NHS Job Evaluation Handbook - Second Edition

NHS Job Evaluation Handbook

2. Factor Plan and Guidance Notes

Factor definitions and factor levels

1. Communication & relationship skills

This factor measures the skills required to communicate, establish and maintain relationships and gain the cooperation of others. It takes account of the skills required to motivate, negotiate, persuade, make presentations, train others, empathise, communicate unpleasant news sensitively and provide counselling and reassurance. It also takes account of difficulties involved in exercising these skills.

Skills required for:

(c) Providing advice, instruction or training to groups, where the subject matter is straightforward.

Level 1:	Providing and receiving routine information orally to assist in undertaking own job. Communication is mainly with work colleagues.
Level 2:	Providing and receiving routine information orally, in writing or electronically to inform work colleagues, patients, clients, carers, the public or other external contacts.
Level 3:	(a) Providing and receiving routine information which requires tact or persuasive skills or where there are barriers to understanding.
	Or
	(b) Providing and receiving complex or sensitive information.
	Or
Level 4:	(a) Providing and receiving complex, sensitive or contentious information, where persuasive, motivational, negotiating, training, empathic or re-assurance skills are required. This may be because agreement or cooperation is required or because there are barriers to understanding.
	Or
	(b) Providing and receiving highly complex information
Level 5:	(a) Providing and receiving highly complex, highly sensitive or highly contentious information, where developed persuasive, motivational, negotiating, training, empathic or re-assurance skills are required. This may be because agreement or co-operation is required or because there are barriers to understanding.
	Or
	(b) Presenting complex, sensitive or contentious information to a large group of staff or members of the public.
	Or
	(c) Providing and receiving complex, sensitive or contentious information, where there are significant barriers to acceptance which need to be overcome using developed interpersonal and communication skills such as would be required when communicating in a hostile, antagonistic or highly emotive atmosphere.
Level 6:	Providing and receiving highly complex, highly sensitive or highly contentious information where there are significant barriers to acceptance which need to be overcome using the highest level of interpersonal and communication skills, such as would be required when communicating in a hostile, antagonistic or highly emotive atmosphere.

Definitions and notes:

From Level 2 upwards communication may be oral or other than oral (e.g. in writing) to work colleagues, staff, patients, clients, carers, public or other contacts external to the department including other trusts or suppliers.

Requirement to communicate in a language other than English. Jobs with a specific requirement to communicate in a language other than English, which would otherwise score at Level 2 will score at Level 3. Any score higher than Level 3 will be dependent on the nature of the communication, the skills required, and the extent to which they meet the factor level definitions not the language of delivery.

Barriers to understanding (Levels 3 to 5a) refers to situations where the audience may not easily understand because of cultural or language differences, or physical or mental special needs, or due to age (e.g. young children, elderly or frail patients/clients).

From Level 3 upwards communication may be oral, in writing, electronic, or using sign language, or other verbal or non-verbal forms.

Tact or persuasive skills (Level 3a). Tact may be required for situations where it is necessary to communicate in a manner that will neither offend nor antagonise. This may occur where there is a job requirement to communicate with people who may be upset or angry, be perceptive to concerns and moods and anticipate how others may feel about anything which is said. Persuasive skills refers to the skills required to encourage listeners to follow a specific course of action.

Complex (Levels 3b, 4a, 5b, 5c) means complicated and made up of several components, e.g. financial information for accountancy jobs, employment law for HR jobs, condition related information for qualified clinical jobs. Most professional jobs normally involve providing or receiving complex information.

Sensitive information (Levels 3b, 4a, 5b, 5c) includes delicate or personal information where there are issues of how and what to convey.

Training - where the subject matter is straightforward (Level 3c) refers to training in practical topics such as manual handling; new equipment familiarisation; hygiene, health and safety.

Empathy (Level 4a, 5a) means appreciation of, or being able to put oneself in a position to sympathise with, another person's situation or point of view.

Highly complex (Levels 4b, 5a, 6) refers to situations where the jobholder has to communicate extremely complicated strands of information which may be conflicting: e.g. communicating particularly complicated clinical matters, difficult to explain and multi-stranded business cases.

Highly sensitive (Levels 5a and 6) refers to situations where the communication topic is extremely delicate or sensitive e.g. communicating with patients/clients about foetal abnormalities or life threatening defects or where it is likely to cause offence e.g. a health or social services practitioner communicating with patients/clients about suspected child abuse or sexually transmitted diseases.

Highly contentious (Levels 5a and 6) refers to situations where the communication topic is extremely controversial and is likely to be challenged e.g. a major organisational change or closure of a hospital unit.

Developed skills (Levels 5a and 6) refers to a high level of skill in the relevant area which may have been acquired through specific training or equivalent relevant experience. It includes formal counselling skills where the jobholder is required to handle one to one and/or group counselling sessions.

Presenting complex, sensitive or contentious information to a large group of staff or members of the public (Level 5b) means communicating this type of information to groups of around 20 people or more in a formal setting, e.g. classroom teaching, presentation to boards or other meetings with participants not previously known to the jobholder. This type of communication may involve the use of presentational aids and typically gains and holds the attention of, and imparts knowledge to, groups of people who may have mixed or conflicting interests.

Communicating in a hostile, antagonistic or highly emotive atmosphere (Level 5c) includes situations where communications are complex, sensitive or contentious (see above) and the degree of hostility and antagonism towards the message requires the use of a high level of interpersonal and communication skills on an ongoing basis such as would be required for communications which provide therapy or have an impact on the behaviour/views of patients/clients with severely challenging behaviour. It also includes communications with people with strong opposing views and objectives where the message needs to be understood and accepted, e.g. communicating policy changes which have an impact on service delivery or employment.

Communicating highly complex information in a hostile, antagonistic or highly emotive atmosphere (Level 6). This level is only applicable where there is an exceptionally high level of demand for communication skills. It applies to situations where communications are highly complex, highly sensitive or highly contentious (see above) and there is a significant degree of hostility and antagonism towards the message which requires the use of the highest level of interpersonal and communication skills such as is required for communications which are designed to provide therapy or impact on the behaviour/views of patients with severely challenging behaviour in the mental health field. It also includes communications with people with extremely strong opposing views and objectives e.g. communicating hospital closure to staff or the community where the message needs to be understood and accepted.

2. Knowledge, training & experience

This factor measures all the forms of knowledge required to fulfil the job responsibilities satisfactorily. This includes theoretical and practical knowledge; professional, specialist or technical knowledge; and knowledge of the policies, practices and procedures associated with the job. It takes account of the educational level normally expected as well as the equivalent level of knowledge gained without undertaking a formal course of study; and the practical experience required to fulfil the job responsibilities satisfactorily.

