Posts Tagged ‘Consultant contract’

Consultant contract: guidance on supporting professional activities

By Mike Broad - 16th February 2010 12:29 pm

What are supporting professional activities?

The consultant contract’s supporting professional activities (SPAs) reflect activities that are essential to the long-term maintenance of service quality but do not represent direct patient care.

These activities include teaching, training, education, CPD (including journals), audit, appraisal, research, clinical management, clinical governance, service development and even dealing with non-clinical emails.

Supporting professional activities should not include major additional responsibilities such as being a clinical or medical or training programme director, or postgraduate dean. They should also not include agreed external duties such as acting as an examiner, peer assessor or carrying out college or GMC work.

2003 consultant contract recommends 2.5 SPAs in a 10 programmed activity (PA) contract, with a higher proportion of SPAs for those working part-time.

PAs are four hours of work if done within the normal working week (7am to 7pm Monday to Friday). A PA done outside this normal working week is three hours of work.

Consultants should always have enough time in their job plans for non-clinical work. It is during SPA time that consultants have the opportunity to improve and hone their skills, research, innovate, develop new techniques and build new services.

What is the optimum number of SPAs?

The BMA is clear on the issue - any deviation from 2.5 SPAs should be questioned by the consultant concerned and the consequences fully understood.

However, in a recent position statement, the Association of Medical Royal Colleges (AMRC) said it’s difficult to produce specific guidance on the appropriate number of SPAs because of the differing demands of different jobs.

It said this uncertainty is exacerbated by revalidation. The process of revalidation and the work that underlies it - such as CPD, audit, multi-source feedback, patient feedback and critical incident review - is all work that should be accommodated within SPA time. AMRC says any recommendation can only be temporary and will need to be reviewed when impact of revalidation is better understood.

The minimum time required for a consultant to just keep up to date is 1.5 SPAs, it says. This does not include the agreed annual study leave allowance.

However, a contract that includes on 1.5 SPAs and 8.5 PAs would have no time at all for other SPA work such as teaching, training, research, service development, clinical governance and contribution to management.

The AMRC says: “It is unthinkable that a consultant could be employed with absolutely no involvement in management, if only attendance at departmental meetings and reading and responding to management messages.

“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.”

Is it reasonable for new consultants to have less SPAs?

New consultants are being offered less SPAs by some trusts because they’re perceived to be less involved in management and teaching.

The AMRC disagrees. New consultants should be encouraged to get involved in clinical innovation, management, teaching and training not discouraged, it says. A new consultant is likely to need additional time for orientation and being mentored and may need additional CPD to develop any specialist aspects of the post not adequately covered by training to CCT level.

The BMA agrees that consultants with 2 SPAs, or fewer, would find it extremely difficult to take any active role in teaching, training or management. Over time, the absence of such duties would also potentially prejudice that consultant if they were applying for Clinical Excellence Awards.

The AMRC recommends that new consultant posts should continue to be advertised with a job plan which typically includes 2.5 SPAs, with an expectation of annual review. If a consultant is employed with 2 or fewer SPAs, any problems with revalidation should lead to an urgent review of the SPA allocation.

What should a consultant do about having too few SPAs?

The BMA recommends that if a consultant accepts a job with fewer than 2.5 SPAs they should make sure that the job plan specifies what the consultant does in their SPA time and what objectives are associated with this work.

The consultant must also keep a diary of all their work once they take up the post. They can request an interim review of their job plan if they’re doing hours and duties beyond or different from what they’ve been contracted to do.

The trust is obliged to undertake a job plan review if requested, and there is a process of mediation and appeal if it does not result in a mutually agreed resolution.

A record of what has previously been achieved in SPA time will underline the importance of the work performed during that period and help convince the employer of its worth.

How do you get trusts to appreciate the importance of SPAs?

The wording in the model contract is that job plans ‘will typically include an average of 7.5 programmed activities for direct clinical care duties and 2.5 programmed activities for supporting professional activities’.

