Responsibilities for patient client care

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This factor measures responsibilities for patient/client care, treatment and therapy. It takes account of the nature of the responsibility and the level of the jobholder’s involvement in the provision of care or treatment to patients/clients, including the degree to which the responsibility is shared with others. It also takes account of the responsibility to maintain records of care/treatment/advice/tests.

Level 1:     Assists patients/clients/relatives during incidental contacts. 
Level 2: Provides general non-clinical advice, information, guidance or ancillary services directly to patients, clients, relatives or carers.
Level 3: (a) Provides personal care to patients/clients, or
(b) provides basic clinical technical services for patients/clients, or
(c) provides basic clinical advice.
Level 4: (a) Implements clinical care/care packages, or
(b) provides clinical technical services to patients/clients, or
(c) provides advice in relation to the care of an individual, or groups of patients/clients.
Level 5: (a) Develops programmes of care/care packages, or
(b) provides specialist clinical technical services, or
(c) provides specialised advice in relation to the care of patients/clients.
Level 6: (a) Develops specialised programmes of care/care packages, or
(b) provides highly specialist clinical technical services, or
(c) provides highly specialised advice concerning the care or treatment of identified groups or categories of patients/clients, or
(d) accountable for the direct delivery of a service within a sub-division of a clinical, clinical technical or social care service.
Level 7: Accountable for the direct delivery of a clinical, clinical technical, or social care service(s).
Level 8: Corporate responsibility for the provision of a clinical, clinical technical or social care service(s).
Definitions and notes:

Clients: alternative term for patients often used for those who are not unwell (pregnant women, mothers, those with learning disabilities) or to whom services are provided in the community. ‘Clients’ does not refer to commercial organisations or customers, nor does it refer to internal customer/client relationships. Please see advice at the end of this section about matching or evaluating non-clinical manager jobs. 

At level 2 or above the clinical activities should be a significant aspect of normal duties. Directly to patients/clients (level 2) on a one-to-one, individual basis, usually face-to-face or over the telephone e.g. reception or switchboard services, food delivery service, ward or theatre cleaning. 

Personal care (level 3a) includes assisting with feeding, bathing, appearance, portering supplied directly to patients/clients. Basic clinical technical services (level 3b) includes cleaning, sterilising or packing specialist equipment or facilities used in the provision of clinical services e.g. sterile supplies, theatres, laboratories; the routine obtaining or processing of diagnostic test samples; medical/ technical/ laboratory support work. 

Basic clinical advice (level 3c) includes the provision of straightforward clinical advice to patients/clients by jobholders who are not clinical specialists e.g. an emergency call service operation.

Implementing care (level 4a) includes carrying out programmes of care, therapy or treatment determined by others. This may entail making minor modifications to the care programme or package within prescribed parameters, and reporting back on progress. It also includes supervising individual or group therapy sessions within an overall programme of care, treatment or therapy.

Provides clinical technical services (level 4b) e.g. initial screening of diagnostic test samples, dispensing of medicines, undertaking standard diagnostic (e.g. radiography, neurophysiology) tests on patients/clients, or maintaining or calibrating specialist or complex equipment for use on patients.

Provides advice (level 4c) provides advice which contributes to the care, wellbeing or education of patients/clients, including health promotion. This level also covers jobs involving the registration, inspection or quality assurance of facilities/services for patients/clients e.g. registration and/or inspection of nursing homes, inspection of storage and use of drugs in residential care homes.

Develops programmes of care/care packages (level 5a) involves assessment of care needs and development of suitable care programmes/packages, to be implemented by the jobholder or by others. It includes giving clinical/professional advice to those who are the subject of the care programmes/packages.

Provides specialist clinical technical services (level 5b) for example, interprets diagnostic test results, carries out complex diagnostic procedures, processes and interprets mammograms, constructs specialist appliances, calibrates or maintains highly specialist or highly complex equipment.

Provides specialised advice (level 5c) provides specialised advice which contributes to the diagnosis, care or education of patients/clients e.g. clinical pharmacy or dietetic advice on individual patient care, specialised input to registration, inspection or quality assurance of facilities/services for patients/clients. This option apples to jobs which do not involve developing programmes of care, as these are covered by level 5a.

