An angry debate over employers’ long-running intentions to introduce a new sub-consultant grade was reignited this week.
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.
Mr Grantham suggests there should be a new hierarchy within the consultant grade. This would comprise: new consultants predominantly engaged in service delivery; established consultants performing more of a training-oriented and managerial role; with senior consultants taking responsibility for the overall running of services as clinical or medical directors.
BMA consultants’ committee chairman Dr Jonathan Fielden said the proposal is “at best woolly thinking and at worst dangerous”. The Association of Surgeons in Training (ASIT) condemns it as a “retrograde step”.
Mr Grantham, a former BMA industrial relations officer, argued that employers are becoming increasingly concerned that the number of doctors who will qualify as hospital specialists over the next ten years will substantially increase.
The new 48-hour working week and shorter training programmes mean that CCT holders of the future will not have acquired the confidence and experience of existing consultants.
This has stimulated debate among employers over the cost and nature of what being a consultant will mean particularly as the relative proportion of trainees is reduced.
Mr Grantham said some employers are already beginning to develop medical workforce models based on the hierarchy concept and in some specialties employers envisage a ‘chef de service’ model where a senior consultant oversees a hierarchy of specialist doctors to deliver a service.
“The important message that employers would want to see conveyed is that we need to look at the numbers. There is plenty of work for doctors that have been trained but there isn’t a guarantee that all of them will be needed consultant level.”
ASIT has issued a position statement which warns: “Patients request and deserve consultant-delivered care. This gold standard should not be diluted by introducing post CCT non-consultant positions in an attempt to circumvent this.”
Dr Fielden said: “This idea would not be supported by consultants because when they understand the implications of a sub consultant grade they realise it wouldn’t solve any of their problems and would potentially threaten their own working lives. This grade would create a dead end for whole cohorts of our juniors who have already been appallingly treated during the recent MTAS debacle.”
Stephen Campion, chief executive of the Hospital Consultants and Specialists Association, added: “I think it’s a very dangerous step to say that patients will be under the care of somebody who is not a consultant. One has got to look at this idea very carefully and say what on earth is objective?”
Read the BMA’s view.