The use of an ambiguous word like ‘typical’ has created uncertainty. While being personally vigilant is important, consultants should also support their representative organisations’ efforts to protect their contract for the good of the profession and the NHS.

Stephen Campion, chief executive of the HCSA, said: “Hospital consultants are working in a highly developing and fast moving NHS. That means they have continuously to 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 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.”

Read the ARMC’s position statement in full.

BMA Scotland advice on the contract and SPAs.

Royal College of Surgeons’ advice on the contract and SPAs for specialty doctors.

Royal College of Ophthalmologists’ advice on job descriptions.

Calls for consultant SPAs to be protected

By Mike Broad - 15th February 2010 5:01 pm

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.

Stand together and see off the contract threat

By Mike Broad - 11th February 2010 3:05 pm

So, the gloves have come off over consultants’ terms and conditions.

A leaked document by the Foundation Trust Network has revealed the full extent of employers’ intentions. An end to CEAs, reduced SPAs, capped pensions and frozen increments on pay progression are just some of them.

We know we’re in difficult times. But, if you were running a foundation trust, would you seek the answer in undermining and compromising the most important members of your workforce, or would you try to inspire them to work together to find real solutions?

It’s an incredible shame that a sizable proportion of NHS employers preferred to collude in secrecy rather than air and share the challenge with their senior medical staff.

Unfortunately, they will now pay a price for this. Their bond of trust with the consultant body is weakened and doctors’ representatives are on guard.  

We’ve started to see foundation trusts, with their greater independence, test national arrangements and offer non standard jobs. Sometimes they’ve done this for the right reasons, but frequently they’ve not.  

Maybe it was inevitable that they would test consultants’ nationally agreed terms and conditions more directly at some point. I’m sure the Foundation Trust Network, or even your individual foundation trust, will try to smooth things over by claiming it was just a discussion document. Don’t be fooled. This is not just about short-term savings, this is about getting consultants where they want them in future: cheaper, more acquiescent and clinically-focused.

Consultants have a contract which is fair - it rewards appropriately but not excessively. If foundation trusts want to change it, they should be forced towards national re-negotiation not local tinkering.

If piecemeal compromises start to happen locally - however the trust justifies them - all consultants will suffer eventually when inferior terms and conditions become common and ‘acceptable’. At that stage, they might not even ‘need’ the sub-consultant grade anymore.

The consultant body, and its representatives, have to show a united front and see off this very real threat.

Goodwill to be biggest casualty of NHS cuts

By Stephen Campion - 10th February 2010 5:10 pm

Two news items caught my blogging eye this week. Number one concerned a leaked document prepared by the Foundation Trust Network that shows beyond doubt (if there ever was any doubt) how the boom years have turned to bust.

Call it ‘strategic financial re-alignment’ or ‘savage cuts’, the fact is that the NHS, its patients and staff are all in for a hard time in the coming years.

Yet we see the absurd spectacle of NHS ministers fuelling public expectations in the run up to a general election, while behind closed doors their NHS managers are trying to figure out which services and staff they must savage to balance the books.

What makes me so angry is that the NHS Foundation Trust Network appears to be riding roughshod over the very terms and conditions that its political lords and masters agreed with staff representatives. I may not be a keen supporter of the 2003 consultant contract but that does not mean I can ignore it! But that is precisely what appears to be the case here.

Secret meetings discussing redundancies, the plundering of pensions, the tearing up of national agreements and other consequences of financial crisis hardly suggest health service personnel are valued, far from it. The NHS has always depended on the goodwill of its staff. But that goodwill may well be the biggest casualty of the cost cutting knife.   

Irritant number two was directed towards the appalling abuse of power and trust by a senior police commander, Ali Dizaei. I wondered whether four years in jail was sufficient. His actions were grossly unacceptable, let down the people he was appointed to serve, brought his profession into disrepute and demonstrated a total lack of accountability.

The judge had his own reasons for imposing the jail sentence but I could not help but wonder whether he should not have turned to precedent when another senior public servant was also found guilty of an abuse of power. Surely the least the judge could have done was to call for a complete overhaul of the way the profession polices itself, and introduce relicensing, revalidation, appraisal and the appointment of Responsible Officers.

