Clinical Fellow Scheme: rota & Pay


The section that enables you to do your sums!

What’s the rota like?

We run a 24-hour middle-grade rota, and since August 2016 we have run a “annualised” rota... so far this is working very well!

Who designs the rota? Is it civilised?

Our clinical Fellow rota is about as far from a traditional rolling rota as you can imagine. It is flexible, annualised, annual leave can be taken whenever you like (so long as there are enough people left to man the ship, of course!) and to sort out Christmas and New Year, we put everyone into a room (those who can’t attend nominate a proxy) and you sort out it in a civilised manner!

The current rota was designed by Dr Rich Griffiths, now a Consultant with us, who was a Clinical Fellows with us in 2012/13, and an ST6 on OOPT from Yorkshire for the last few months of his training in mid-2016.

How does an “annualised rota” work?

Because we use the SAS doctor pay-scale (calculated in sessions, with a weekday daytime session bring 4 hours and evening, weekend and night shifts sessions 3 hours) we can offer an annualised rota, in line with the RCEM recommendations for sustainable working.  It means your shifts can start to fit around your life, instead of vice versa.

Not all shifts are not created equal…

Over a 12-month post, imagine that a standard full-time 13-session Clinical Fellow has (e.g.) 440 sessions rostered to the ED shop floor. But whereas a standard 8-hour day shift is 2 sessions, a 10-hour night or weekend shift is 3.33, with weekday evening shifts are in between.

This means:

•If you work more proportionately more night or weekend shifts, you could work fewer shifts overall and enjoy more days off (which can then be added to your AL).

•If you work proportionately fewer nights or weekends, you’ll have more weekday daytime shifts, but work a higher number of shifts (but not more sessions) overall.

The full benefit of annualising is only seen if, within the rota participants, there are a range of preferred shift patterns – if everyone wants the same, there’s no benefit. That is a risk with a whole bunch of “typical” Clinical Fellows (usually around 30, rarely with kids). However, it’s usually not too difficult to at least find someone who doesn’t mind night shifts but wants to reduce weekend frequency (e.g. spouse/partner lives outside of North Wales) and someone who doesn’t mind working a higher weekend frequency in return for more weekday days off (e.g. mountain bunny who wants to get out into the hills when there are fewer tourists!).

To fully enjoy the many benefits of an annualised rota system, a collegiate approach to rota planning is essential, with civilised & open communication, and give and take on all sides. Remaining engaged is essential – we use private Facebook Group for communications and all participants have to check social media regularly. 

Of course, if a majority of appointees decided they prefer a traditional rolling rota, we can switch back, but we really wouldn’t recommend doing so!

Key features

  1. Night shifts are split Fri/Sat/Sun and then either as 4 nights or 2+2 nights for Mon-Thus (currently about half the Fellows have opted for 2+2 and the remainder prefer a run of 4)

  1. Weekday day shifts are currently 8-4 or 9.30-5.30 (compatible with normal life!) and even the 2-10.30 just about allows you to hare down to the pub for a drink after work

  1. By the time you have spent 9 weeks doing PHEM/MedEd/Management-QI (which can be all weekday daytime, unless you choose to work weekend PHEM shifts to maximise exposure and Helimed shifts), 6 weeks annual leave and 2 weeks study leave allowance... you’re only actually at work in the ED two-thirds of the year. One third of the year is spent having fun.

  1. The Clinical Fellows as a group are allowed to make changes to their rota on a democratic basis - for example, if a majority of them wish to make the day shift longer and the late shift shorter, they can do so. If a majority can’t be reached, they are free to negotiate individual adjustments with colleagues... “if you stay an extra two hours till 7pm on Thursday, I’ll come in two hours early on Monday....”

  1. Weekend frequency is between 3-in-7 and 3-in-8 weekends  (we’d love to reduce it further, but abolishing weekend locums is how we funded the increased number of posts from August 2016 to meet the demand for them!). If you are in a PHEM post and doing EMRTS shifts, you will end up working 6-7 extra weekend shifts over the 12 months, this is in addition to your ED commitment (obviously you will get extra weekday time off as recompense).

  1. Night frequency is never worse than 1:8, and we aim for 1:10 or better (it’s been around 1:12 for the past few years) We do not believe it is sensible or humane for anyone - doctors or patients - to impose a 7/7 24/7 full shift with fewer than 8 individuals on the rota. If you are working somewhere that has you on a 1 in 5 full shift rota, you would find life here significantly more civilised! 

We think this is a much healthier way to run a rota than to impose one, although in the event that a bunch of Clinical Fellows couldn’t or wouldn’t come up with something agreed by all, obviously the consultants would have to step in to do so. 

   What’s the pay?

Please download the #NotTheOfficialJobDescription for full information

   We use the Speciality Doctor payscale for these posts, which is sessional: this means we can easily offer annualised rostering and a choice of how many sessions each week you want to work. This is different to both the old and new (English) trainees’ payscale.

