ࡱ> %'"#$' kGbjbjff <!h!h;?/P P 8.t"It&(N"pppKKKHHHHHHH$KLNHKKHppH(((^ppH(H((:<p ;HH0"I;N N(<<nN]=0 K0{"(KKKHH$ KKK"INKKKKKKKKKP X : UCL School of Life and Medical Sciences 2022/23 ANNUAL CLINICAL ACADEMIC JOB PLAN REVIEW For Clinical & Public Health Consultants, Clinical Dental & Senior Academic G.P. Staff IMPORTANT: Throughout this document there are references to supplementary reference notes, which can be found on page 6. It is essential that you read these notes whilst completing this form to avoid any delays in processing due to incomplete or incorrect information provided by you. All sections must be completed if not relevant to you please put N/A. SECTION 1: PERSONAL & APPOINTMENT DETAILS Name  UCL Division / Institute UCL Job Title Title of current Honorary Clinical post and name of Trust where held [Note 1]Title: Main Trust issuing Honorary contract: Secondary Trust issuing Honorary contract (where applicable): Name of Academic Line Manager Name of Clinical Line Manager (Main Trust)  Tel: Email: Date of first appointment to the new Consultant /Senior Academic G.P. contract: [Note 2] DD/MM/YY Salary Threshold or Seniority level awarded upon appointment or transfer:Please read the categories below and then enter details in the relevant section [see Note 3]AI took up my first appointment on the new Consultant Clinical Academic contract on a date between 1 April 2003 31 January 2004 (or it was backdated to a date within this period) My credited seniority level was: _______ (years) B My first appointment on the new Consultant Clinical Academic contract commenced on or after 1 February 2004. My salary on the new contract was set at Threshold: -----and my credited seniority level was ----years_ CI took up my first appointment on the Senior Academic G.P. contract on a date between 1 April 2005 31 July 2005 (or it was backdated to a date within this period) My credited seniority level was: _______ (years) DMy first appointment on the Senior Academic G.P. contract commenced on or after 1 August 2005 My salary on the new contract was set at Threshold: _____And my credited seniority level was______  Merit or Clinical Excellence Award If you currently hold an award, please detail accordingly.Distinction AwardDiscretionary PointsCEALevel held:Level held:Level held: If a CEA National Award is held state renewal dateDate:GMC/GDC registration number Speciality (ies) Date of last 911 Appraisal: Has your registration been called into question since your last appraisal? YES/NO If YES please provide a brief overview of reasons and action to date, to inform discussion with your appraisers If this is the first appraisal, is your registration currently in question?YES/NO If YES please provide a brief overview of reasons and action to date, to inform discussion with your appraisersDate of last / future revalidation:   SECTION 2: DUTIES AGREED IN THE LAST UCL JOB PLAN YOU SUBMITTED In order that both your clinical and academic line managers will have ready reference to the activities agreed in the job plan you last submitted, to inform their agreement on activities for the following 12-month period, please complete the details below. [Note 4] NB: Please do not complete this section if this is your first Job Plan submission since commencing employment at 911. 1. Programmed Activities (P.A.): 4 hr slots - a full time member of staff will have basic working week of 10 P.A.s i.e. 40 hrs UCL (PA) NHS (PA)NHS Trust(s) at which clinical P.A.s undertaken [Note 5]Total P.A.s agreed per week (maximum 10)  2. Additional Programmed Activities (APA): exceptionally agreed where additional work undertaken on a regular basis, over & above contractual hours of workUCL (APA)NHS (APA)NHS Trust(s) agreeing clinical APA(s) [Note 5]Total APAs agreed per week (maximum 2) 3. On-Call Activities [Note 10]: CategoryFrequencyNHS Trust awarding 4. Additional NHS responsibilities and/or external duties Do you receive either a UCL or NHS management or special allowance to reflect extra responsibilities you hold or undertake? If YES please detail (adjacent):Rate per annum (): Name/Type of allowance received:  5. Private Medical Practice Do you undertake private practice activities? If YES please detailPrivate Practice activities over past 12-month period: Occasional clinics 6. Please detail any changes that have subsequently been agreed and implemented Out of Job Plan Detail change:Date: SECTION 3: NEW JOB PLAN - duties agreed for NEXT 12-MONTH period I confirm that the academic and clinical activities detailed in this Job Plan [Note 6] are agreed for the period: FROM: __________________ (DD/MM/YY) TO: _______________ (DD/MM/YY) Is this Job Plan exceptionally agreed for a period other than 12 months from the anniversary date? [Note 7] Yes / No (delete as applicable) If Yes the following statement must be initialled and signed by the clinical and academic leads: The duties contained in this Job Plan are agreed by us to also cover the requisite 12 month period from your anniversary date Clinical lead Initials:___ / Date:_______ Academic lead initials: ___ Date: _______  PROGRAMMED ACTIVITIES PER WEEK (P.A.) Type by codes  Describe duty & detail code TimeNo. P.A.s agreed per week & beneficiaryUCLNHS Academic related duties U1 U12 Direct clinical care C1 C11 Supporting Professional Activities S1 S7Additional NHS Responsibilities A1- A5Other Duties D1 D7Additionally remunerated work P1 P3Non-work activity N1-N2  Totals must not exceed 10 [ Note 8] Total P.A.s agreed per weekUCL NHS *  * Where clinical work is undertaken at more than one Trust please show the number of PAs undertaken at each [Note 5]Main Trust (name) Number of PAsSecondary Trust (name)Number of PAs ADDITIONAL PROGRAMMED ACTIVITIES (APA)No. P.A.s agreed per week & beneficiary. UCL NHS Duty described with Trust Name for each (where undertaken at two Trusts) [See Note 5] Totals must not exceed 2 [ Note 9]Total A.P.A.s agreed per weekUCL NHS On-Call Activities: [Note 10]1. NHS Trust awarding:Category:Frequency:2. NHS Trust awarding:Category:Frequency:Additional responsibilities and/ or external duties Do you receive either a UCL or NHS management or special allowance to reflect extra responsibilities you hold or undertake? If Yes please detail in the adjacent boxes: [Note 11]Rate per annum (): Name/Type of allowance received: Name of awarding authority: Private Medical Practice Will you be undertaking private practice activities in the next 12-month period? If YES please detail:Private Practice activities over past 12-month period:  SECTION 4. PROCESSING OF PERSONAL INFORMATION UNDER THE DATA PROTECTION ACT Please Read In order that you may undertake the full remit of the duties required for your appointment as a clinical academic member of staff you will hold both a substantive academic contract and an honorary NHS appointment. From time to time information about your employment, including matters relating to integrated job planning, probation, appraisal, promotion, discipline and dismissal may need to be shared with your honorary employer. It is a condition of your appointment that you allow UCL to share such information, including sensitive personal data as defined in the Data Protection Act, with your honorary clinical employer. SECTION 5. SIGN OFF - ANNUAL INTEGRATED JOB PLAN REVIEW We agree that the details included in this document are an accurate summary of our discussion regarding duties and activities to be undertaken in the 12 month period immediately following the anniversary date of first appointment to either the Consultant Clinical Academic or Senior Academic G. P. contract. [Note 1] If the duties of this job plan have been agreed for a period other than the 12 months immediately following the anniversary date of appointment, by annotating the Section 3 from/to dates and signing below we authorise the extension of the duties agreed (and any additional salary payments they may attract) either retrospectively or until the requisite anniversary date. We undertake to agree future years job plans for the 12-month period following anniversary of appointment to the CCA or SAGP contract. [Note 2 and 3] Additionally, we agree that sufficient time has been allocated in the Integrated Job Plan to facilitate the completion of the agreed academic and clinical objectives as detailed in this document and the undertaking of any training identified following the annual clinical academic appraisal processes. Clinical Academic: Signature: Date:Job Plan reviewer on behalf of University College London: (Academic Lead) Name (please print): Position Held: Signature: Date:Job Plan reviewer on behalf of honorary clinical employer: (Clinical Lead) [Note 12] [Note 13:UCLH]Name (please print): Position Held: Name of Trust / Practice: Signature: Date:UCLH DCD:Name Signature Date: NOTE TO CLINICAL ACADEMIC On completion please submit this document to your Divisional / Institute Manager/HR Manager for processing. You should retain a copy for your future reference [Note 14]  SECTION 6. DIVISION / INSTITUTE TO COMPLETE (It is assumed all information in this Job Plan represents the work in total being carried out and any work not being remunerated is clearly noted) Honorary Contract with main Trust has been verifiedYES / NO (please circle)Appointment date to CCA or SAGP has been verifiedYES / NO (please circle)Clinical Academics Seniority and Pay Threshold point has been verified YES / NO (please circle)Is pay progression now due? [Note 15]YES / NO If YES, please detail below (please delete) Current Threshold _________ Point____________ New Pay Threshold ________ Point__________ Date new Pay Threshold is effective: ______________________ Has the new Pay Threshold been approved by the Clinical HR Business Partner? YES / NO (please delete)Have all previous Job Plans been submitted and approved if so complete AJP DT Important:For any new or increased pay elements to be funded by external stakeholders an Award letter must be supplied to NHS Billing and/or Research Grants. Where there have been changes to APAs, On-call, CEAs or allowances an OJP DT form should be completed Any changes to fte (increase or decrease) please complete a Changes of Appointment DT on MyHRExisting PA split per week:Academic:Revised PA split per week:Academic:Clinical:Clinical:Director of Division / Institute Signature: Print name:Date:NB The Director must sign this page even if they have also