Posts Tagged ‘Consultant role’

“Can we afford consultant delivered NHS?”

By Francesca Robinson - 31st January 2012 3:08 pm

A review which provides new evidence that a consultant-delivered health service improves the quality of patient care has provoked debate over its affordability and whether the consultant contract is out-of-date.

The report, by the Academy of Medical Royal Colleges (AMRC), cites over 70 relevant studies and written and oral evidence from professional organisations and individuals on the benefits of a consultant-delivered care throughout the week.

But it warns that to deliver this gold standard the NHS would be unlikely to be able to afford the required increase in consultants.

However, the BMA argues that the UK cannot afford not to provide consultant-delivered care and that everything the AMRC makes a case for could be delivered within the terms of the existing consultant contract.

The report says the key benefits of consultant-delivered care are: rapid and appropriate decision making; improved outcomes for patients; more efficient use of resources; better access for GPs to the opinions of fully trained doctors; improved patient expectation of access to appropriate and skilled clinicians and better training for junior doctors.

But to achieve consultant expansion the NHS has to address the affordability of an increased number of doctors coming through training. Since 1995 the number of consultants has doubled from 18,000 to 36,000 and the number of trainee doctors has risen from 27,000 to 51,000.

If current trends continue there could be an increase of over 60% in the fully trained hospital doctor headcount by 2020. If all eligible doctors become consultants this could raise the consultant pay bill to £6 billion, £2 billion more than the 2010 bill.

The report says that delivering a meaningful consultant-delivered service would require changes to traditional models of service delivery and some “reshaping” and “layering” of consultant careers and working patterns.

It says: “It could be argued that the funding of such consultant expansion is a priority for the country. However, the realities of the current economic climate and, in particular, the financial pressures on the NHS make this unlikely.”

Dr Ian Wilson, deputy chairman of the Consultants Committee, said the report added new evidence to the case for a ‘consultant-present’ service the BMA and many other organisations had been arguing for over many years.

“While some people say we cannot afford a consultant-based service I would argue we can’t afford not to have one - given the consequences of reduced quality, poorer outcomes and increased risks if you don’t have one.”

He pointed out that a shift towards providing more consultant-delivered care had already occurred in some areas of the country and in some specialities such as paediatrics, obstetrics and anaesthetics

“It doesn’t need a new contract. Everything the Academy is arguing for is completely deliverable within the terms and conditions of the existing consultant contract,” said Wilson.

He said a new guide to consultant job planning produced jointly by the BMA and the NHS Employers was now available to give trusts and consultants all the support they needed to deliver change.

“When we work together we can deliver profound and sustainable change. This report adds a huge amount to the debate about a consultant-present service. It is really well thought through and now needs to be properly debated, planned for and paid for,” said Wilson.

Prof Terence Stephenson, AMRC vice-chair, said: “The weight of evidence makes it clear that it can no longer be acceptable for some patients to have to risk poorer outcomes because consultants may not be available at some times of the day or week.

“This will mean changes to the working patterns of consultants but also to how services need to be staffed and configured in a local area to provide safe care.”

Read The benefits of consultant delivered care.

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“Support extended consultant delivered services”

By Mike Broad - 21st September 2011 1:58 pm

A leaked NHS London report suggests that over 500 deaths a year in London could be prevented if consultant cover was increased at weekends.

Sir Richard Thompson, president of the Royal College of Physicians, commented on the report in a letter published in The Independent.

Here is that letter in full:

Dear Sir,

Your article ‘Hospital staff shortages cause 500 deaths a year’ shows too few junior doctors are caring for too many patients over night and at the weekend. Patients who are admitted to hospital in the evening and at the weekend risk receiving sub-standard care.

Despite the best efforts of consultants who work above their contracted hours, patients are not getting sufficient input to their care from senior doctors during these periods. The supervision and training of junior doctors is also adversely affected by a lack of senior input during these periods. More doctors are required to provide this high level service.

