NHS at risk of “stagnating" as BMA survey shows cuts to consultants' time to develop services
(issued Wednesday 02 Jun 2010)
Innovation in the NHS is at risk of being stifled as hospitals cut the amount of time senior doctors can devote to new services, the BMA warns today (Wednesday 2 June 2010).
Under their standard contract, NHS consultants should have ten hours a week available for Supporting Professional Activities (SPAs), such as the introduction of new services, research, clinical governance, and training junior doctors.
However, interim findings from a UK-wide survey of over 2,000 NHS consultants, published today at the BMA’s Consultants Conference, indicate widespread cuts to the time available for such activities.
Over a fifth (21%) said the number of SPAs in their job plan had been reduced since they transferred to the new consultant contract in 2004, or since they started. Only seven per cent said the number of SPAs had increased. 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, says: “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.”
Nearly two thirds (65.4%) said the decrease to their SPA time was employer-driven. Areas identified as having already been affected by reductions, or at risk of being affected in future, included the training of junior doctors and continuing professional development. Of those respondents who reported that their SPAs had not changed, more than nine in ten (91.1%) said they would not be willing to accept a decrease in future.
The survey also shows that:
- Consultants are contracted to work an average 44 hours a week, but work on average an additional four
- Over a quarter (25.5%) of consultants report increased out of hours work over the past year
- Consultants now spend on average 12.1% of their working time out of hours – an increase from 9.3% in 2008
- Of those consultants who reported changing their working patterns over the past year, 61.4% reported doing so because of decreased availability of middle grade doctors, and 48.5% said it was to improve the standard of patient care
Dr Porter adds: “In many specialties, consultants are taking on a greater front-line role in response to the needs of patients. The challenge for the NHS is to make sure that this time is used for consultant-level patient care and not just to replace other doctors in shorter supply.”
The survey also shows that eight in ten (80.7%) consultants have a strong or very strong desire to practise medicine.
Notes to editors
2. 2,152 consultants responded to a BMA postal survey between 23 March and 13 May 2010 – a 27.5% response rate. View the key survey findings and methodology below (a final survey report will be published later in the year)
BMA survey of the consultant contract in a changing NHS – Interim report
It has been more than half a decade since new contracts were introduced for consultants and the BMA’s Central Consultants and Specialists Committee (CCSC), which commissioned this survey, believe it is important to have a valid and representative picture of consultants’ opinions of their working lives.
As senior clinical leaders in the NHS, it is essential that the views of consultants are recognised if the NHS is to work coherently and constructively. With finances tightening, cuts in the NHS appear to be inevitable and some of those cuts could impact on the work that consultants do. This survey highlights the commitment of consultants to the NHS – they work unpaid hours, they care about the quality of care they deliver and when given the tools, consultants across the UK can help the NHS progress. Now, more than ever, it is important that this message is realised by those who make decisions about healthcare in the UK, enabling informed choices that secure the long-term future of the NHS for patients.
On 23 March 2010, a postal survey was sent to a random sample of 3,000 doctors registered as consultants on the BMA membership database in England, and all doctors registered as consultants on the BMA membership database in Scotland, Wales and Northern Ireland. A total of 7,827 questionnaires were sent out across the UK. The questionnaire asked respondents about the number of programmed activities (PAs) they worked, the composition of their clinical and non-clinical responsibilities and potential changes to consultants’ working arrangements in the future.
The survey was closed to further responses on 13 May 2010 when the weekly response rate had declined to less than 50 questionnaires per week, giving a response rate of 27.5 per cent (2,152 of 7,827). Initial analysis of the data indicated a response bias in terms of country of work and gender. There was an expectation of respondent bias for country of work due to over sampling in Scotland, Wales and Northern Ireland which would allow for country specific analysis.
To account for any response bias, data analysis in the present interim report has been weighted to the UK consultant population for each country and for gender. After weighting, the total response rate was adjusted to 2,093.
Respondents on the new consultant contract were contracted to work an average 44.0 hours per week (11 PAs) but actually worked an average additional four hours per week, equivalent to one PA above their contracted level.
Respondents were contracted to work an average 32 hours (eight PAs) of Direct Clinical Care PAs (DCCs) per week but actually worked an average of 36 hours (nine PAs).
Of those respondents who indicated their DCCs had increased since starting on their new contract, 42.2 per cent reported that the increase was employer driven.
Of those respondents who reported that their Supporting Professional Activities PAs (SPAs) had decreased, 65.4 per cent reported the decrease was employer driven.
Of respondents whose SPAs had not changed since their new contract, more than nine in 10 (91.1 per cent) said they would not be willing to accept a decrease in future.
84.4 per cent of respondents were opposed or strongly opposed to employers using decreases in consultant SPAs to meet increased clinical demands.
25.5 per cent of respondents reported increased out of hours working in the last year.
On average, 12.1 per cent of respondents’ working time was outside of 7am to 7pm Monday to Friday (England, Wales and Northern Ireland) or 8am to 8pm Monday to Friday and 9am to 1pm Saturday (Scotland), an increase from 9.3 per cent in 2008.
Of those respondents who reported changing their working patterns in the last year, 61.4 per cent reported doing so because of a decreased availability of middle grade doctors and 48.5 per cent changed their working pattern to improve the standard of patient care.
Of those respondents who had not changed their working pattern in the last year, 72.9 per cent would be willing to change to increased out of hours working.
Within their job, respondents were least satisfied with the ability to drive improvements in patient care and their relationship with NHS management and were most satisfied with the amount of variety in their work and with their colleagues and fellow workers.
The majority of respondents stated they would recommend a career as a consultant to an undergraduate student or junior doctor.
80.7 per cent of respondents reported having a very strong or strong desire to practise medicine.
Programmed activity (PA)
PAs are four hours of work if done within the normal working week (7am to 7pm Monday to Friday).
Direct clinical care (DCC)
Direct Clinical Care is defined as work directly relating to the prevention, diagnosis or treatment of illness.
Supporting Professional Activity (SPA)
An SPA is a specific allocation of time within consultants’ contracts to undertake teaching, training, education, CPD (including reading journals), audit, appraisal, research, clinical management, clinical governance, service development etc, - activities that are essential to the long-term maintenance of the quality of the service but do not represent direct patient care.
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