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.