More consultants not fewer or watered down ones

We’ve led the teams that have cut waiting times and mortality rates. We teach and train new doctors and we develop the research base that is the lifeblood of UK healthcare. We’re leaders, innovators and we’re fighting daily to provide excellent care to our patients. Underpinned by the CCT and the national contract, the day to day work of consultants is the foundation of high quality NHS care.

The BMA has led moves to promote the concept of consultant-based care. In this model, a development from consultant-led care, consultants are involved in all major decisions affecting patient care, and undertake a significant proportion of the treatment of patients, as appropriate to their skills. This concept is now gaining wide-spread support, as is our call for focused consultant expansion.

However, in recent years the safeguards on consultant-based service have come under repeated attack, sometimes overtly, sometimes more insidiously. The initial MMC blueprint suggested the Department of Health (DH) was interested in creating ‘accredited specialists’ - a post-CCT, non-consultant role, something the BMA robustly fought.

In the wake of the catastrophic implementation of MMC, we then saw proposals for Post-CCT fellowships, which again threatened to quietly usher in a sub-consultant grade, despite a lack of workforce need, and in face of the fact that it could have amounted to a career cul-de-sac for many. Once again the BMA fought to limit these to only those areas where the training need was clear.

While such schemes have not been allowed to take root, I believe new threats to consultant-based care are likely to appear on the horizon. There are two reasons for this, one financial, one political. In the current economic climate, with the NHS being required to achieve billions of pounds worth of efficiency savings, consultants are already being targeted. Misleading editorials about our pay are starting to appear and the right-wing think tank Reform has called for 10% salary cuts.

Yet the idea that a subconsultant grade would save the NHS money does not stand up to scrutiny. Post-CCT posts, whatever form they may take, will by definition need to be taken up by doctors who have undergone lengthy training and will come in at, or close to, the base consultant pay scale. The closest current examples have been in some of the ISTCs, which have needed to offer inflated salaries to attract consultant equivalents.

More importantly, cutting back on quality will not improve efficiency - giving patients the highest possible standards of care now will save money in future. There are multiple examples of how consultants add to the efficiency, safety and value for money of service delivery; let alone of the benefits we provide leading and managing the service. We should look at better opportunities to save the taxpayer money, not least the costly marketisation agenda, PFIs and under-performing ISTCs.

The other threat to eroding the ethos of the consultant-based service is the potential move to locally negotiated contracts. We are starting to see isolated examples of advisory appointment committees being sidestepped, and more importantly hospitals advertising jobs with inadequate numbers of SPAs for new entrants. These are insidious erosions of the quality of consultant jobs. A foundation trust in Stockport recently recruited two doctors to resident on-call consultant posts in O&G - posts which did not have royal college approval, and which provided fewer than the 2.5 SPAs recommended in the contract. This happened because the trust’s foundation status meant it did not have to go through an advisory appointments committee.

Our concern is that this moves us another step away from an existing appointments process, with its national overview, and the principle of an NHS with the same standards anywhere in the country.

We shouldn’t allow any watering down of what trainees can expect from their futures and we should be looking to allow more, not fewer, of them to pursue careers as consultants. This isn’t just BMA protectionism - there is a vast amount of clinical evidence in favour of focused and planned expansion in the number of consultants. This is not idealistic; putting high quality care - driven by a consultant-based service - at the heart of a high quality service is what our patients deserve.

Tags: MMC, Sub-consultant grade