It may be hugely bureaucratic, costly, time-consuming and tiresome, but at least we will be reassured that nothing like this can ever, ever, happen again - can’t we?

Leak reveals plans to slash consultant ‘costs’

By Mike Broad - 1:41 pm

Foundation trusts want to stop clinical excellence awards; slash SPAs for existing and newly appointed consultants; cap pensions for higher earners and remove pensionable items; and freeze increments on incremental pay progression.

These are the provocative proposals of a leaked Foundation Trust Network (FTN) paper, which is part of the influential NHS Confederation. It’s a response to the health secretary Andy Burnham’s commitment, in December, to exploring with unions “whether we could offer frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint”.

The leaked paper, obtained by public sector union Unison, seeks to identify areas for savings, warning that NHS funding could be worse that currently predicted. Flexibility and mobility are being sought because of the intention to move up to 40% of activity from secondary care into community services.

Certain proposals within the document are underlined in red. These indicate key priorities including freezing increments on incremental pay progression for two to three years; stopping CEAs; and, reducing SPAs for newly appointed consultants to one “to enable them to develop clinical skills”.

Other non-red line proposals include capping the pensions of those earning over £100,000, and removing pensionable items such as CEAs and London weighting. On programmed activities, foundation trusts are urged to reduce SPAs for existing consultants from 2.5 to 1.5 or 1 if possible. 

The FTN also calls for the NHS to make it clear that not every trainee will be offered employment from now on.

Stephen Campion, chief executive of the HCSA, said: “This leaked document shows how the boom years have turned to bust. What we need is a lot more honesty and a lot less secrecy.

“The tragedy of the NHS at the moment is that ministers are fuelling public expectations in the run up to a general election whilst NHS management is trying to figure out which services and staff they must cut to balance the books. In a service that has always depended on trust and goodwill, this paper may well destroy more than money can buy.”

In response to the health secretary’s question on being able to offer staff an employment guarantee, the FTN is non committal. It says: “The group believed that the flexibilities outlined above were now a requirement for managing the fiscal realities but that even with these it would not be possible to give job guarantees.

“In reality many of the factors that will determine the shape of future health and social care services are not under the control of providers but will be determined by commissioning decisions around pathways and competition in service provision.”

The BMA has circulated advice to its local negotiating committees on the FTN paper, describing the proposals as a ‘serious threat to the terms and conditions of service’.

While reassuring LNCs that it is a speculative discussion paper and not policy, the BMA says LNCs should not negotiate on the issues and oppose them where necessary.

On CEAs, the union says: ‘Cutting CEAs would mean a major cut to overall consultant remuneration and will impact on pensions. It must be opposed firmly in all trusts. We suggest that where this is proposed, the LNC should decline to negotiate any changes until they are negotiated nationally.’

On SPAs it says: ‘The 2003 contract makes it clear that consultants should be allocated appropriate SPA time in their job plans to enable them to carry out a range of non-clinical duties. As such a blanket reduction of SPA is inappropriate as job plans must be agreed with individual consultants.’

There are 125 foundation trusts in the NHS, representing about half of all acute trusts.

Read the leaked Foundation Trust Network’s document in full.

Did trusts teach Sir Thomas Legg a thing or two?

By Stephen Campion, HCSA chief executive - 16th October 2009 5:51 pm

A week is a long time in politics and so too can it be for the NHS.

In between listening to a medical director lecture a consultant that whatever his employment contract might say if he did not work all the hours required to satisfy the accountants his job would be on the line, and wondering just how the NHS would really benefit from levying a hefty fine on, or even closing, the Royal Cornwall Hospital, it dawned on me how brilliant Sir Thomas Legg has been.

Sir Thomas has reviewed all expenses submitted by our MP’s. He has concluded that whatever the rules may have been at the time they were inadequate and should not have been followed. So MPs who claimed their entitlement now have to pay some of the money back. The brilliance of this approach is that Legg has not only recovered money for the Treasury but has succeeded in changing the relationship between the public and its MPs.