The job requires:

Level 1:	Understanding of a small number of routine work procedures which could be gained through a short induction period or on the job instruction.
Level 2:	Understanding of a range of routine work procedures possibly outside immediate work area, which would require job training and a period of induction.
Level 3:	Understanding of a range of work procedures and practices, some of which are non-routine, which require a base level of theoretical knowledge. This is normally acquired through formal training or equivalent experience.
Level 4:	Understanding of a range of work procedures and practices, the majority of which are non-routine, which require intermediate level theoretical knowledge. This knowledge is normally acquired through formal training or equivalent experience.
Level 5:	Understanding of a range of work procedures and practices, which requires expertise within a specialism or discipline, underpinned by theoretical knowledge or relevant practical experience.
Level 6:	Specialist knowledge across the range of work procedures and practices underpinned by theoretical knowledge or relevant practical experience.
Level 7:	Highly developed specialist knowledge across the range of work procedures and practices underpinned by theoretical knowledge and relevant practical experience.
Level 8:	(a) Advanced theoretical and practical knowledge of a range of work procedures and practices,
	Or
	(b) Specialist knowledge over more than one discipline/function acquired over a significant period.

Definitions and notes:

Small number of routine work procedures (Level 1) includes those that could normally be learned on the job without prior knowledge or experience.

Short induction period (Level 1) is generally for days rather than weeks.

Job training (Level 2) refers to training that is typically provided on the job through a combination of instruction and practice or by attending training sessions. At this level the required knowledge generally takes a few weeks in the job to learn. It also refers to the knowledge required for Large Goods Vehicle or Passenger Carrying Vehicle licences.

Base level of theoretical knowledge (Level 3) equates to NVQ level 3, RSA 3, City & Guilds certification or equivalent level of knowledge.

Equivalent experience (Levels 3 and 4) refers to experience which enables the jobholder to gain an equivalent level of knowledge.

Intermediate level of theoretical knowledge (Level 4) equates to an Higher National Certificate, AAT (Association of Accounting Technicians) Technician Level or other diploma or equivalent level of knowledge.

Expertise within a specialism (Level 5) normally requires degree level or equivalent level of knowledge. This level of knowledge could also be obtained through an in-depth diploma plus significant experience. Jobs requiring a degree or an equivalent level of knowledge e.g. Registered General Nurse, should be scored at this level.

Specialist knowledge (Level 6): refers to a level of knowledge and expertise which can be acquired through either in-depth experience or theoretical study of a broad range of techniques/processes relating to the knowledge area. This equates to post-registration/graduate diploma level or equivalent in a specific field. This level also refers to the specialist organisational, procedural or policy knowledge required to work across a range of different areas. The jobholder is influential within the organisation in matters relating to his/her area and provides detailed advice to other specialists and non-specialists.

Highly developed specialist knowledge (Level 7) refers to knowledge and expertise which can only be acquired through a combination of in-depth experience and postgraduate or post-registration study, such as that obtained through a Master's degree or equivalent experience/qualification or doctorate, or significant formal training or research in a relevant field, in addition to short courses and experience. Jobs requiring a doctorate or equivalent knowledge as an entry requirement such as medical, dental, scientific or specialist management qualifications should be assessed at this level as a minimum.

Advanced theoretical and practical knowledge (Level 8a) refers to the highest level of specialist knowledge within the relevant specialist field. It is equivalent to a doctorate plus further specialist training, research or study. It is, therefore, appropriate for posts requiring significant expertise and experience and where the entry level is a doctorate or equivalent e.g. healthcare or scientific consultant posts.

Specialist knowledge over more than one discipline/function (Level 8) refers to extensive knowledge and expertise across a number of subject areas, e.g. a combination of some of the following areas - clinical, research and development, personnel, finance, estates.

Note:

Please refer to the additional guidance in Section 3 (Evaluating/Matching jobs under Factor 2: Knowledge, Training and Experience) when evaluating or matching this factor.

3. Analytical and judgemental skills

This factor measures the analytical and judgemental skills required to fulfil the job responsibilities satisfactorily. It takes account of requirements for analytical skills to diagnose a problem or illness and understand complex situations or information; and judgemental skills to formulate solutions and recommend/decide on the best course of action/treatment.

Skills required for:

Level 1:	Judgements involving straightforward job-related facts or situations.
Level 2:	Judgements involving facts or situations, some of which require analysis.
Level 3:	Judgements involving a range of facts or situations, which require analysis or comparison of a range of options.
Level 4:	Judgements involving complex facts or situations, which require the analysis, interpretation and comparison of a range of options.
Level 5:	Judgements involving highly complex facts or situations, which require the analysis, interpretation and comparison of a range of options.

Definitions and notes:

Facts or situations, some of which require analysis (Level 2) includes both clinical and non-clinical facts/situations where there is more than a straightforward choice of options and there is a requirement in some cases to assess events, problems or patient conditions in detail to determine the best course of action e.g. selection of staff, resolving staffing issues, problem solving, fault finding on non-complex equipment.

Range of facts or situations which require analysis, and comparison (Level 3) includes both clinical and non-clinical facts/situations where there is more than a straightforward choice of options and there is a requirement in a range of different cases to assess events, problems or illnesses in detail to determine the appropriate course of action. Examples of this type of analysis and judgement are fault finding on complex equipment, initial patient assessment, analysis of complex financial queries or discrepancies.

Complex (Level 4) means complicated and made up of several components which have to be analysed and assessed and which may contain conflicting information or indicators e.g. assessment of specialist clinical conditions, analysis of complex financial trends, investigating and assessing serious disciplinary cases.

Interpretation (Levels 4 and 5) indicates a requirement to exercise judgment in identifying and assessing complicated events, problems or illnesses and where a range of options, and the implications of each of these, have to be considered.

Highly complex (Level 5) means complicated and made up of several components, which may be conflicting and where expert opinion differs or some information is unavailable. This type of analysis and judgment may be required in posts where the jobholders are themselves experts in their field and judgments have to be made about situations which may have unique characteristics and where there are a number of complicated aspects to take into account which do not have obvious solutions.

4. Planning and organisational skills

This factor measures the planning and organisational skills required to fulfil the job responsibilities satisfactorily. It takes account of the skills required for activities such as planning or organising clinical or non-clinical services, departments, rotas, meetings, conferences and for strategic planning. It also takes account of the complexity and degree of uncertainty involved in these activities.