Develops specialised programmes of care/care packages (level 6a) takes account of the depth and breadth of this responsibility. Clinicians working in a specialist field typically provide this level of care.

Provides highly specialist clinical technical services (level 6b) provides a highly specialist clinical technical service, which contributes to the diagnosis, care or treatment of patients/clients e.g. the maxillo-facial prosthetology service.

Provides highly specialised advice (level 6c) provides highly specialised advice, which contributes to the diagnosis, care or education of patients/clients in an expert area of practice. Clinicians working in a specialist field typically provide this level of advice. This option applies to jobs which do not involve developing specialist care programmes/packages, which are covered by level 6a.

Within a sub division of (level 6d) refers to responsibility for either a geographical or functional sub division e.g. area manager for a service, locality manager.

Accountable for direct delivery (level 7) refers to the accountability vested in jobholders who directly manage the providers of direct patient/client care, clinical technical service or social care service and may or may not provide direct care, clinical technical services or advice themselves, for example, professional health care managers. The accountability must be for a whole service.

Corporate responsibility (level 8) refers to the accountability, normally at board or equivalent level, for clinical governance across the organisation e.g. director of nursing and midwifery services.

Clinical service refers to services such as oncology and paediatrics.

Clinical technical service refers to services such as medical physics, diagnostic radiography, audiology and haematology.

Social care service refers to services such as child protection, learning disabilities.

Please note:

Responsibility for the provision of a service which contributes to patient care, e.g. hotel services management, should be regarded as a policy and service development responsibility and assessed under that factor. The responsibilities of those providing such services should be assessed under the relevant responsibility factor(s) such as maintenance of facilities or equipment under Responsibilities for Financial and Physical Resources.

Matching and local evaluation of non-clinical manager jobs in clinical areas

National monitoring of matching and local evaluations of non-clinical managerial jobs in clinical areas has revealed some misunderstanding of how the Agenda for Change JES should be applied to these jobs, particularly in relation to the Responsibility for Patient Care factor. The problem appears to have arisen from:

  • The initial absence of national profiles for such jobs, which has led panels to match them to the (healthcare) Professional Manager profiles (which have level 7 for Responsibility for Patient Care).
  • The labelling and classification (in the job family ‘other’ on the NHS Employers website and THE COMPUTERISED SYSTEM) of the Professional Manager profiles, which does not make it clear that they are intended for clinical professional manager roles.
  • The wording of the guidance on ‘accountable for direct delivery of a service’ at levels 6(d) and 7 on the ‘Responsibility for Patient Care factor’, which reads: ‘accountability vested in jobholders who manage the providers of direct patient/client care, clinical technical service or social care service and may or may not provide direct care, clinical technical services or advice themselves, for example, professional healthcare managers.’

The JEG has reviewed the situation and confirmed that level 6d and level 7 of the Responsibility for Patient Care factor were intended to be applied only to healthcare practitioner roles with clinical accountability for the direct delivery of clinical or social care services. They were not intended to apply to non-clinical roles and those general manager roles with responsibilities for the delivery of clinical services.

Use of the professional manager profiles for non-clinical or social care jobs and/or evaluation of such jobs at level 6(d) or 7 on the responsibility for patient/client care factor runs a risk of challenge on equality grounds.

It is recommended that non-clinical managerial jobs in clinical areas, for example:

  • General or business manager jobs in clinical areas: or
  • Non-clinical or divisional/departmental managers of clinical divisions/departments  should, wherever possible, be matched to the professional manager, performance/operations profiles (in the business administration and projects job family). These are in bands 8b-d.

The guidance in relation to accountable for direct delivery should be read as follows: ‘refers to the accountability vested in jobholders requiring a health or social care practitioner background in order to* directly manage the providers of direct patient/client care, clinical technical service or social care service, and may or may not provide direct care, clinical technical services or clinical or social care* advice themselves, for example professional health care managers.’

Mismatching of non-clinical manager jobs may carry risks of equal pay claims.
This advice also applies where non-clinical managerial roles are undertaken by those with professional health or social care backgrounds and expertise, if this is not a requirement of the role.

* The text in italics is additional guidance to assist in the correct use of this factor level.

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