The Royal College of Physicians believes that there is an urgent need to review workforce patterns in hospitals to ensure that medical in-patients receive direct input from consultant physicians on a seven day a week basis.

We previously issued guidance for physicians caring for very sick patients. Hospitals admitting acutely ill medical patients should have a consultant physician on-site for at least 12 hours per day, seven days per week, at times related to peak admissions. Consultants should have no other duties during this period.

We can begin now by reconfiguring acute services. Concentrating specialist services in centres of excellence will improve standards and help to provide a consultant delivered service.

Furthermore, junior doctors’ contract, the New Deal, and the European Working Time Directive must be renegotiated to provide more local flexibility when designing staff rotas in hospitals.

The RCP calls on the government to take urgent action to ensure that extended consultant delivered services - providing safer care for patients and the opportunity for excellent training of the next generation of doctors - can be achieved.

Yours faithfully

Sir Richard Thompson

President

Royal College of Physicians

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Coming to terms with being a consultant

By Dr Anita Houghton - 26th May 2009 12:20 pm

NHS consultants are no strangers to change, so the implementation of the 48 hour week should not come as any great shock to the system. After all, we’ve handled regular restructurings, wholesale changes in the way out-patient appointments are booked, skill-sharing with other professions, less junior support and more on call, to name but a few.

And yet, how often do we reflect on the effects of all this change on our day to day working? How often do we stop and think about how we’ve adapted over the years, and how often do we try to anticipate what a new development is going to require of us personally?

Looking back, it’s interesting to ponder on what the changes have meant for the average hospital consultant; and here you find some paradoxes. On the one hand, consultants are encouraged more and more to contribute to the management of their service, simply maintaining a good clinical service is not enough. On the other hand, consultants arguably have less authority than ever before. Ask a consultant ten, fifteen years ago who their line manager was and they would probably have laughed at you. And that’s only the ones who knew what ‘line manager’ actually meant. More recently appointed consultants are quite accustomed to seeing one of their colleagues as their boss.

In clinical work there has been a trend away from independent working towards team work, and not only medical teamwork, but multidisciplinary team work. Yet, for the most part, the buck for clinical decisions still stops at the consultant. Because of changes in clinical training, and because juniors work fewer hours, they do less and less of the low level tasks. This means that consultants, while managing more at the top end, are also clerking patients and ordering investigations. More paradoxes.

The way consultants are expected to relate to patients has also changed. The expression ‘person-centred’ may have as many meanings as the people who use it, but one thing is certain - it is no longer enough simply to provide a scientifically sound diagnosis and treatment.

So the modern NHS consultant needs to be not only different from the old version, but considerably more. If you have been a consultant in both the old and the new orders, how have you coped with these changes in expectation? Have you moved easily with the times, adapting your style, and if so, what changes have you made, specifically?

Alternatively, have you dug your heels in, or drawn a circle around yourself within which you hope to continue operating in the way you always have? Whichever route you have taken, and most people will have struck some kind of a balance between the two extremes, how has that been for you? 

One thing that doesn’t seem to have changed at all is the expectation that doctors think of themselves as tough people who, in all circumstances, cope. But change is difficult, and if kindness and support in that change is not forthcoming from the system, then doctors have to provide that for themselves. If you have been in the system for a while, operating in a way that seems to be required of you, it’s very tough to find yourself suddenly in the wrong.

Give yourself a little compassion. And if you are managing someone like that, try to understand that their rigidity and lack of cooperation is purely a defence. Underneath that defence lies a repository of sadness for what has been lost, and fear of what is to come. These feelings need to be dealt with before anyone can change.

The next article in this series on management will examine what is required of a modern NHS consultant. 

Anita Houghton provides career and management coaching for doctors and other professionals, and is author of Finding Square Holes, a self-help book for career development, available at www.workinglives.co.uk/articles.htm 

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