Skills required for:

Level 1:	Organises own day to day work tasks or activities.
Level 2:	Planning and organisation of straightforward tasks, activities or programmes, some of which may be ongoing.
Level 3:	Planning and organisation of a number of complex activities or programmes, which require the formulation and adjustment of plans.
Level 4:	Planning and organisation of a broad range of complex activities or programmes, some of which are ongoing, which require the formulation and adjustment of plans or strategies.
Level 5:	Formulating long-term, strategic plans, which involve uncertainty and which may impact across the whole organisation.

Definitions and notes:

Straightforward tasks, activities or programmes (Level 2) means several tasks, activities or programmes, which are individually uncomplicated such as arranging meetings for others.

Planning and organisation (Level 2) includes planning and organising time/activities for staff, patients or clients where there is a need to make short-term adjustments to plans e.g. planning non-complex staff rotas, clinics or parent-craft classes, allocating work to staff, planning individual patient/client care, ensuring that accounts are prepared for statutory deadlines, planning administrative work around committee meeting cycles.

Planning and organisation of a number of complex activities (Level 3) includes complex staff or work planning, where there is a need to allocate and re-allocate tasks, situations or staff on a daily basis to meet organisational requirements. It also includes the skills required for co-ordinating activities with other professionals and agencies, e.g. where the jobholder is the main person organising case conferences, or discharge planning where a substantial amount of detailed planning is required. These typically involve a wide range of other professionals or agencies. The jobholder must be in a position to initiate the plan or co-ordinate the area of activity. Participating in such activities does not require planning and organisational skills at this level.

Complex (Levels 3 and 4) means complicated and made up of several components, which may be conflicting.

Planning and organisation of a broad range of complex activities (Level 4) includes planning programmes which impact across or within departments, services or agencies.

Formulating plans (Levels 4 and 5) means developing, structuring and scheduling plans or strategies.

Long term strategic plans (Level 5) extend for at least the future year, take into account the overall aims and policies of the service/directorate/organisation and create an operational framework.

5. Physical skills

This factor measures the physical skills required to fulfil the job duties. It takes into account hand-eye co-ordination, sensory skills (sight, hearing, touch, taste, smell), dexterity, manipulation, requirements for speed and accuracy, keyboard and driving skills.

Level 1:	The post has minimal demand for work related physical skills.
Level 2:	The post requires physical skills which are normally obtained through practice over a period of time or during practical training, e.g. standard driving or keyboard skills; use of some tools and types of equipment.
Level 3:	(a) The post requires developed physical skills to fulfil duties where there is a specific requirement for speed or accuracy. This level of skill may be required for advanced or high speed driving; advanced keyboard use; advanced sensory skills or manipulation of objects or people with narrow margins for error.
	Or
	(b) The post requires highly developed physical skills, where accuracy is important, but there is no specific requirement for speed. This level of skill may be required for manipulation of fine tools or materials.
Level 4:	The post requires highly developed physical skills where a high degree of precision or speed and high levels of hand, eye and sensory co-ordination are essential.
Level 5:	The post requires the highest level of physical skills where a high degree of precision or speed and the highest levels of hand, eye and sensory co-ordination are essential.

Definitions and notes:

Physical skills normally obtained through practice (Level 2) includes skills which jobholders develop in post or through previous relevant experience, e.g. use of cleaning, catering or similar equipment. It also includes manoeuvring wheel chairs/trolleys in confined spaces, using hoists or other lifting equipment to move patients/clients, intra-muscular immunisations/injections and use of sensory skills.

Standard keyboard skills (Level 2) includes the skills exercised by those who have learned over time and those who have been trained to RSA 1 or equivalent.

Specific requirement (Level 3a) means that the job demands are above average and require specific training or considerable experience to get to the required level of dexterity, co-ordination or sensory skills.

Advanced or high speed driving (Level 3a) includes driving a heavy goods vehicle, ambulance, minibus or articulated lorry where a Large Goods Vehicle, Passenger Carrying Vehicle or Ambulance Driving Test or equivalent is required.

Advanced keyboard use (Level 3a) includes the skills exercised by qualified typists/word processor operators (RSA 2/3 or equivalent).

Advanced sensory skills (Level 3a) includes the skills required for sensory, hand and eye co-ordination such as those required for audio-typing. It also includes specific developed sensory skills, e.g. listening skills for identifying speech or language defects.

Restraint of patients/clients (Level 3a) indicates a skill level that requires a formal course of training and regular updating.

Manipulation of fine tools or materials (Level 3b) includes, e.g. manipulation of materials on a slide or under a microscope, use of fine screw drivers or similar equipment, assembly of surgical equipment, administering intravenous injections.

Highly developed physical skills (Level 4) includes, e.g. the skills required for performing surgical interventions, intubation, tracheotomies, suturing, a range of manual physiotherapy treatments or carrying out endoscopies.

Highest level of physical skill (Level 5) includes, e.g. keyhole or laser surgery or IVF procedures.

6. Responsibilities for patient/client care

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.

At Level 2 or above, the 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, well being 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) e.g. 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.

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), e.g. maintenance of facilities or equipment under Responsibilities for Financial and Physical Resources.

7. Responsibilities for policy and service development implementation

This factor measures the responsibilities of the job for development and implementation of policy and/or services. It takes account of the nature of the responsibility and the extent and level of the jobholder's contribution to the relevant decision making process, for instance, making recommendations to decision makers. It also takes account of whether the relevant policies or services relate to a function, department, division, directorate, the whole trust or employing organisation, or wider than this; and the degree to which the responsibility is shared with others.

Level 1:	Follows policies in own role which are determined by others, no responsibility for service development, but may be required to comment on policies, procedures or possible developments.
Level 2:	Implements policies for own work area and proposes changes to working practices or procedures for own work area.
Level 3:	Implements policies for own work area and proposes policy or service changes which impact beyond own area of activity.
Level 4:	Responsible for policy implementation and for discrete policy or service development for a service or more than one area of activity.
Level 5:	Responsible for a range of policy implementation and policy or service development for a directorate or equivalent.
Level 6:	Corporate responsibility for major policy implementation and policy or service development, which impacts across or beyond the organisation.

Definitions and notes:

Policies (Level 1 upwards) refers to a documented method for undertaking a task which is based on best practice, legal requirements or service needs e.g. directorate policy on treatment of leg ulcers or trust policy on reporting accidents.

Follows policies in own role (Level 1) refers to a responsibility for following policy guidelines which impact on own job, where there is no requirement to be pro-active in ensuring that changes are implemented.

Implements policies (Level 2 and above) refers to the introduction and putting into practice of new or revised policies, e.g. implementing policies relating to personnel practices, where the jobholder is pro-active in bringing about change in the policy or service. This is a greater level of responsibility than following new policy guidelines for own job, which is covered by the Level 1 definition.

Own work area (Levels 2 and 3) refers to the immediate section/department.