Before the summer recess the public was in hanging mood, ready then to draw and quarter MPs who had abused the system; and, as we know, shares in duck house manufacturers and moat cleaning firms took a nosedive.

But now even the public is beginning to realise that changing the rules retrospectively to suit political ends is unfair. MPs may not be held in the highest esteem but our tendency to fair play offers at least a modicum of sympathy for people who acted within the rules but find, years later, that those rules should not apply.

I wonder if Sir Thomas came to this view after close study of the NHS? Too many trusts are saying that they simply do not care what was agreed between the Department of Health and the BMA in 2003.

Even though they were hailed and endorsed by the government, too many trusts are adopting the ‘Sir Thomas’ approach. “We don’t like the rules and as the game is played on our pitch we will decide how the game is to be played.” Like MPs doctors are entitled to ask whether this is fair.

Perhaps we should agree a new set of rules. My rules would not result in consultants being paid in units of Programmed Activities of four hours each, calculated to the third or fourth decimal point. My rules would recognise that doctors are professionals who resent this time sheet approach. My rules would recognise the value consultants bring. My rules would be work sensitive; not time sensitive.

Who wants to play?

Trusts short change new consultants on SPAs

By Francesca Robinson - 8th October 2009 3:54 pm

New consultants across the UK are being pressurised into accepting contracts with reduced time for supporting professional activities (SPAs) warn doctors’ leaders.

Both the BMA and HCSA say consultants are increasingly being offered contracts with 9 programmed activities (PAs) and only 1 SPA.

This contravenes the terms of the 2003 contract, which recommended a split of 7.5 PAs to 2.5 SPAs.

HCSA chief executive Stephen Campion said: “This started 18 months after the 2003 contract was introduced and is now becoming widespread. Up and down the country more and more trusts are seeking to dilute SPAs in favour of direct patient care activity. 

“It has always been our concern that the 2003 deal was never going to be a national contract so long as trusts were at liberty to offer whatever terms they liked for new appointees.”

He said in one large foundation trust in the south of England he was able to persuade the medical director not to offer new seniors contracts with a 9PA/1SPA split but in other trusts negotiations failed.

Many consultants were accepting these new terms because they did not want to start a career with a disagreement with their clinical director. In some trusts, depending on the workload in different departments, new consultants were being offered contracts with varying amounts of SPA time.

“The thing that will upset many consultants is that after years of painstaking negotiation the contract that was finally agreed in 2003 is not worth the paper it is written on,” said Campion.

The issue recently came to a head in Scotland when the Workforce Directorate of the Scottish Executive Health Department issued guidance stating that NHS Boards should advertise new posts with a 9 PA/1 SPA split.

The BMA has protested to the Scottish Government and has boycotted a working group set up with employers to look into workforce issues.

Dr Charles Saunders, chair of the BMA’s Scottish consultants’ committee, said: “We simply don’t trust the employers. The only thing that would allow us to start trusting them again and have any faith in their behaviour is for the guidance they have issued to be withdrawn.”

He warned that diluting the time available for SPAs would impact adversely on education and training, audit, clinical governance, consultant development and patient safety.

It would also affect the ability of Scottish hospitals to attract and retain high quality staff and could drive some juniors to work abroad after completing their training. 

Mr Paul Flynn, deputy chair and negotiator for the BMA consultants committee, said: “This is an area of great concern to us because the SPA is the part of a consultants’ job plan that enables them to ensure they are doing a high quality job.”

He said they had been receiving a steady stream of phone calls and emails from concerned members and were in the process of doing some work to ascertain the full extent of the problem.

“At the moment we don’t know how many people are actually just putting up with these new contracts because they don’t want to rock the boat. This will be the most important issue for me this year,” said Flynn.

The BMA is advising consultants to ask for a job plan review if they feel they are being short changed on their SPAs and to formally appeal the result if they are still unhappy.

