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Cut SPA time and juniors’ hours, consortium says

Proposals to cut the wage bill of NHS staff working in 20 hospitals in south-west England could impact on all grades of doctors, two reports reveal.

The South West Pay, Terms and Conditions Consortium (SWC), a coalition of 20 trusts formed to tackle the financial challenges facing the NHS, has published two discussion documents outlining “staff cost reduction potential opportunities”.

The reports argue that NHS’ largest expenditure – staff pay – could be better designed to reflect the needs of each organisation in safeguarding and building on high quality health services, whilst recognising and rewarding high performing staff.

SWC’s proposals for changing the pay and conditions of all NHS staff across the region over three years are designed to save £12m and safeguard 6,000 jobs.

Potential savings which impact on doctors in a sample trust employing 3,500 staff include:

1. Reduce additional programmed activity (APA) rates, valued at £10,000 plus employer costs.

2. Clinical excellence awards, costing around £3000, could be better connected to “desired” service activities.

3. Consultant on-call supplements: reduce paid time allocated to on- and off-site on-call thereby reducing PA and supplementary rates.

4. Junior doctors: a saving of up to 50% on 1,000 staff could be made by introducing a limited working employment contract which is mostly education without access to the current percentage enhancements.

5. Locum and retired consultants: end offer of guaranteed supporting professional activity (SPA) time – this could affect around 10 consultants potentially saving £140,000.

6. New consultant roles: introduce “static” consultant roles which provide only direct clinical care PAs – a potential saving of £250,000 on 15 new posts.

7. Reduce the working week: a 10% reduction in the working week could save a notional 4 hours per consultant.

8. Reduce SPA time from 2.5 to 0.5. Based on 150 consultants this could save £180m.

The alternative to addressing pay, terms and conditions would be an undesirable and costly reduction of jobs which would potentially compromise minimum staffing levels and patient safety, say the reports.

The SWC stresses that these are so far only proposals designed to help them draw up a business case which will be discussed later in the year by the board of each trust member of the consortium.

It says other trusts across England have been closely following what the SWC is doing and have made similar assessments regarding the financial gap facing them.

Saffron Cordery, director of strategy at the Foundation Trust Network, said: “We could well see more FTs developing local responses in future. These are cash strapped times and trusts need to use their resources in the most effective way to improve the quality of care for patients and invest in its biggest asset – its workforce. A one-size-fits-all agreement is not always the way to achieve this.”

The BMA has joined forces with other health unions to develop joint plans to fight any moves towards the development local pay, terms and conditions.

BMA council chair Dr Mark Porter said: “The BMA recognises the financial difficulties facing many NHS trusts, but the focus should be on managers working with staff to find more efficient ways of working and of shaping services, while improving or at least maintaining quality.

“It’s also important to recognise that the current pay freeze for doctors already means that significant efficiency gains will be delivered through the national contracts.”

Chris Bown, SWC chair and chief executive of Poole Hospital NHS Foundation Trust, said: “The consortium acknowledges the concerns expressed by some staff and unions at the establishment of this group, and as these plans take shape I would like to reiterate our commitment to continue to seek to work positively and constructively with staff as well as unions.

“At the heart of the consortium’s work is a shared desire to preserve and protect employment while safeguarding high quality health services for the populations we serve into the future.”

Read the reports: 1. The economic, financial and service challenges 2. Addressing pay, terms and conditions.

Doctors’ pay scales

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14 Responses to “Cut SPA time and juniors’ hours, consortium says”

  1. Malcolm Morrison says:

    The implication of these proposals is that there are many doctors being paid for work they are not doing! If this is the case, why do the managers not sort out the ‘fraudsters’? And who agreed the Job Plan?

    All the tales I hear suggest that most doctors are still doing work that is beyond their contract. In which case, if the managers want to ‘reduice staff costs’, they should identify the work that they do not want the doctors to do and then tell them to stop doing it! I think they might find that a lot of useful and necessary work would have to go, so ‘productivity targets’ would suffer.

    They must also realise that ‘juniors’ are there to be trained; and training takes time – both their time and the trainer’s time. And I’m sure they are aware of the adage:”Time is money”.

  2. Bob Bury says:

    It will be the new contract all over again, when they said ‘we’ll make you work 40 hours’ and we said ‘fair enough, what do you want us to stop doing?’. Result – a massive pay rise that we hadn’t been expecting, forced on to us by a socialist health minister!

    As Malcolm says, the only message to be drawn from this is that they think we are being paid for work we aren’t doing OR that the work we are doing is unnecessary. So the ball is in their court. i suspect that many colleagues would be only too happy to spend more time with their families. I look forward to seeing the managers cover the on-call that we aren’t doing any more.

  3. Off to oz says:

    This is another very sad situation for the NHS. Training is gradually being eroded and the goodwill of doctors exploited.
    I hope if a contract like this gets introduced that the doctors put their foot down and do not do charity work required to balance the managers books.
    I’d like to see a cut in bureaucracy and red tape. That would save vast amounts and improve care.
    I’m frustrated up to the eyeballs with the current situation in the NHS, hence myself and a few others I know are jumping ship to Oz for a better lifestyle, better opportunities and better pay, without management treating doctors like a thorn in their side.

