Posts Tagged ‘Consultant contract’

Job planning for consultants: a collaborative approach

By Mike Broad - 5th August 2011 4:34 pm

Guidance on consultant job planning has been released following agreement between the BMA and NHS Employers.

Managers and consultants will need to work even more closely together to ensure that NHS organisations are able to meet the challenges created by structural change and financial pressure. Effective job planning is a key mechanism through which consultants and managers can agree, monitor and deliver this shared responsibility.

Here’s a summary of the guidance:

A job plan can be described in simple terms as a prospective, professional agreement that sets out the duties, responsibilities, accountabilities and objectives of the consultant and the support and resources provided by the employer for the coming year.

However, in order to drive measurable and sustainable improvements in quality, an effective job plan needs to be more than a high level timetable which sets out in general terms the range of a consultant’s activity. It is vital that it articulates the relationship between the organisation and the consultant and the desired impact on patient care.

Key principles

Job planning should be:

• undertaken in a spirit of collaboration and cooperation

• completed in good time

• reflective of the professionalism of being a doctor

• focused on measurable outcomes that benefit patients

• consistent with the objectives of the NHS, the organisation, teams and individuals

• transparent, fair and honest

• flexible and responsive to changing service needs during each job plan year

• fully agreed and not imposed

• focused on enhancing outcomes for patients whilst maintaining service efficiency.

Objective setting

Objectives should be set for most of the activities the consultant has in their job plan. This can be explicit - in a stated objective, or implicit in the agreed job schedule and annually agreed Programmed Activities (PAs) delivered. They should set out a mutual understanding of what the trust and consultant will be seeking to achieve over the year and how this will contribute to team, service and organisational objectives.

Clear objectives provide focus for consultants and managers and will help with both service provision and quality improvements. Objectives may be ‘hard’, relating to quantifiable achievements, or ‘soft’, where they may be more descriptive about how someone goes about their job.

The process should follow the SMART formula: specific, measurable, achievable and agreed, realistic, timed and tracked.

Objectives should cover all aspects of a consultant’s role; direct clinical care (DCC), supporting professional activities (SPAs) including personal development and those which are more professionally oriented and academic sessions, where appropriate.

All objectives should ultimately focus on the benefits to patients, and remain focused on key strategic and service aims.

Team planning

The team of consultants should meet and look at the team’s objectives for all. Individual consultant objectives should link to the team objectives and individual job plans should be considered collectively to see how they fit together and work as a whole towards meeting the needs of patients.

The clinical director’s aims should be to:

• enhance the quality and efficiency of patient care

• remove unnecessary duplication of effort amongst the consultant and wider medical team

• achieve comprehensive coverage of the SPA and other non-clinical work needing to be done. An example would be the contribution of the consultants to delivering the education and training of junior doctors

• assure that responsibility for this work is shared and does not rest with one individual consultant

• provide the supporting resources needed for this work

• regularly monitor progress.

Pay

It is the norm for consultants to achieve pay progression, but progression is not automatic. Consultants should not be penalised for failing to meet objectives for reasons beyond their control, such as illness, whether this is due to a lack of agreed supporting resources or another reason. However, both employers and consultants have a responsibility to identify potential problems with achieving objectives as they emerge rather than waiting for an annual job plan review meeting.

Supporting resources

The job plan review should identify and agree the resources that are necessary if the objectives are to be met. There is no point in agreeing objectives if they cannot be realistically achieved.

Not completing an objective may be because of a lack of necessary resources or the existence of organisational barriers to progress. If this happens the consultant and manager should meet to discuss how such barriers could be overcome at the earliest possible opportunity.

