her protected salary, whichever is the greater, except that where the salary is protected at a point on the trainee scale the supplement shall be paid in any case. 18. Paragraph 190a: Termination of Employment: Representations against dismissal (Amended to include Senior Clinical Medical Officer, Senior Medical Officers (Public Health Medicine) and Clinical Medical Officers on or above the 6 th point of the salary scale: 190.a. Subject to sub-paragraph (c), a consultant, SHMO, SHDO, AS, Senior Clinical Medical Officer, Senior Medical Officer (Public Health Medicine), Clinical Medical Officer on or above the 6 th point of the salary scale or hospital practitioner who considers that his or her appointment is being unfairly terminated may appeal to Scottish Ministers against the termination by sending to Scottish Ministers a notice of appeal at any time during the period of notice of termination of his or her appointment. 19. Paragraph 191: Alternative Employment The phrase "another hospital" (in relation to alternative employment) has been replaced with "elsewhere in the NHS". 20. Paragraphs 205 & 206: Annual Leave Amended to include SCMOs, senior medical officers (public health medicine) and CMOs. 21. Paragraph 209: Leave Years Simplified by cross-referencing with paragraphs 205 and 206. 22. Paragraph 251a: Recommended standard for professional and study leave taken in the United Kingdom.

Amended to include SCMOs and senior medical officers (public health medicine). 23. Paragraph 251c: Amended to include CMOs. Also altered to make reference to trainees studying for an MSc in PHM or other similar courses. 251.c i. Either: day release with pay and expenses for the equivalent of one day a week during university terms; or leave with pay and expenses within a maximum calculated at the rate of thirty days in a year (the year for this purpose being counted from 1 October); of leave with pay and expenses to attend approved full or part-time academic courses; and payment of expenses for attendance at approved conferences or seminars (including those held in the evenings and weekends). This allowance may accumulate over the period of the appointment, provided that the total amount due in the period of the appointment is not taken until one year of the appointment has been served. Attainment of an MSc in public health medicine or other similar courses should form a separate part of the employment contract. 24. Addition of the supplement "Terms and Conditions of Service for Doctors Undertaking Sessional Work in the Community Health Services, Providing Medical Service to Local Authorities Under the Collaborative Arrangements and Undertaking Medical Examinations of Prospective NHS Employees". 25. Appendix I has been amended to refer to the salary scales fees and allowances for doctors in Public Health Medicine and the Community Health Service. 26. Appendix II and Appendix III have been uprated to reflect changes to the General Whitley Council Handbook. 27. Appendix IV has been updated to refer to the new rates for other fees and allowance, effective from 1 July 2002. 28. The format of Appendix V (Index to examples of category 1 and 2 items of service) has been changed to make it more readable.

ANNEX B GUIDANCE ON TRANSFERS FROM CLINICAL MEDICAL OFFICER (CMO) SENIOR CLINICAL MEDICAL OFFICER (SCMO) TO STAFF GRADE/ASSOCIATE SPECIALIST APPOINTMENTS PROCEDURES 1. The appointments procedures to Staff Grade and Associate Specialist are not statutory. In the main, transfers from CMO to Staff Grade, regradings from SCMO to Associate Specialist on a personal basis, and transfers of sessional doctors to substantive appointments should be straightforward. It is expected that such transfers/regradings should have been completed by 1 April 2006, at which time this process will be reviewed. Transfer from the community health to hospital terms and conditions of service does not imply a change in the duties of the practitioner. It would therefore be inappropriate to impose participation in acute hospital rotas from practitioners transferring. However, an agreement may be reached between an individual practitioner and his/her employing authority to participate in such work. Any resulting training requirements should be established in consultation with the Postgraduate Dean, the practitioner and the employing authority. Employing authorities and appointments committees should take all previous service into account for all continuity of service provisions and treat service as SCMO and CMO as equivalent to service in appropriate hospital posts when transfer and/or promotion to a hospital career grade is being considered. Transfers from CMO to Staff Grade 2. Normal appointments mechanisms outlined in s 1989(PCS)4 and NHS Circular PCS(DD)1997/5 should be applied, although it will not be necessary to hold an appointments committee in cases where the transfer from CMO to Staff Grade involves no substantial change in duties. Where transfers are not straightforward and will result in substantial change in duties, employing authorities should constitute an appointments committee under 1989(PCS)4. Regrading from SCMO to Associate Specialist 3. The normal arrangements (see s 1990(PCS)2 and PCS(DD)1993/3) for appointment to associate specialist will apply, in order to assess the suitability of the job description for the proposed post and of the candidate. Doctors wishing to be regraded will need to discuss the matter with their employing authority prior to assessment in order for the proposed job description to be drawn up.

SALARIES ON TRANSFER 4. The salaries of practitioners transferring from CMO or SCMO to Staff Grade or Associate Specialist should be set at the nearest highest monetary point on the Staff Grade or Associate Specialist pay scale. To resolve the anomaly which results when CMOs, whose normal hours of duty are 37, transfer to Staff Grade, whose normal hours of duty are 40 per week, the provisions set out in paragraph 122 of the Terms and Conditions of Service shall apply. For this purpose, service in the CMO and SCMO grades should be regarded as service in an equivalent career grade. The resulting salary increase recognises the difference in working hours. Alternatively, where the doctor does not wish to increase the number of hours worked, a 9-session (36 hours) contract should be considered and the salary calculated on the basis of nine-tenths of the appropriate point of the Staff Grade pay scale. In all cases the salaries or part-time practitioners shall be calculated on a pro-rata basis. FIXED TERM APPOINTMENTS 5. CMOs and SCMOs already hold permanent career grade posts, therefore it would not be appropriate, except in the most wholly exceptional circumstances, for those transferring to Staff Grade to be appointed on a fixed term basis.