  4. js says:

    Are you still here “Off to oz”?

  5. common sense says:

    Not one proposal of what the savings would be if they reduce the number of bean counters, managers and management consultants. Consultants provide the service that the NHS is there for, managers do not. Why dont we trim the NHS of this flab gained during the labour years?

  6. Clare says:

    If juniors are only there to be trained, who is going to see patients out of hours? Not the consultants, who are having their already derisory rates of pay for on call cut even further!
    Clearly no doctor in the SW will be able to complete enhanced appraisal for revalidation in the 0.5 SpA so what will they do when none of the doctors revalidate?
    Who will chair clinical governance commitees, lead audit, participate in research or work on service developments?
    Have they considered the implications for morale, sickness, early retirement?

  7. gasman says:

    A consortium that agrees and then enforces a pay structure across multiple trusts: Hmmm, price fixing, anti-competitive, OFT etc comes to mind…

  8. david gordon says:

    The question to ask Mr Bown and every other CE is the bonus they will receive for achieving their financial control target. Have a look at the DOH document on pay framework for “very Senoir Managers” or VSMs as they are called updated in July 2012. No austerity for them! Financial control is the number one criterion. Care for your workforce and patients? Forget it.

  9. ian alexander says:

    If they want to do it they will; yet we have the power to block such moves. When the new contract came in many took additional non supperannuable extra sessions and still took work home, sat on committees out of hours, and went those extra miles working beyond their contracted paid for hours. In other words acting as a 3rd column to achieve their additional awards – which management now want to scrap. The goodwill that has run the NHS for the 4 decades of my clinical life has evaporated. Time for worms to turn. Only do 10 sessions or less if desired (improves quality of life and you only have this one); no overtime; work to one’s allotted and paid for contractual hours. Perhaps easier for the non acute specialties but, as the targets are not met, and managers do not reach their bonus targets, thier minds may well become focused on the error of their ways (hopefully) – but their concerns are not our problem.

  10. Nuraja says:

    The proposals will defeat the aim of CPD. Currently I work well past my contract, out of interest and love. SPA time gets fullty utilised + I do much more work that is not claimed. Such stringent attitude will mean ALL extra commitments eg teaching training, working on management related matters would be claimed seprately or one may choose to not contribute to it at all. Managers have to realise that a purely service based post is the first nail in the coffin of a profession which has developed on the love for profession.
    But I do agree that some Drs use SPA time as “free” time. Perhaps managers should check the private clinic schedules of such busy consultants 🙂

  11. truama&kids says:

    2 generations of my family have given everything to the NHS until recently in return for reasonable status, respect, pay, terms & conditions & pension (or perhaps as Batman put it recently not quite everything yet).

    The only solution to this anticompetitive price fixing introduced above and beyond the constraints currently in place from Government is for the Consultant profession to leave the NHS and for the NHS to contract our services should they wish to do do so at a rate we find satisfactory in terms of earning a living and reflecting the hardship years of diligent study, maintaining professional standards and increasingly overworking in an ever less supportive environment.

    Do not leave for the antipodes, do what they did years ago and do it now before we are outmanouvred, as our Candian colleagues were.

    The time for preserving the NHS is gone and Government is looking for an excuse to disband it so let’s give it to them and in 20 years we will need Obamacare. Nothing is new under the sun but the writing is surely on the wall.

  12. David says:

    Point 8: reduce SPA’s from 2.5 to 0.5 for 150 consultants giving a saving of £180 million, presumably over the three years cited at the beginning of the piece.

    This means that each consultant is getting £1.2 m over 3 years for 2 SPA’s, i.e.£200k per SPA per annum or £1m pa for a 10 PA contract.

    Can I work there please.

  13. joshek says:

    the fact that there is no mention, not a single word, about the massive increase in the numbers of administrators, “managers” and all sorts of paper shufflers between 1997 and 2010 is mind boggling. instead, the mantra is:”prevent job losses”. that is plain wrong!

  14. Peter Guy says:

    I personally think the plan to slash SPA’s could be fantastic for me. I assume we would be asked to do clinics operating lists etc instead, which would presumeably be 4 hour blocks. The 10 – 11PA working week would then be nicely filled.

    Of course, all the administration, letters, complaint resolution, service development planning, succession planning, appraisals etc, which currently gets done on Saturdays or in the evenings would be completely abandoned. Most of us use our SPA’s to fulfill these tasks, rather than the purposes they were designed for. Within about 2 weeks, the medical administration no longer carried out by consultants would build up, and the system would collapse in utter chaos.

    However, colleagues, noone really has any sympathy for hard working consultants – patients or Chief Execs. So I am in favour of 9.5 “clinical” PAs a week, 1/2 a PA of journal reading, and off fishing for the weekend! The sheer joy released by NOT cramming “clinical management” into non-existant hours would be unimaginable.

    I do just wonder if the DoH has estimated the cost of having to remunerate us to bail them out of the administrative chaos that would result – but that is for another day! Its the new NHS Logo. “Never knowingly overpaid”

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