Excessive consultant workloads are preventing the delivery of good care, the chair of the BMA’s consultants committee told its annual conference.
It will lead to more burn out and recruitment and retention crises in certain specialties, Dr Paul Flynn warned.
Flynn said: “The effect of rising pressure on services was laid bare in recent BMA surveys in which half of consultants described their workload as unmanageable, and identified excessive workloads as the greatest barrier to delivering the care they wanted to for patients. Almost half of consultants reported working outside of their regular hours and satisfaction with work life balance had fallen more amongst consultants than any other group of doctors.
“Many consultants routinely work across seven days, with nine in 10 working evenings and weekends as part of an on call rota with a worrying seven in 10 reporting that they don’t have adequate rest periods between shifts.
“Excessive workloads and stressful working environments are leading to burnout and a recruitment and retention crisis in some specialities, such as emergency medicine, as junior doctors chose to train in other areas of medicine or existing doctors leave the NHS and work abroad.”
He said the breakdown, after 18 months, in the discussions between the BMA and NHS Employers on possible changes to consultant contracts was largely due to the lack of protections.
The BMA walked away from the talks in October 2014 because the BMA could not accept a Heads of Agreement that didn’t provide adequate contractual protections against excessive workload and burnout, which affect patient safety and care as much as consultants’ health and wellbeing. The Government has since asked the DDRB to consider evidence relating to consultant contracts and make recommendations in the coming months.
He said: “Years of experience have taught us that employers often turn a blind eye to good practice guidance and that only those limits which are enforceable by law or by contract offer any sort of protection from excessive workload. That even after over 18 months of negotiations the employers’ side were still trying to move contractual safeguards into guidance told us that our concerns were not being taken seriously.
“Let me make this clear: if the Government wants change, they will have to offer us something in return. Consultants are not superhuman; we deserve time to rest and time with our families. Patients not only understand this, they want it. How many here would like to be treated by an exhausted consultant?”
Despite BMA requests, he said the government didn’t provide sufficient data or modelling to establish what consultants could expect to earn – or to lose – from the proposals.
“The Consultants Committee is preparing to give oral evidence to the DDRB and we expect them to report in July,” he said. “After that, the ball is in the Minister’s court but we have always made clear that we are willing to talk about contract change as long as it comes about through genuine negotiation and meets the needs of our members and their patients. A successful contract reform does not arise from the middle of a tangle of politically-driven red lines. It doesn’t sprout from a desert of facts, barren of realistic modelling. And it certainly doesn’t grow when it is starved of the investment that it needs.”
Flynn also highlighted how consultants value national terms and conditions, but that if they are to be protected then they need to be better defended locally.
“It’s no longer enough for us just to negotiate a national contract – we have to be able to enforce it,” he said. “This is not something that the Consultants Committee alone can do – we need our Local Negotiating Committees to preserve national terms & conditions. And this is why strengthening LNCs is a key area of work for the Consultants Committee this year.”
The BMA will be putting a programme of training and information together for LNCs.
In the bigger picture, Flynn warned that NHS budgets must not be used to prop up social care in the name of integration.
“The Five Year Forward View proposes important changes to the model of care, focusing on greater integration of health and social care which will, no doubt, affect how we work. Only last week the Government announced that £6bn of healthcare spending would be devolved to local authorities in Manchester,” he said. “The challenges posed by these changes are considerable, we must ensure that an already overstretched NHS budget isn’t used to prop up a woefully underfunded social care budget, and we must also ensure that, where appropriate, consultants are put back in the driving seat when it comes to decisions about changes to how care is delivered. We are on the frontline, day in day out, that makes us better placed than any politician or manager to identify how and where improvements can be made in the best interests of patients.”