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.

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.

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.