Proposes policy or service changes (Level 3) includes participation on working parties proposing policy changes as an integral part of the job (i.e. not a one off exercise on a single issue). At this level, policy or service changes must impact on other disciplines, sections, departments or parts of the service.

Beyond own area of activity (Level 3) refers to own function/service/discipline and not a geographic area, e.g. where policy changes impact on other disciplines within multi-disciplinary (non-clinical or clinical) teams or outside own specialist area. It does not refer, for example, to the same function, service or discipline in other parts of the trust/organisation.

Service (Level 4) refers to a (discrete) stand alone service, which may be a sub-division of a directorate e.g. oncology, haematology, care of the elderly, catering, accounts.

Responsible for policy implementation and for discrete policy or service development (Level 4) applies where the jobholder has overall responsibility for policy or service development and for its practical implementation. This responsibility should normally be specified on the job description.

Directorate or equivalent (Level 5) refers to areas such as the Medical Services, Childrens Services, Community Services, Estates Services, Hotel Services, Finance Directorate and Human Resources Directorate.

Corporate responsibility (Level 6) refers to responsibility for policy or service development such as is held by those on the Board or equivalent level of accountability, e.g. Director of HR, Director of Corporate Services, provided they hold the highest level of responsibility for the particular policy or service development area, besides the Chief Executive.

8. Responsibilities for financial and physical resources

This factor measures the responsibilities of the job for financial resources (including cash, vouchers, cheques, debits and credits, invoice payment, budgets, revenues, income generation); and physical assets (including clinical, office and other equipment; tools and instruments; vehicles, plant and machinery; premises, fittings and fixtures; personal possessions of patients/clients or others; goods, produce, stocks and supplies).

It takes account of the nature of the responsibility (e.g. careful use, security, maintenance, budgetary and ordering responsibilities); the frequency with which it is exercised; the value of the resources; and the degree to which the responsibility is shared with others.

Level 1:	Observes personal duty of care in relation to equipment and resources used in course of work.
Level 2:	(a) Regularly handles or processes cash, cheques, patients' valuables.
	Or
	(b) Responsible for the safe use of equipment other than equipment which they personally use.
	Or
	(c) Responsible for maintaining stock control and/or security of stock.
	Or
	(d) Authorised signatory for small cash/financial payments.
	Or
	(e) Responsible for the safe use of expensive or highly complex equipment.
Level 3:	(a) Authorised signatory for cash/financial payments.
	Or
	(b) Responsible for the purchase of some physical assets or supplies.
	Or
	(c) Monitors or contributes to the drawing up of department/service budgets or financial initiatives.
	Or
	(d) Holds a delegated budget from a budget for a department/service.
	Or
	(e) Responsible for the installation or repair and maintenance of physical assets.
Level 4:	(a) Budget holder for a department/service.
	Or
	(b) Responsible for budget setting for a department/service.
	Or
	(c) Responsible for the procurement or maintenance of all physical assets or supplies for a department/service.
Level 5:	(a) Responsible for the budget for several services.
	Or
	(b) Responsible for budget setting for several services.
	Or
	(c) Responsible for physical assets for several services.
Level 6:	Corporate responsibility for the financial resources and physical assets of an organisation.

Definitions and notes:

Personal duty of care in relation to equipment and resources (Level 1) refers to careful use of communal equipment and facilities. Ordering supplies for personal use is also included at this level.

Regularly (Level 2a) means at least once a week on average.

Safe use of equipment (Level 2b) includes dismantling and assembling equipment for use by other staff or patients/clients. It also includes overall responsibility, e.g. for office machinery or cleaning equipment for a location or area of activity.

Maintaining stock control (Level 2c) is appropriate for jobs which include responsibility for re-ordering goods/stock from an agreed point/supplier on a regular basis.

Security of stock (Level 2c) is appropriate for jobs where the responsibility is a significant feature of the job, e.g. responsible for the security of a substantial amount/volume of drugs/materials. It also includes being a departmental key holder, but holding the food store or drugs cupboard key for the shift is not sufficient to be assessed at this level.

Authorised signatory for small cash/financial payments (Level 2d) includes e.g. "signing off" travel expenses, overtime payments, agency/bank staff time sheets totalling less than around 1,000 per month. It also includes responsibility for the financial verification of documents/information such as expense sheets or purchase documents up to this amount, where it is a significant and on-going job responsibility. This role would normally be carried out within the finance department.

Safe use of expensive equipment (Level 2e) refers to the personal use of individual pieces of equipment valued at 30,000 or more.

Highly complex equipment (Level 2e) refers to the personal use of individual pieces of equipment which are complicated, intricate and difficult to use, for example radiography equipment.

Authorised signatory (Level 3a) includes for example, "signing off" travel expenses or overtime payments agency/bank staff time sheets totalling around 1,000 or more per month. It also includes responsibility for the financial verification of documents/information such as expense sheets or purchase documents up to this amount, where it is a significant and on going job responsibility. This role would normally be carried out within the finance department.

Responsible for the purchase of some physical assets or supplies (Level 3b) covers responsibility for the purchase or signing off of orders valued at around 5,000 per year or greater. This level is appropriate for jobs where there is discretion to select suppliers taking into account cost, quality, reliability etc.

Monitors (Level 3c) is applicable to situations where a jobholder is required to regularly review a set of financial information/accounts to ensure that they are consistent with guidelines and within pre-determined budgetary limits, as an ongoing job responsibility.

Financial initiatives (Level 3c) includes income generation and cost improvement programmes.

Delegated budget (Level 3d) refers to jobs which have responsibility for a sub-division of a departmental or service budget. This level also applies to jobs involved in committing substantial financial expenditures from a budget held elsewhere without formally holding a delegated budget, e.g. commissioning care packages for social services clients.

Responsible for the installation or repair and maintenance (Level 3e) refers to jobs which have a responsibility for carrying out repairs and maintenance on equipment, machinery or the fabric of the building. It also includes overall responsibility for security of a site.

Department/service* (Levels 4a, b and c) is appropriate where there is full responsibility for budget/physical assets over a department or service. Where it involves large and multi-stranded financial/physical services, this should be treated as the equivalent of "several services" (i.e. Levels 5a, b, c).

Budget holder (Level 4a) refers to responsibility for authorising expenditure and accountable for expenditure within an allocated budget.

Budget setting (Levels 4b and 5b) refers to an accounting activity with responsibility for overseeing the financial position.

Responsible for procurement (Level 4c) refers to responsibility for selecting suppliers or authorising purchases, taking into account cost, quality, delivery time and reliability.

Several services* (Levels 5a, b and c) is appropriate where there is significant responsibility over different departments and/or services and where the responsibility covers large and/or multi stranded financial/physical services.