Preparation

Preparation is the key to effective job planning. The teams should meet beforehand so that job planning flows naturally from organisational and team objectives and that job plans are not drawn up in isolation. Some of the areas the team should explore include:

• mapping the current commissioning and contracting environment, including expectations for the coming year and beyond

• reviewing the previous year and identifying what went well and where there might be areas for improvement across the organisation/directorate

• identifying the actions and resources needed to improve quality

• reviewing areas of strength and weakness and methods to maximise the opportunities and minimise the possible threats

• identifying the priorities the organisation(s) and the team(s) want to deliver and the shared objectives which might influence job plans

• setting out what will be needed to meet clinical governance requirements, including education, training and research

• improving the use of data in setting objectives and the job plan

• linking to personal objectives around appraisal

• determine any known or likely significant demands on consultant time away from the trust (for example, senior college roles) that will impact on service delivery.

The NHS Quality, Innovation, Productivity and Prevention (QIPP) challenge and CQUIN (Commissioning for Quality and Innovation) are encouraging NHS organisations to think critically about how they can continue to improve the quality of the care they provide and to do so more efficiently. It follows that job planning should also focus on outcomes and the patient experience.

The job plan diary has the potential to provide the most immediate piece of data on activities undertaken by consultants, which can then be supplemented by other sources of information, for example Finished Consultant Episodes (FCE) spells linked to service level agreements.

Some of the data being used to assess the productivity of consultants can be limited in scope, and can fail to measure quality of care or reflect the intricacies of patient care and how consultants contribute to that care. Those involved in job planning should bring all the relevant data needed to plan the activities for the coming year.

For example this could include:

• a working time diary

• appraisal and agreed personal objectives

• any academic objectives

• service business plan and performance over past 12 months covering the ‘whole practice’ of the consultant

• individual performance over past 12 months

• information on activities undertaken in supporting professional activity (SPA) time, such as audits, teaching, clinical management and CPD

• relevant specialty advice, for example, royal college and specialty association guidelines

• evidence of the benefits of external duties/work for outside organisations to the trust and local patients.

The job planning process

It is important that at the outset there is a common understanding of the purpose and scope of the meeting. At least an hour should be set aside for the meeting at a time when all parties are free of other commitments and can avoid interruptions.

The job planning meeting will generally take place between the individual consultant and their clinical manager (who will usually be the clinical director) and academic manager for clinical academics.

As objectives are at the heart of the consultant job plan it is best to start by reviewing the objectives from the previous job planning round. If any have not been achieved then the reasons for this should be explored in a non-critical fashion. If any change in overall direction of the consultant’s job plan is anticipated this should be discussed at this point.

The next step is to consider what objectives are appropriate for the new job plan. It may be helpful to consider the organisation’s objectives and ask the consultant how they think they can contribute. This should lead to the agreement of a new set of objectives for the coming year. It can be entirely appropriate for some of these to be identical to the previous year’s objectives but, in general, to have a completely unchanged set suggests poorly chosen objectives.

Once the objectives are agreed, the resources required to achieve them should then be considered. These could, for example, include clinic or operating theatre time, support from other staff, SPA time, or secretarial and IT support.

Disagreement

The job plan is so central to the work of consultants that it is worth taking the time to get it right. If an element of the job plan cannot be agreed then it may be best to leave that issue for further discussion at another time.

Both parties should consider if they can meet half way for example, where there is an activity that the consultant wants to continue but there seems little room within the overall PA envelope for it, alternating this activity with another on a weekly basis may satisfy both parties.

An alternative strategy may be to suggest a trial of a particular job plan and schedule a review within six months. While there is an agreed process for mediation and appeal, it is best if the parties can arrive at an agreed job plan by themselves.

End product

A job plan should include:

• a timetable of activities

• a summary of the total number of PAs of each type in the timetable

• on-call arrangements i.e. supplement category and rota

• a list of agreed SMART objectives

• a list of supporting resources necessary to achieve objectives

• a description of additional responsibilities to the wider NHS and profession

• any arrangements for additional PAs

• any details of regular private work

• any agreed arrangements for carrying out regular fee-paying services

• any special agreements or arrangements regarding the operation/interpretation of the job plan

• accountability arrangements

• any agreed annualised activity (annualisation is an approach to job planning in which a consultant contracts with their employer to undertake a particular number of PAs or activities on an annual, rather than a weekly, basis).

