Radiology, pathology and anaesthetics should be more productive considering the “high number” of doctors working in those specialties, an Audit Commission report claims.
The report, called Making the most of NHS frontline staff, urges trusts to take a more disciplined and transparent approach to the consultant contract. It says the number of SPAs assigned each week to consultants ranges from 1 to 2.6, and some consultants are working 15 PAs - equivalent to a 64-hour week.
“The essential problem is the quality of consultant job planning, which often lacks rigour or alignment with service objectives,” it says.
The study, which is based on benchmarking work carried out at more than 50 trusts, suggests there is potential to make significant savings by making better use of doctors and nurses. Hospital doctors, it claims, account for 13% of the acute hospital budget.
It finds that the numbers and grade mix of doctors often does not seem to be the result of careful planning of service and training needs. The average number of trainees supervised per consultant in general surgery varies from less than one to more than six in the hospitals it looked at with no obvious rationale.
Furthermore, the cost of locum doctors in trusts varies from 3% to 20% of medical spending. It says: “Clearly there are concerns abou the quality and continuity of care delivered when such extensive use is made of temporary doctors. In some cases, high spend is focused on particular departments.”
It also highlights the variance in admission rates per doctor. It varies by an “inexplicable” factor of more than two, from 129 per doctor each year to 329. The number of first outpatient appointments per doctor varies from 108 to 380 each year.
In nursing, it finds a wide variation in the cost per occupied bed, the number of nurses per bed and the use of temporary nursing. There’s also an unexplained variation in grade mix. The size of wards is the most significant factor in nursing costs per bed.
The report concludes: “The number of hospital admissions has continued to rise year on year. However, there will be greater emphasis in the future on treating people earlier and closer to home so, in theory, reducing the demand for hospital care. This will put further pressure on staffing, making knowledge of the workforce and strategies for efficient management even more important.”
Read the full report.
Tags: Consultant contract, Funding, Productivity
This report contains the usual management consultant speak and assertion rather than an an anlysis of the full facts. Perhaps this is the intention. Sadly it displays a naievety that means that much of the assertion that makes a parallel between industrial productivity and medical workforce will be rightly ridiculed and thus ignored. One wonders if the authors have set foot in a hospital and looked at different patient problems and needs rather than lumping figures together and subjecting them to a very superficial analysis!
The ongoing fiction that fewer patients WILL come to hospital rather than a recognition that more are doing so because of the difficulty and sometimes impossibility of securing care outside hospital is a non sequitur that analysis of attendance figures in most emergency departments gives the lie to.
The report is generally so flawed as to make any of its conclusions laughable. It concludes that some surgeons see more patients than others. Well, if you are a urologist you’ll operate on, say, 10 patients in a list… wheras a major colorectal list will have one (multi-hour) case. Not exactly rocket science
I’m horrified that the detail in this report is SO badly considered and thought through from an organisation that OUGHT to be priding itself on good husbandry of resource - it certainly wasted a lot of resource on this ill-thought-through amateur nonsense.