The HCSA is urging consultants to check out the terms and conditions of any job before applying for it and to find out how many SPAs the outgoing consultant has been receiving. They can also negotiate the requirements of the job plan after accepting any post.

A NHS Employers spokesman said: “There are no plans to change the general provisions of the consultant contract in England which suggests a typical split of 7.5 PAs to 2.5 SPAs. However flexibility exists for employers to agree with consultants locally the exact proportion of time allocated to supporting professional activity as part of the overall job planning process.”

You can work for others in own time, says report

By Mike Broad - 25th September 2009 3:01 pm

Consultants should not generally be prevented from working for other providers of NHS-funded services in their own time, the government has been advised.

The Cooperation and Competition Panel said that restricting consultants from working with other health providers in their non-contracted hours would reduce patient choice, limit innovation and undermine investment.

Submissions to the CCP’s inquiry revealed that many trusts were adopting ‘bully boy’ tactics in an effort to prevent their consultants working for new NHS-funded providers. Thirty eight of the 59 trusts making submissions had placed some form of restriction on consultants’ use of their non-contracted time.

The final report recommends that there are only two limited situations in which patients and taxpayers might benefit overall from a restriction placed on consultants: firstly, to address legitimate patient safety concerns arising from the specific performance of a consultant; and, secondly, to prevent a consultant from holding a strategic management position in more than one organisation providing NHS-funded care, or working on competing bids.

Any other restriction imposed by a hospital on a consultant’s ability to work for other providers is likely to be in breach of the Principles and Rules of Cooperation and Competition.

Andrew Taylor, director of CCP, said: “It is clear from the evidence that preventing consultants from working with a wider range of NHS providers hampers efforts to deliver NHS care in new and improved ways.

“The experience and specialist expertise of NHS consultants must be readily available to NHS patients in a range of settings - in local and community-based services, in treatment centres, in integrated care organisations and so on - not just in one hospital alone. By breaking down these traditional barriers we can expect to see patients and communities benefit from better access to NHS care, the development of new NHS services and competition driving real improvements in quality.”

The CCP’s final report has been submitted to its sponsors, the Department of Health and Monitor, which will consider the recommendations and what action to take.

Stephen Campion, chief executive of HCSA, welcomed the report. He said: “If this report puts an end to the intimidation that has undoubtedly taken place it will serve the NHS and its consultants well. But the key focus of the report is that competition is a major driver in meeting government policy. NHS trusts should be in no doubt that this requires cooperation with consultants and not confrontation. We now expect to see that cooperation, and will certainly intervene where it is lacking.”

Read more about trust intimidation on this issue.

Time to run the NHS like a successful business

By Dr Mukhlis Madlom, consultant paediatrician and HCSA executive committee member - 31st July 2009 5:31 pm

In the current financial climate, there has been a lot of talk about future finances of the NHS. Clearly, there is little chance of the NHS continuing to enjoy the sort of generosity in its funding of recent years. In fact, the NHS will be asked to start saving and self-finance.

What can the NHS do to improve its finances? My personal view is that for the NHS to succeed, it should become independent of political and central control and be managed like any successful business. The politicians are unlikely to concede control simply because they lack the courage to do so - but both managers and politicians believe in the idea of managing the NHS as a business.

How successful have they been? The vast majority of managers in the NHS have very little if any true business experience. Although some might argue that it is useful to have managers from within the NHS because they know the system, the problem is that they are likely to have many idiosyncrasies. They lack the wide experience and thinking that is available in business. This needs to change if the NHS finances are to improve. In fact, we have seen evidence of success in having outside business people investigating and turning around failing units. The experience of Sir Gerry Robinson is a recent example.

The other problem with the NHS is size. The combination of central control and bureaucracy have been paralysing the NHS and in the process preventing innovation that is so vital for the success of any business. This can be improved if the NHS is broken down into small units that are run locally. Market forces will continue to work stimulating incentives and innovation. Such smaller units are accountable to the local population and eventually to parliament.

The combination of advances in science and technology and an ageing population will continue to burden the NHS finances and, therefore, we need to look at how the system is funded.  