Read the full guidance.

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Collaboration needed on consultant job planning

By Mike Broad - 6th July 2011 12:59 pm

Guidance on consultant job planning has been released following agreement between the BMA and NHS Employers.

Guide to consultant job planning is intended to help consultants and managers to achieve the collaborative approach to job planning.

It highlights the importance of aligning organisational, team and individual objectives. This ensures that job plans are not drawn up in isolation and that they reflect meaningful and measureable objectives designed to deliver high quality care.

The job plan is defined as a prospective, professional agreement that sets out the duties, responsibilities, accountabilities and objectives of the consultant and the support and resources provided by the employer for the coming year.

The new guide also outlines the benefits of effective preparation for both managers and consultants and covers objective setting, information gathering, supporting resources that may be required and some of the contractual provisions relevant to component parts of the job plan.

Dr Mark Porter, chairman of the BMA’s consultants committee, said: “Patients deserve and expect expert medical care, and consultants provide it. The consultant job plan is the vehicle through which a consultant’s expertise is made available, and this guide will help both consultants and managers to work their way through the job planning process.”

The guidance sets out some key principles which should characterise a collaborative approach to job planning. These include the process being undertaken in a spirit of collaboration and cooperation; being completed in good time; reflective of the professionalism of being a doctor; focused on measurable outcomes that benefit patients; consistent with the objectives of the NHS, the organisation, teams and individuals; flexible and responsive to changing service needs during each job plan year, and fully agreed and not imposed.

The job plan should also be focused on enhancing outcomes for patients whilst maintaining service efficiency, and fully reflect the responsibilities of consultants, including in particular the academic roles of clinical academics.

Dean Royles, director of the NHS Employers, said: “We are confident that job plans which fulfil the key principles in the guide will be more able to deliver high quality patient care in the face of testing financial circumstances and complex organisational change.

“Some trusts are looking at different initiatives to achieve improvements in job planning including using new IT tools, annualisation and team or departmental job planning. All these have the potential to improve the process and should be explored, but the best way to ensure sound job planning is to focus on objectives.”

Read the full guidance.

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Cutting consultant SPAs is a “false economy”

By Mike Broad - 9th December 2010 4:24 pm

The NHS will struggle to improve quality and make efficiency savings if consultants’ supporting professional activities continue to be cut, the BMA says.

A report, called Quality Time, highlights the importance of SPAs - protected time for work such as the development of new services, research and training - and features consultants who have used the time to improve the quality of patient care and save the NHS money.

One example is Mr Hamish Brown, who worked on a re-design of breast surgery services at Birmingham City Hospital, resulting in average hospital stays dropping from five days to one, and the trust saving an estimated £300,000 a year.

Another is Dr Catherine Ralph, an anaesthetist who trains staff to deal with obstetric emergencies, who reduced the amount the Royal Cornwall Hospital in Truro has to pay to the NHS Litigation Authority.

SPA time was also used beneficially by Dr Steve Mather, co-leader of the Bristol Medical Simulation Centre, who has introduced the latest simulation techniques to provide high-tech training to junior doctors.

All the doctors involved in the case studies in the report suggest they would have been either impossible or less likely without protected time.

However, although the model NHS contract for consultants states that their working week should typically include ten hours of SPA time, there have been widespread cuts. Over a fifth (21%) of consultants surveyed by the BMA earlier this year said the number of SPAs in their job plan had been reduced. More than one in seven (15.1%) said their employer had reduced the standard number of SPAs for all consultants, and almost a quarter (23.8%) said their employer had reduced SPAs for newly appointed consultants.