Corporate responsibility (Level 6) refers to accountability for financial governance across the organisation(s).

Note:

*The assessment should take into account the range and scope of the responsibility and the degree of control that is required. It is also helpful to consider whether the jobholder has full control of the budget(s)/physical assets or whether it is a delegated responsibility.

9. Responsibilities for human resources (HR)

This factor measures the responsibilities of the job for management, supervision, co-ordination, teaching, training and development of employees, students/trainees and others in an equivalent position.

It includes work planning and allocation; checking and evaluating work; undertaking clinical supervision; identifying training needs; developing and/or implementing training programmes; teaching staff, students or trainees; and continuing professional development (CPD). It also includes responsibility for such personnel functions as recruitment, discipline, appraisal and career development; and the long term development of human resources.

The emphasis is on the nature of the responsibility, rather than the precise numbers of those supervised, co-ordinated, trained or developed.

Level 1:	Provides advice, or demonstrates own activities or workplace routines to new or less experienced employees in own work area.
Level 2:	(a) Responsible for day to day supervision or co-ordination of staff within a section/function of a department/service.
	Or
	(b) Regularly responsible for professional/clinical supervision of a small number of qualified staff or students.
	Or
	(c) Regularly responsible for providing training in own discipline/practical training or undertaking basic workplace assessments.
	Or
	(d) Regularly responsible for the provision of basic HR advice.
Level 3:	(a) Responsible for day to day management of a group of staff.
	Or
	(b) Responsible for the allocation or placement and subsequent supervision of qualified staff or students.
	Or
	(c) Responsible for the teaching/delivery of core training on a range of subjects or specialist training.
	Or
	(d) Responsible for the delivery of core HR advice on a range of subjects.
Level 4:	(a) Responsible as line manager for a single function or department.
	Or
	(b) Responsible for the teaching or devising of training and development programmes as a major job responsibility.
	Or
	(c) Responsible for the delivery of a comprehensive range of HR services.
Level 5:	(a) Responsible as line manager for several/multiple departments.
	Or
	(b) Responsible for the management of a teaching/training function across the organisation.
	Or
	(c) Responsible for the management of a significant part of the HR function across the organisation.
Level 6:	Corporate responsibility for the human resources or HR function.

Definitions and notes:

Day to day supervision or co-ordination (Level 2a) includes work allocation and checking. It also includes ongoing responsibility for the monitoring or supervision of one or more groups of staff employed by a contractor.

Professional and clinical supervision (Level 2b) is the process by which professional and clinical practitioners are able to reflect on their professional practice in order to improve, identify training needs and develop. It can be conducted by a peer or superior. It is not for the purpose of appraisal or assessment and only for the purpose of improving practice in context of clinical governance etc.

Regularly (Level 2b, c and d) at least once a week on average but could be in more concentrated blocks, e.g. six weeks every year. Above Level 2 the responsibility must be ongoing.

Practical training (Level 2c) e.g. training in lifting and handling, COSHH regulations.

Training in own discipline (Level 2c) means training people from own or other disciplines concerning subjects connected with own work, e.g. an accountant training departmental managers in budgetary requirements, a specialist dietitian providing training to other professionals concerning the importance of diet in different clinical situations.

Undertaking basic workplace assessments (Level 2c) includes undertaking assessments of practical skills, e.g. NVQ assessments.

Provision of basic HR advice (Level 2d) refers to a specific and ongoing responsibility for giving basic advice on HR policies and practices to staff other than those who they supervise/manage, for example, on recruitment procedures and practices within the organisation.

Day to day management (Level 3a) includes responsibility for all or most of the following: initial stages of grievance and discipline; appraisal, acting as an appointment panel member; ensuring that appropriate training is delivered to staff; reviewing work performance and progress; work allocation and checking.

Responsibility for allocation or placement and subsequent supervision (Level 3b) includes liaison with training providers, allocation of students/trainees to staff for training purposes, ensuring that student/trainee records or assessments are completed.

Responsibility for teaching/delivery of core or specialist training (Level 3c) refers to a significant and on-going job responsibility for training individuals in either elements of the jobholder's specialism or a core range of subjects. The trainees may be from either within or outside the jobholder's profession.

Responsible for delivery of core HR advice across a range of subjects (Level 3d) refers to responsibility for giving advice and interpretation across a range of HR issues, e.g. recruitment, grievance and disciplinary matters, employment law, as a primary job function.

Line manager (Level 4a) includes responsibility over own staff for all or most of the following: appraisals; sickness absence; disciplinary and grievance matters; recruitment and selection decisions; personal and career development; departmental workload and allocation (i.e. allocation and re-allocation of blocks of work or responsibilities for areas of activity, not just allocation of tasks to individuals).

Single function or department (Level 4a) means any unit of equivalent scope to a department where there is a significant management responsibility; taking into account the diversity and scope of the workforce managed.

Teaching or devising training - as a major job responsibility (Level 4b) refers to situations where teaching or devising training is one of the primary job functions and specified as a 'job purpose' and/or as a major job duty.

Corporate responsibility (Level 6) refers to accountability for human resources across the organisation(s).

10. Responsibilities for information resources

This factor measures specific responsibilities of the job for information resources (e.g. computerised; paper based; microfiche) and information systems (both hardware and software, e.g. medical records).

It takes account of the nature of the responsibility (security; processing and generating information; creation, updating and maintenance of information databases or systems); and the degree to which it is shared with others. It assumes that all information encountered in the NHS is confidential.

Level 1:	Records personally generated information.
Level 2:	(a) Responsible for data entry, text processing or storage of data, utilising paper or computer based data entry systems.
	Or
	(b) Occasional requirement to use computer software to develop or create reports, documents, drawings.
Level 3:	(a) Responsible for taking and transcribing formal minutes.
	Or
	(b) Regular requirement to use computer software to develop or create reports, documents, drawings.
	Or
	(c) Responsible for maintaining one or more information systems where this is a significant job responsibility.
Level 4:	(a) Responsible for adapting/designing information systems to meet the specifications of others.
	Or
	(b) Responsible for the operation of one or more information systems at department/ service level where this is the major job responsibility.
Level 5:	(a) Responsible for the design and development of major information systems to meet the specifications of others.
	Or
	(b) Responsible for the operation of one or more information systems for several services where this is the major job responsibility.
Level 6:	Responsible for the management and development of information systems across the organisation as the major job responsibility.
Level 7:	Corporate responsibility for the provision of information systems for the organisation.

Definitions and notes:

Records personally generated information (level 1) includes personally generated:

• clinical observations
• test results
• own court or case reports
• financial data
• personnel data
• research data

in whatever form the data is recorded (manuscript, word processed, spreadsheets, databases).

