A review which provides new evidence that a consultant-delivered health service improves the quality of patient care has provoked debate over its affordability and whether the consultant contract is out-of-date.
The report, by the Academy of Medical Royal Colleges (AMRC), cites over 70 relevant studies and written and oral evidence from professional organisations and individuals on the benefits of a consultant-delivered care throughout the week.
But it warns that to deliver this gold standard the NHS would be unlikely to be able to afford the required increase in consultants.
However, the BMA argues that the UK cannot afford not to provide consultant-delivered care and that everything the AMRC makes a case for could be delivered within the terms of the existing consultant contract.
The report says the key benefits of consultant-delivered care are: rapid and appropriate decision making; improved outcomes for patients; more efficient use of resources; better access for GPs to the opinions of fully trained doctors; improved patient expectation of access to appropriate and skilled clinicians and better training for junior doctors.
But to achieve consultant expansion the NHS has to address the affordability of an increased number of doctors coming through training. Since 1995 the number of consultants has doubled from 18,000 to 36,000 and the number of trainee doctors has risen from 27,000 to 51,000.
If current trends continue there could be an increase of over 60% in the fully trained hospital doctor headcount by 2020. If all eligible doctors become consultants this could raise the consultant pay bill to £6 billion, £2 billion more than the 2010 bill.
The report says that delivering a meaningful consultant-delivered service would require changes to traditional models of service delivery and some “reshaping” and “layering” of consultant careers and working patterns.
It says: “It could be argued that the funding of such consultant expansion is a priority for the country. However, the realities of the current economic climate and, in particular, the financial pressures on the NHS make this unlikely.”
Dr Ian Wilson, deputy chairman of the Consultants Committee, said the report added new evidence to the case for a ‘consultant-present’ service the BMA and many other organisations had been arguing for over many years.
“While some people say we cannot afford a consultant-based service I would argue we can’t afford not to have one – given the consequences of reduced quality, poorer outcomes and increased risks if you don’t have one.”
He pointed out that a shift towards providing more consultant-delivered care had already occurred in some areas of the country and in some specialities such as paediatrics, obstetrics and anaesthetics
“It doesn’t need a new contract. Everything the Academy is arguing for is completely deliverable within the terms and conditions of the existing consultant contract,” said Wilson.
He said a new guide to consultant job planning produced jointly by the BMA and the NHS Employers was now available to give trusts and consultants all the support they needed to deliver change.
“When we work together we can deliver profound and sustainable change. This report adds a huge amount to the debate about a consultant-present service. It is really well thought through and now needs to be properly debated, planned for and paid for,” said Wilson.
Prof Terence Stephenson, AMRC vice-chair, said: “The weight of evidence makes it clear that it can no longer be acceptable for some patients to have to risk poorer outcomes because consultants may not be available at some times of the day or week.
“This will mean changes to the working patterns of consultants but also to how services need to be staffed and configured in a local area to provide safe care.”