The maximum number of sessions per week is 13: this equates to an old band 1A rota and maximises both pay and your choice of PHEM/MedEd/Mgt/QI “playtime”. However, we actually recommend you pick the lowest number of sessions you can afford to... the fewer you work, the more flexible your rota and the maximum benefit to your work-life balance. Anything 10 sessions or more is classed as full-time for pension purposes, and our Fellows tell us that 11 sessions is the “sweet spot” for balancing income against quality of life, flexibility of rota, and sufficient “playtime”. 

Whilst weighing up your finances (and yes, if you intend to run a second home in Bangor whilst maintaining a property +/- partner/spouse elsewhere, you do need to do this!) the good news is that:

  1. a)Living in North West Wales is remarkably cheap compared to big cities.... a room in a shared house or flat is only likely to cost you about £400-450/month and a 2/3-bedroom house of your own typically £600-800. 

  1. b)We rarely have any locum shifts available in Bangor ED, but our neighbouring hospital in Ysbyty Glan Clwyd (same health board) would probably snap you up if you offered!

  1. c) You may only get 10 days of study leave as a Clinical Fellow, but you get up to £5000 of study leave funded, including any PGCerts you may be undertaking. Which is probably more than your deanery will have funded you for the rest of your trainee career.  Please don’t forget to bear this in mind when you do your sums!

We certainly aren’t out to screw anyone, and we try very hard to ensure that nobody loses out financially from coming to Bangor after ST3, by adjusting the sessional uplift if required. As with all NHS appointments (stand by for blurb) “…. the exact point of scale is determined upon verification of previous NHS service. The post is subject to the Wales NHS Hospital Medical and Dental Staff terms and conditions of service”. 

NB: the introduction of the new trainees’ contract in England means that we will have Fellows entering our posts from the new contract/payscale, the old contract/payscale (some runthrough trainees and those from Wales/Scotland), non-trainees, or from outside the NHS. Our HR department are studying the implications but it is entirely possibly that to comply with NHS T&Cs we will end up with Fellows on all sorts of different points on the pay scale... we will be doing our level best to ensure this is fair!

    Are there any removal expenses?

Six and 12-month posts aren’t eligible for standard NHS removal expenses packages..... so sadly, no.

If I moved to Bangor for a year, I’d have to live apart from my partner/spouse... how many weekends are spent working?

This is a biggie.... we lost two wonderful Clinical Fellows early in the early days of the scheme as they found living at the other end of the country from their other half simply too difficult. And we fully sympathise... Bangor really isn’t all that far from Liverpool, Chester, Manchester or Stoke (1.5-2 hours drive) but by the time you are looking at Newcastle, Oxford, or Bristol, it’s a very long drive home on Friday night. 

It’s really important that you factor the long-distance relationship thing into the equation if you are considering our posts, but your partner isn’t portable!

Obviously, we can’t move the hospital, so our options for ameliorating this are a bit limited. But we will consider 6-month posts (instead of 12 months) for candidates who have completed ACCS (EM) or have at least 10/12 EM experience.... this option isn’t open to anaesthetists within only 6/12 EM experience who generally need a couple of months to get back into the swing of EM before starting to undertake anything else.

On a 6-month post, you’d need to be prepared to pull your finger out with project work to get the best out of a 6-month post, and you really would get only a taster of pre-hospital EM: 4.5 weeks in 6 months isn’t a lot (though you could top that up to 5.5 weeks by using your study leave). But we have had some Clinical Fellows achieve a huge amount in their first 6 months, so it is possible. 

You can also opt to work fewer sessions - 10 would be typical - and “bunch” up shifts, so that you come to Bangor to so a run of shifts and then head home. It works well for those who have done it, although if you’re doing big journeys by train you need to book ahead to reduce the costs of tickets. Fellows who are basically living away do also miss out a bit on the social life and mountains, as when they’re around they’re working, so if the access to outdoor life is part of the reasons to move to Bangor, this option probably wouldn’t suit you. 

The current rota is 3 in 8 weekends for anyone on 10 or more sessions (with an additional 3-4 weekends/year for PHEM Fellows who have opted to do EMRTS sessions). For various long and complicated reasons we can’t both reduce that frequency and reduce night shift frequency, because it is not-requiring additional weekend locum shifts that pays for any middle grades over n=10, which is the only way to reduce night shift frequency.

If your other half is medical, though, you may be in luck: we can very often find a post for medical partners/spouses elsewhere in North Wales.  If your other half isn’t portable, please don’t try commuting any further than Wrexham - you’ll wreck yourself. You’d need a pad over here (budget £400-500 for a room in a nice shared house including bills) from where you can enjoy living here, accepting guests etc.

We don’t recommend living in the hospital residence for a full year: it’s convenient, and warm, but it’s only marginally cheaper than a shared house and completely unsuitable for entertaining! If you try to live in the residence you’ll probably spend most of your time off travelling out of North Wales, rather than making the best out of living here.