Fears are mounting that patient safety and clinical quality will be compromised if trusts continue to reduce consultants’ allocation of supporting professional activities (SPAs).
Many new consultant posts are already being advertised with job plans that only include 1 SPA per week. And, last week, a leaked document from the Foundation Trust Network revealed that trusts are planning to reduce existing consultants to 1 SPA if they can to save money.
The 2003 consultant contract recommends 2.5 SPAs in a 10 programmed activity contract.
This week the Association of Medical Royal Colleges (AMRC) called for new consultant posts to continue being advertised with 2.5 SPAs.
It also said that when revalidation is fully introduced consultants will require more SPAs to meet its demands, and if a consultant has 2 SPAs, or less, any problems with revalidation should lead to an urgent review of the SPA allocation.
SPAs include activities that contribute to maintaining the quality of the service but do not represent direct patient care. AMRC estimates that the minimum time required for a consultant just to keep up to date is 1.5 SPAs. But the full range of SPA activities include teaching, training, education, CPD (including journals), audit, appraisal, research, clinical management, clinical governance and service development.
The AMRC position statement says: ‘It is unthinkable that a consultant could be employed with absolutely no involvement in management. Similarly it is difficult to envisage a post that never involves any teaching or training of any sort; most NHS employers receive funding for undergraduate and postgraduate teaching and should be able to explain how this is used.
‘A post that does not permit any involvement in service development or clinical governance would be contrary to our concept of the consultant role. From this it follows that 1.5 SPAs in total would be inadequate and that the original recommendation in the consultant contract of 2.5 SPAs as typical seems reasonable.’
The AMRC also says that the process of revalidation and the work that underlies it - such as CPD, audit, multi-source feedback and patient feedback - is all work that should be accommodated within SPA time.
Stephen Campion, chief executive of the HCSA, commented: “Consultants must continuously keep abreast of modern medicine, maintain their professional skills and ensure that their responsibilities to the GMC are delivered. Thus SPA time is critical for reasons of clinical governance and patient safety. That was the case accepted by government in 2003 and is as relevant, perhaps more so, today.
“Consultants teach and through training the doctors of tomorrow, many contribute to the development of quality standards within the profession. These roles and responsibilities are often overlooked by many NHS managers for whom priority is given to trust survival in preference to the interests of the wider NHS. The short term consequences of diluting SPA time will undoubtedly have a longer lasting and damaging impact on clinical governance, patient safety, the quality to training and maintenance of professional skills.”
The AMRC also takes issue with new consultants being offered less SPAs on the grounds that they’re less involved in management and teaching. ‘New consultants should be encouraged to get involved in clinical innovation, management, teaching and training not discouraged,’ it says.
Read the AMRC’s full position statement.
Tags: Consultant contract, SPAs
