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Flexible Working in Surgery

When you have been appointed to a substantive post, you may be able to consider a number of flexible working options.

These options include:

  • Annualised contracts
  • Compressed hours
  • Early/late contracts
  • Part time
  • Flexible retirement options
  • Term time working

To arrange any of these, local discussions are necessary between human resources, surgical colleagues and directorate management to ensure that the proposed working patterns will not adversely affect patient care, or cause undue detriment to other members of the surgical team. 

Many Trusts support flexible working, to enable patient centred care to be delivered at more beneficial times and to increase efficiency and throughput. Examples of this include early bird and night owl clinics, 3 session theatre lists, and elective weekend working.

Annualised contracts

Annualised contracts consider your work output and allow you to do the same amount of work over a different period. For example, you may work more hours over particular months and complete your agreed output so that you can have a longer period not working over summer. These can be arranged with a Trust, when a mutually agreed timetable has been agreed, between your surgical colleagues, surgical directorate, and Human Resources.

An annualised contract can be at either full-time or part-time. In order to calculate how many sessions are required to be worked each year, an annual availability for clinical work schedule is calculated, depending on the years of service previously worked, and the annual leave entitlement. 

An average clinical work schedule will take in to account when each Consultant is available for clinical work, excluding annual and study leave. The full-time equivalent contract is then extrapolated, to identify how many clinical sessions in theatre/endoscopy/clinic etc are required. Once this is established, the number of administration sessions and SPA sessions are agreed, and the total expected performance outcome for a one-year period is established. A basic working pattern may be undertaken, with flexible sessions at a time of increased clinical demand. Alternatively, a totally flexible working pattern, using orphan clinics and lists can be offered.

Once the agreed performance outcome is completed for the year, the contract is fulfilled. Annual leave is contracted at zero days, and can be taken flexibly to accommodates work flow patterns.

Compressed hours

Rather than undertake work over a full week, many surgeons prefer to work longer but fewer days i.e. for a standard full-time 40 hour week, which equates to a 10 PA contract, it is possible to undertake 4 x 10 hour days.

Early/late contracts
Some surgeons are in possession of a standard full-time contract, but arrange to undertake their clinical work at different hours i.e. early bird or night owl clinics, or a 3-session theatre lists. 

Term time contract

It is possible to negotiate to increase annual leave, on an unpaid basis, to enable 12 - 14 weeks of holiday to coincide with school holidays. This method of working becomes impractical if all members of staff have similar needs, but can work very well when this is not the case.


Part time means working less than 40 hours per week and can either lead to standard days off, or can be undertaken as part of another flexible working pattern. 

There is a pro-rata reduction in both clinical and supporting professional activity. It is important to consider how many PAs you need to undertake to maintain safe clinical practice. Some Surgical Specialty Associations may be able to provide guidance on recommended procedure numbers etc. 

Once the number of PA's per week worked falls below 10, there are implications for both pension accrual and the reduction in monetary value of clinical excellence awards, which has a further knock on effect on the size of the eventual pension pot. Therefore any decision to undertake a less than full-time contract must be considered carefully.

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