Dr Mark Porter, chairman of the BMA’s consultants committee, commented: “NHS organisations, increasingly squeezed financially and having to achieve more with less, are trying to reduce consultants’ SPA in a search for ‘efficiency’. At its worst this can lead to pressure to treat patients as units of production rather than as individuals engaged in a difficult journey at a testing time.

“We believe it represents a false economy. When consultants have time to reflect on services and improve them, they frequently save the taxpayer significant sums of money. The NHS has been tasked with saving £20 billion by 2014, but this already Herculean task will become even harder if staff are denied time to stand back and consider ways of working more efficiently.”

Read the full report.

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Job planning needs to improve to deliver more

By Mike Broad - 5th July 2010 11:15 am

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.

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SPAs being cut as trusts seek savings

By Mike Broad - 1st June 2010 11:45 pm

A fifth of consultants say their supporting professional activities have been cut since they either transferred or started on the consultant contract.

This is the headline finding of a BMA survey of over 2,100 NHS consultants released today at the annual consultants’ conference.

Dr Mark Porter, chairman of the BMA’s consultants committee, fears that innovation in the NHS is at risk of being stifled as consultants’ SPAs are cut.

He said: “Pretty much every clinical service that a hospital provides has been planned during this time. If hospitals cut it, they risk stifling innovation and allowing the NHS to stagnate.

“This is being driven by the financial pressures we all face but it’s a false economy because the new services consultants develop often save the NHS money.”

The consultant contract’s 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, audit, appraisal, research, clinical management, clinical governance and service development.

Other findings from the survey include 15% saying their employer had reduced the standard number of SPAs for all consultants, and 24% say their trust had reduced SPAs for newly appointed consultants.

Nearly two thirds of respondents said the decrease in their SPA time was employer driven.

Of those respondents who reported that their SPAs had not changed, 91% said they would not be willing to accept a reduction in future.

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

Read a guide to SPAs.

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Employers squeeze consultants’ SPAs

By Mike Broad - 19th April 2010 9:34 am

Trusts are eroding the time allocated to consultants for supporting professional activities.

Two pieces of research on the time given to consultants to conduct such activities as training, research, audits, teaching and clinical governance, suggest that it’s being compromised in a bid to save trusts’ money and raise ‘productivity’.

A study by the BMA of job adverts reveals that 38% of consultant posts advertised in March had fewer than the minimum recommended SPAs. The 2003 contract suggested that consultants should typically have 2.5 SPAs built into a 10 PA contract. The original allocation was recently re-examined and supported in a position statement by the Academy of Medical Royal Colleges (AMRC).

BMA analysis of a similar sample from 2009 revealed that only 10% had fewer than 2.5 SPAs.

Furthermore, freedom of information requests from 99 trusts by HSJ reveal a fifth of acute trusts have reduced or plan to cut the time consultants spend on SPAs. A further 15% admit to looking closely at the value provided by SPAs.

A recent leaked document from the Foundation Trust Network revealed that many employers will seek to reduce consultants’ SPAs to one per week within their job plans.

Dr Mark Porter, chair of the BMA’s consultants committee, said: “SPAs are central to patient care. This is the time when consultants reflect on their work and improve the quality of their personal work and that of the teams in which they work.”

BMA Scotland recently won an exchange with NHS Scotland’s management steering group over advice issued to employers saying new consultants should be offered just one SPA.

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.

Stephen Campion, chief executive of the HCSA, said that many trusts don’t understand the importance of time being made available to consultants for supporting activities.

He said: “Diluting SPA time in favour of more clinical activity is damaging to the NHS.

“The targeting of SPA time comes at a time of financial cutbacks, a shortage of trainees and as a consequence of the Working Time Directive. Consultants are being expected to pay the price for these underlying deficiencies. I am concerned that unless trusts recognise the importance of SPA time, as typically provided in the 2003 contract, recruitment, retention and goodwill will be the inevitable casualty.”

Read more on protecting your SPAs. 

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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.

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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.

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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.

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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?

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