Data entry, text processing or storage of data (Level 2a) includes word processing, typing or producing other computerised output such as drawings; inputting documents or notes compiled by others (e.g. test/research results, correspondence, medical or personnel records); collating or compiling statistics from existing records; 'pulling' and/or filing of medical, personnel or similar records.

Occasional (Level 2b) at least two or three times per month on average.

Requirement to use computer software to develop or create reports, documents, drawings (Levels 2b and 3b) refers to a specific job requirement to design and create reports, databases and spreadsheets for others where it is necessary to adjust or set up the formulae or use desktop publishing tools. It also includes Computer Aided Design (CAD).

Taking and transcribing formal minutes (Level 3a) includes board or trustee meetings, case conferences or similar where formal minutes are required, which are published to a wider audience than those attending the original meeting, and where this is a significant job responsibility. It does not include taking notes at departmental meetings or similar, or processing notes taken by others.

Information systems (Levels 2b and 3b) refers to a methodical and structured way of recording, storing or transmitting large amounts of information using manual or computerised methods.

Regular (Level 3b) at least two or three times a week on average.

Responsible for maintaining one or more information systems as a significant job responsibility (Level 3c) includes responsibility for:

• updating software, operating help facilities for an information system(s)
• managing storage and retrieval of information or records.

Responsible for adapting /designing information systems (Level 4a and 5a) refers to an ongoing and specific job responsibility for modifying or creating software, hardware or hard copy information systems.

NOTE: Level 5a is appropriate where the jobholder is responsible for the design and development of an entire system or equivalent.

Responsible for the operation of one or more information systems (Level 4b and 5b) includes direct responsibility for managing the operation of one or more systems which process, generate, create, update, or store information.

Responsible for the operation of one or more information systems for several departments/services (Level 5b) includes responsibility for several departments/ services which process, generate, create, update, or store information as a principal activity.

Responsible for the management and development of information systems (Level 6) is appropriate only where it is the principal job responsibility and where it covers the whole organisation.

Corporate responsibility (Level 7) refers to accountability, normally at board or equivalent level, for information resources across the organisation(s).

11. Responsibilities for research and development

This factor measures the responsibilities of the job for informal and formal clinical or non-clinical research and development (R & D) activities underpinned by appropriate methodology and documentation, including formal testing or evaluation of drugs, or clinical or non-clinical equipment.

It takes into account the nature of the responsibility (initiation, implementation, oversight of research and development activities), whether it is an integral part of the work or research for personal development purposes; and the degree to which it is shared with others.

Level 1:	Undertakes surveys or audits, as necessary to own work; may occasionally participate in R & D, clinical trials or equipment testing.
Level 2:	(a) Regularly undertakes R & D activity as a requirement of the job.
	Or
	(b) Regularly undertakes clinical trials.
	Or
	(c) Regularly undertakes equipment testing or adaptation.
Level 3:	Carries out research or development work as part of one or more formal research programmes or activities as a major job requirement.
Level 4:	Responsible for co-ordinating and implementing R & D programmes or activity as a requirement of the job.
Level 5:	Responsible, as an integral part of the job, for initiating (which may involve securing funding) and developing R & D programmes or activities, which support the objectives of the broader organisation.
Level 6:	Responsible, as an integral part of the job, for initiating and developing R & D programmes, which have an impact outside the organisation, e.g. NHS wide or outside the health service.

Definitions and notes:

Research and development (All levels) this includes testing of, e.g. drugs and equipment and other forms of formal non-clinical research (e.g. human resources, communications, health education) as well as formal clinical research. This factor measures the requirement for active direct participation in research or trials and does not include indirect involvement as a result of a patient being involved in the research.

Occasionally (Level 1) one or two such projects or activities per year.

Undertaking audits (Level 1) includes building and facilities audits or surveys, functional audits, clinical audits. Specific, one off complex audits using research methodology should be counted as R & D activity (Level 2a).

Undertakes R & D activity (Level 2a) includes complex audits using research methodology for example specific one-off audits designed to improve a particular area or service. It also includes the collation of research results.

Undertakes clinical trials or equipment testing (Levels 2b and 2c) is appropriate where active participation is required.

Regularly (Levels 2a, 2b and 2c) is appropriate where it is a regular feature of the work, normally identified in a job description, with relevant activity at least once a month on average and usually more frequently.

Major job requirement (Level 3) indicates a continuing involvement for at least some part of every working week (20% or more per week on average). This level is only appropriate where the jobholder normally has at least one project ongoing requiring this amount of involvement. Where the high level involvement is only required for a one-off project the job should be assessed according to the normal degree of involvement. Formal audits/investigations which meet the continuing involvement criteria should also be included at this level.

Co-ordinating and implementing R&D programmes (Level 4) includes taking overall control of a local, regional or national programme, which may be managed elsewhere. It also includes project management of R & D activities.

An integral part of the job (Level 5) is appropriate where R & D is a significant part of the job and takes up a substantial amount of working time.

Initiating and developing (Level 6) is appropriate where the jobholder is required to specify and develop R & D programmes and get these off the ground.

12. Freedom to act

This factor measures the extent to which the jobholder is required to be accountable for own actions and those of others, to use own initiative and act independently; and the discretion allowed to the jobholder to take action.

It takes account of any restrictions on the jobholder's freedom to act imposed by, for example supervisory control; instructions, procedures, practices and policies; professional, technical or occupational codes of practice or other ethical guidelines; the nature or system in which the job operates; the position of the job within the organisation; and the existence of any statutory responsibility for service provision.

Level 1:	Generally works with supervision close by and within well established procedures and/or practices and has standards and results to be achieved.
Level 2:	Is guided by standard operating procedures (SOPs), good practice, established precedents and understands what results or standards are to be achieved. Someone is generally available for reference and work may be checked on a sample/random basis.
Level 3:	Is guided by precedent and clearly defined occupational policies, protocols, procedures or codes of conduct. Work is managed, rather than supervised, and results/outcomes are assessed at agreed intervals.
Level 4:	Expected results are defined but the post holder decides how they are best achieved. Is guided by principles and broad occupational policies or regulations. Guidance may be provided by peers or external reference points.
Level 5:	Is guided by general health, organisational or broad occupational policies, but in most situations the post holder will need to establish the way in which these should be interpreted.
Level 6:	Is required to interpret overall health service policy and strategy, in order to establish goals and standards.

Definitions and notes

Within well-established procedures and/or practices (Level 1) is appropriate where jobholders are required to follow well defined procedures and do not generally deviate from these without seeking advice and guidance.