signed elsewhere. DIVISION/INSTITUTE PLEASE FORWARD BY EMAIL TO HR SERVICES  HYPERLINK "mailto:hr.services@ucl.ac.uk" hr.services@ucl.ac.uk and NHS BILLING  HYPERLINK "mailto:nhsbilling@ucl.ac.uk" nhsbilling@ucl.ac.uk   EE number______________ Does the paid work shown match payroll? _____________ Is any payroll element on suspense or NHS unauthorised account _____________ Are all previous job plans complete______________  Signed on behalf of the UCL: __________________________  Date: ___________  APPENDIX: SUPPLEMENTARY REFERENCE NOTES PLEASE REMOVE THIS PAGE BEFORE SUBMITTING JOB PLAN Note 1: Title of Honorary Clinical Contract and name of Trust where heldIf you hold two honorary clinical contracts you should enter the Trust where the majority of your clinical PAs are undertaken and this is the Trust that should sign off your Job Plan. You should also enter the name of any other Trust(s) where you hold a secondary honorary clinical contractNote 2: First Appointment on the new CCA or SAGP ScaleThis is the start date of your first appointment to the CCA or SAGP contract, which may have been prior to joining UCL (not necessarily your first consultant appointment) Note 3: Salary Threshold or Seniority level awarded on appointment Please complete the section relevant to the date of your first appointment or transfer to the CCA/SAGP scale (could be prior to joining UCL) Complete section A (CCA) or C (SAGP) if your transfer was within the time period shown or you transferred later but it was backdated to that period. Complete section B (CCA) or D (SAGP) if your first consultant appointment was within the time period shown Note 4: Last Job Plan submittedYou should enter details as shown in your last signed off Job Plan. Where changes have been subsequently agreed Out of Job Plan please indicate this in the box available. Note 5: Programmed Activities / Additional Programmed Activities If your clinical PAs or APAs are split between more than one Trust you should indicate how many PAs are undertaken at each. This applies to Last and Current Job Plans.Note 6: Job Plans period of validation Note 7: Alternative Job Plan Review DateYour terms of employment require that that the duties agreed in your Integrated Job Plan are (i) reviewed annually, (ii) a Job Plan is agreed for the 12- month period following the anniversary date of your first taking up appointment on either the Consultant Clinical Academic or Senior Academic G.P. In exceptional circumstances, i.e. where the Trust holds an annual Job Planning round, your Job Plan may be agreed for a period other than 12 months immediately following the anniversary date of your appointment to the CCA or SAGP contract. In such cases all parties must sign and date the exception statement in section and understand that by doing so, they authorise the extension of the working commitments agreed in this job plan (and any additional salary payments these may attract) for the period up to and including your anniversary date. For example, your anniversary date is 1 June each year but your job plan has been agreed for the period 1 April 31 March. By additionally signing in section 3 relevant parties agree that the details in the job plan will be extended to cover the period 1 April 31 May. Note 8: Programmed Activities P.A.)One full P.A. will account for 4 hours of work per week, of which a full time clinical academic will contractually have 10 (i.e. a 40 hour working week)Note 9: Additional Programmed Activities (APA)Agreed in exceptional cases where specific and identifiable needs of a service require the clinical academic to undertake duties above their contracted hours. APAs are assigned to an individual via the annual job plan review process and may increase, reduce or cease at any point during the 12 month period, as the needs of the service determine. A Maximum of 2 APAs may be agreed per week, in one of the following combinations: (i) 2 x Clinical APA or (ii) 1 x Academic APA + 1 x Clinical APA Note 10: On Call ratesCategory A must be in attendance Category B can assist remotely Frequency High - (range 1 in 1 to 1 in 4) Frequency Medium - (range 1 in 5 to 1 in 8) Frequency Low - (range 1 in 9 or less frequent)Note 11: Additional responsibilities and/ or external dutiesYou should detail the allowance and amount and name the awarding authority i.e. UCL/grant funding body or name of NHS TrustNote 12: Sign OffWhere you have indicated more than one clinical lead on page 1, only the lead at your Main Trust needs to sign under Section 5Note 13: Sign Off (UCLH)For those with honorary contracts at 911H the clinical Job Plan reviewer and signatory should be the Divisional Clinical DirectorNote 14: Annual submission date for receipt by UCLYour completed job plan must be submitted via your local Divisional / Institute Director no later than 1 month prior to the anniversary of your first taking up appointment upon either the Consultant Clinical Academic (CCA) or Senior Academic G.P. (SAGP) contract.Note 15: Pay ProgressionThe final decision on pay progression (where applicable) is dependent upon the timely receipt of your fully signed job plan each year.     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