There has been a lot of noise about hospital consultants’ performance but little about the performance of NHS managers. Over the last few years with the relentless changes in the NHS organisation and culture of targets, the number of managers has substantially increased but I have seen little data or evidence both in the literature and on the ground about their effectiveness or performance.

The NHS is an inefficient organisation that is full of duplication and wastage. A glaring example of this is the disintegration of services into primary and secondary care with little liaison or coordination. This is despite the obvious fact that both are inter-dependant and activity in one section is very likely to impact on the other. The other flawed idea is that primary care should drive secondary care. There is no logical or scientific basis for this.

Currently, there are two highly paid medical professionals, the GP on one side and the hospital consultant on the other doing the same job to a large extent. Take, for example, the referrals for inpatient and outpatient care from primary to secondary care. These activities can be reduced substantially if there is more liaison and coordination between primary and secondary care at all levels including training at junior levels of both sets of professionals.

The employers’ organisations complain that despite the substantial increase in the number of consultants, neither their efficiency or performance had not improved. Where is the problem? The problem surely is in the consultant contract the NHS had negotiated with the BMA. This is time-based rather than activity-based and therefore takes no account of clinical activity.

For many years the HCSA has recommended a work sensitive contract. This is based on what clinical activity is achieved by the consultant within a specified unit of time and therefore addresses both the time and work carried out at the same time. This was suggested by the HCSA but refused by the BMA at the time of the consultant contract negotiations.

My view is that NHS efficiency and finances can be significantly improved; but this needs some commonsense, true business mentality and independence.

Trust under fire for sub-consultant grade

By Mike Broad - 19th July 2009 12:29 pm

University Hospitals Birmingham NHS Foundation Trust has been criticised for setting up a medical workforce that differs from the rest of the NHS and introducing a sub-consultant grade.

UHB has created 40 new roles for doctors alongside its training grades, the most senior of which is called a specialist consultant.

The pay and terms and conditions of the specialist consultant role are based on the 2003 consultant contract. But the salary only mirrors that of the consultant contract for the first five salary increments (£74,504 to £83,829) after which it doesn’t progress.

Dr Mark Porter, deputy chair of the BMA’s consultants committee, said the creation of a new workforce model was “tragic” and undermines the intentions of the national training system - to produce consultants of a consistently high standard.

He said: “Doctors with the qualifications to be an NHS consultant will be taking up a job with similar responsibilities but on worse terms and conditions of service and pay, and without the same prospect of advancement.”

But Dr David Rosser, medical director of UHB, said the specialist consultant role is intended to help “a small number” of senior registrars move on to the specialist register.

He said the role will help the trust retain a number of doctors, originally from overseas, who are struggling to secure consultant positions because of bureaucracy or non-recognition of their specialties. It is also targeted at senior doctors who may or may not have their CCT and are happy to be more clinically focused than a typical consultant. 

The number of supporting programmed activities will be negotiated separately for each position. Rosser said the SPAs will range between the 2.5 and 1 depending on how clinically-oriented the role is.

Describing the workforce development as “contractual honesty”, Rosser explained that all the new roles were being introduced to retain and develop doctors. The new posts would not replace training roles and will have more training opportunities than traditional trust grade positions. Their intention is to bring people back into training, he said.

Rosser said: “I can see why the BMA are taking the stance they are - but I disagree with them. Over the years, the BMA hasn’t done enough to improve trust grade posts. The national training scheme is too inflexible to allow a large, complex trust like us to change and develop our services as we need to.”

The trust is committed to keeping these roles at under 10% of the medical workforce. “They’re the grease in the cogs of the mechanism and not a major step away from national training scheme,” said Rosser.

The BMA’s Porter said: “The big question people considering these posts need to ask themselves is - will the training be recognised?”

Hospital Dr recently reported that an alternative specialist grade is currently being road tested by David Grantham, head of programmes at NHS Employers. A briefing paper says there is a need for the grade to soak up the increasing numbers of doctors completing their training.