Is guided by standard operating procedures (SOPs), good practice, established precedents (Level 2) is appropriate for jobs where there are clearly defined methods and processes for most work activities. Jobholders are required to use a degree of initiative and deal with matters independently where they can, e.g. a jobholder may be required to deal with enquiries and other matters which are generally routine, but is normally able to refer to others non-routine enquiries and other matters.

Is guided by precedent and clearly defined occupational policies, protocols, procedures or codes of conduct (Level 3) is appropriate where the jobholder has the freedom to act within established parameters. Qualified professional/clinical/ technical/scientific/administrative roles typically meet this requirement.

Work is managed, rather than supervised, (Level 3) is appropriate where jobholders are required to act independently within appropriate occupational guidelines, deciding when it is necessary to refer to their manager.

Is guided by principles and broad occupational policies (Level 4) is appropriate where the jobholder has significant discretion to work within a set of defined parameters. This applies, for example, to those who are the lead specialist or section/department manager in a particular (non-clinical or clinical) field, e.g. a human resource job specialising in continuing personal development (CPD), a clinical practitioner specialising in a particular field. This level also applies to jobs with responsibility for interpreting policies in relation to a defined caseload or locality in the community.

Establish the way in which these should be interpreted (Level 5) indicates freedom to take action based on own interpretation of broad clinical/professional/ administrative/technical/scientific policies, potentially advising the organisation on how these should be interpreted, e.g. consultant, professional and managerial roles. This also applies to specialists, who have the freedom to initiate action within broad policies seeking advice as necessary. By definition, there can only be one or a very small number of jobs at this level in any service or department.

Is required to interpret overall health service policy and strategy (Level 6) would be appropriate for jobs with an ongoing requirement to act with minimal guidelines and set goals and standards for others.

13. Physical effort

This factor measures the nature, level, frequency and duration of the physical effort (sustained effort at a similar level or sudden explosive effort) required for the job. It takes account of any circumstances that may affect the degree of effort required, such as working in an awkward position or confined space.

	The job requires:
Level 1:	A combination of sitting, standing and walking with little requirement for physical effort. There may be a requirement to exert light physical effort for short periods.
Level 2:	(a) There is a frequent requirement for sitting or standing in a restricted position for a substantial proportion of the working time.
	Or
	(b) There is a frequent requirement for light physical effort for several short periods during a shift.
	Or
	(c) There is an occasional requirement to exert light physical effort for several long periods during a shift.
	Or
	(d) There is an occasional requirement to exert moderate physical effort for several short periods during a shift.
Level 3:	(a) There is a frequent requirement to exert light physical effort for several long periods during a shift.
	Or
	(b) There is an occasional requirement to exert moderate physical effort for several long periods during a shift.
	Or
	(c) There is a frequent requirement to exert moderate physical effort for several short periods during a shift.
Level 4:	(a) There is an ongoing requirement to exert light physical effort.
	Or
	(b) There is a frequent requirement to exert moderate physical effort for several long periods during a shift.
	Or
	(c) There is an occasional requirement to exert intense physical effort for several short periods during a shift.
Level 5:	(a) There is an ongoing requirement to exert moderate physical effort.
	Or
	(b) There is a frequent requirement to exert intense physical effort for several short periods during a shift.
	Or
	(c) There is an occasional requirement to exert intense physical effort for several long periods during a shift.

Definitions and notes:

Light physical effort (Levels 2 to 4) means lifting, pushing, pulling objects weighing from two to five kilos; bending/kneeling/crawling; working in cramped conditions; working at heights; walking more than a kilometre at any one time.

Sitting or standing in a restricted position (Level 2a) restricted by the nature of the work in a position which cannot easily be changed, e.g. inputting at a keyboard, wearing a telephone headset, in a driving position, sitting at a microscope examining slides; standing at a machine in a restricted area; standing while making sandwiches or serving meals on a conveyor belt system.

Moderate physical effort (Levels 2 to 5) means lifting, pushing, pulling objects weighing from six to fifteen kilos; controlled restraint of patients, e.g. in mental health or learning disabilities situations; sudden explosive effort such as running from a standing start; clearing tables, moving patients/heavy weights (over fifteen kilos) with mechanical aids including hoists and trolleys; manoeuvring patients/clients into position e.g. for treatment or personal care purposes; transferring patient/clients from bed to chair or similar.

Intense physical effort (Levels 4 to 5) means lifting, pushing, pulling objects weighing over fifteen kilos with no mechanical aids; sudden explosive effort such as running from a standing start pushing a trolley; heavy manual digging, lifting heavy containers; heavy duty pot washing.

Occasional at least three times per month but fewer than half the shifts worked, a shift being a period of work.

Frequent occurs on half the shifts worked or more, a shift being a period of work.

Several periods this applies to jobs where there are repeated recurrences of physical effort and does not apply to jobs where the effort in question occurs only once per shift. For example, Level 3c applies to jobs involving the repeated moving or manoeuvring of patients, with mechanical or human assistance, into positions in which care or treatment can be carried out.

Weights quoted are illustrative only. Evaluators should take into account the difficulty of the lifting.

Ongoing continuously or almost continuously.

Short periods are up to and including 20 minutes.

Long periods over 20 minutes.

Walking or driving to work is not included.

14 Mental effort

This factor measures the nature, level, frequency and duration of the mental effort required for the job (e.g. concentration; responding to unpredictable work patterns, interruptions and the need to meet deadlines).

Level 1:	General awareness and sensory attention; normal care and attention; an occasional requirement for concentration where the work pattern is predictable with few competing demands for attention.
Level 2:	(a) There is a frequent requirement for concentration where the work pattern is predictable with few competing demands for attention.
	Or
	(b) There is an occasional requirement for concentration where the work pattern is unpredictable.
Level 3:	(a) There is a frequent requirement for concentration where the work pattern is unpredictable.
	Or
	(b) There is an occasional requirement for prolonged concentration.
Level 4:	(a) There is a frequent requirement for prolonged concentration.
	Or
	(b) There is an occasional requirement for intense concentration.
Level 5:	There is a frequent requirement for intense concentration.

Definitions and notes:

General awareness and sensory attention (Level 1) is the level required for carrying out day-to-day activities where there is a general requirement for care, attention and alertness but no specific requirement for concentration on complex or intricate matters.

Concentration (Levels 2 to 4) is where the jobholder needs to be particularly alert for cumulative periods of one to two hours at a time, e.g. when checking detailed documents; carrying out complex calculations or analysing detailed statistics; active participation in formal hearings; operating machinery; driving a vehicle; taking detailed minutes of meetings; carrying out screening tests/microscope work; examining or assessing patients/clients.

Unpredictable (Levels 2b and 3a) is where the jobholder is required to change from one activity to another at third party request. Dealing with frequent interruptions (as in telephone or reception work) is not unpredictable unless they frequently cause the post holder to change from what they are doing to another activity (e.g. responding to emergency bleep, or changing from one accounting task to another in response to requests for specific information). These levels are appropriate for jobs where the jobholder has no prior knowledge of an impending interruption but has to immediately change planned activities in response to one.

Prolonged concentration (Levels 3b and 4a) refers to a requirement to concentrate continuously for more than half a shift, on average, excluding statutory breaks. This is appropriate where the jobholder undertakes few duties other than concentrating on a detailed, intricate and important sample/slide/document, for example cytology screening, clinical coding.

Intense concentration (Levels 4b and 5). Requires in-depth mental attention, combined with pro-active engagement with the subject, e.g. carrying out intricate clinical interventions; undergoing cross examination in court, where the jobholder not only has to apply sustained concentration to the subject matter, but also has to respond/actively participate, as in clinical psychology or speech and language therapy. This is greater than a requirement to observe and/or record the reactions of a patient/client or other person.

Occasional fewer than half the shifts worked, a shift being a period of work.

Frequent occurs on half the shifts worked or more, a shift being a period of work.

15. Emotional effort

This factor measures the nature, level, frequency and duration demands of the emotional effort required to undertake clinical or non-clinical duties that are generally considered to be distressing and/or emotionally demanding.

Level 1:	(a) Exposure to distressing or emotional circumstances is rare.
	Or
	(b) Occasional indirect exposure to distressing or emotional circumstances.
Level 2:	(a) Occasional exposure to distressing or emotional circumstances.
	Or
	(b) Frequent indirect exposure to distressing or emotional circumstances.
	Or
	(c) Occasional indirect exposure to highly distressing or highly emotional circumstances.
Level 3:	(a) Frequent exposure to distressing or emotional circumstances.
	Or
	(b) Occasional exposure to highly distressing or highly emotional circumstances.
	Or
	(c) Frequent indirect exposure to highly distressing or highly emotional circumstances.
Level 4:	(a) Occasional exposure to traumatic circumstances.
	Or
	(b) Frequent exposure to highly distressing or highly emotional circumstances.

Definitions and notes:

Exposure relates to actual incidents but the extent of the emotional impact can be either direct where the jobholder is directly exposed to a situation/patient/client with emotional demands or indirect where the jobholder is exposed to information about the situation and circumstances but is not directly exposed to the situation/patient/ client.

Indirect exposure will generally reduce the level of intensity, so, for example, indirect exposure to highly distressing or emotional circumstances (e.g. word processing reports of child abuse) - Levels 3b or 4b - is treated as equivalent to the levels below i.e. Levels 2a or 3a.

Distressing or emotional circumstances (Levels 1 to 3) for example:

• Imparting unwelcome news to staff, patients/clients or relatives. This includes disciplinary or grievance matters, or redeployment/redundancy situations.
• Care of the terminally ill.
• Dealing with difficult family situations or circumstances.
• Exposure to severely injured bodies/corpses.

Indirect exposure to highly distressing (Levels 2c and 3c) e.g. taking minutes or typing reports concerning child abuse.

Highly distressing or emotional circumstances (Levels 3b and 4b) for example:

• This includes imparting news of terminal illness or unexpected death to patients and relatives; personal involvement with child abuse or family breakdown.
• Dealing with people with severely challenging behaviour.

Traumatic incidents (Level 4a) for example:

• Arriving at scene of, or dealing with patients/relatives as a result of, a serious incident.

Rare means less than once a month on average.

Occasional means once a month or more on average. This level is also appropriate where the circumstances in which the jobholder is involved are very serious, such as a major accident or incident, but occur less than once a month.

Frequent means once a week or more, on average.

Fear of violence is measured under Working Conditions.

16 Working conditions

This factor measures the nature, level, frequency and duration of demands arising from inevitably adverse environmental conditions (such as inclement weather, extreme heat/cold, smells, noise, and fumes) and hazards, which are unavoidable (even with the strictest health and safety controls), such as road traffic accidents, spills of harmful chemicals, aggressive behaviour of patients, clients, relatives, carers.

Level 1:	Exposure to unpleasant working conditions or hazards is rare.
Level 2:	(a) Occasional exposure to unpleasant working conditions.
	Or
	(b) Occasional requirement to use road transportation in emergency situations.
	Or
	(c) Frequent requirement to use road transportation.
	Or
	(d) Frequent requirement to work out doors.
	Or
	(e) Requirement to use Visual Display Unit equipment more or less continuously on most days.
Level 3:	(a) Frequent exposure to unpleasant working conditions.
	Or
	(b) Occasional exposure to highly unpleasant working conditions.
Level 4:	(a) Some exposure to hazards.
	Or
	(b) Frequent exposure to highly unpleasant working conditions.
Level 5:	Considerable exposure to hazards.

Definitions and notes:

Exposure to unpleasant working conditions is rare (Level 1) is appropriate where exposure to unpleasant working conditions occurs on average less than three times a month.

Unpleasant working conditions (Levels 1 to 3) includes direct exposure to dirt, dust, smell, noise, inclement weather and extreme temperatures, controlled (by being contained or subject to health and safety regulations) chemicals/samples. Verbal aggression should also be treated as an unpleasant working condition. This level also includes being in the vicinity of, but not having to deal personally with, body fluids, foul linen, fleas, lice, noxious fumes (i.e. highly unpleasant working conditions if there is direct exposure).

Highly unpleasant working conditions (Levels 3b to 4b) means direct contact with (in the sense of having to deal with, not just being in the vicinity of) uncontained body fluids, foul linen, fleas, lice, noxious fumes.

Hazards (Levels 4 to 5) is appropriate where there is unavoidable exposure to uncontrolled and unsafe situations, e.g. face to face physical aggression, spills of harmful chemicals, road traffic accidents. This level does NOT apply in situations where potential hazards (chemicals, laboratory samples, electricity, radiation) are controlled through being contained or subject to specific health and safety regulations.

Some exposure to hazards (Level 4a) is appropriate where there is scope for limiting or containing the risk (e.g. through panic alarms or personal support systems) e.g. accident and emergency departments and acute mental health wards.

Considerable exposure to hazards (Level 5) is appropriate where there is exposure to hazards on all or most shifts and where the scope for controlling or containing the exposure is limited, e.g. emergency ambulance service work. This level does NOT apply in situations where potential hazards (chemicals, laboratory samples, electricity, radiation) are controlled through being contained or subject to specific health and safety regulations.

Rare means less than three times a month on average.

Occasional three times a month or more on average.

Frequent several times a week with several occurrences on each relevant shift.

Driving to and from work is not included.