To think large proportions of the population do not understand how consultant job plans work?

You lot are only looking to improve your bank accounts.

@Timeforabitofpeace Time for a reality check then. People don’t like serial complainers and organisations that cannot improve to serve the public. They become self serving. The op is really saying it’s hugely inefficient. Most of us know that but there’s no incentive to be efficient. Is anyone ever sacked? What happens when a department is inefficient - yes, patients suffer. The last time I saw a consultant he said only 3 people had appeared for their appointments the day before. 3. But do they remind people? My hairdresser does. Do they levy a fee for no show? A restaurant does. It takes my CC details. It’s very easy to not care when it’s not your money.

Another consultant here, although not surgical.

I have hundreds of patients under my outpatient care, many of whom are having blood tests every 2 weeks. I look at every blood test requested under my name - that's admin. I look up my list of patients I have sent for scans to see if the scans are done yet and if they are done and reported, I write to the patient or maybe write a referral letter to another specialty as well. I get multiple queries a day from other members of the dept and people outside my dept, including patients asking advice. If we attend an MDT, we may only discuss 1 of my patients, but the MDT may take an hour or more because there are other people's patients on it, and it enables both learning for me and colleagues but also a chance to discuss with colleagues, see if anyone else has any ideas.

I do jobs that an admin person or secretary could do for a fraction of the cost, because managers seem to be happy with cutting costs for admin personnel, and for a consultant to be doing it, instead of trying to work out how they can get me to do the bit of my job that no-one else can do - assessing patients, making decisions and taking overall responsibility for them.

You forgot to mention that the reason why a 10PA consultant may be working only 3 days/week is that duration of PAs varies by the time it's delivered - it's only 3 hours for premium time, and being present and working overnight it can be 2 hours - weekend, evening, overnight activities mean that it's easy for a 10PA consultant to burn through their allowance with oncalls and a relatively small amount of weekend work.

You forgot to mention that often the supplements for being non-resident overnight are tiny. I was medical consultant on call overnight for approx £30 per night, and for that I needed to be available to be woken up, and if needed (fortunately very rare) to attend, after having worked a full day and with a full day the next day.

YABVVU to expect a member of the public to understand the nuts and bolts of it - I don't really understand how a solicitor/barrister does the nuts and bolts of their job.

Wow, what a staggering level of both apathy and poor reading comprehension from so many pps. Don't know which is worse. Does the average MNer really find that information hard to understand? It really wasn't very complex, even if the meaning of PA wasn't specified. It only took one quick read to infer that the OP is highlighting the poor time efficiencies in her little corner of the NHS, wherever that is. I doubt it is the case everywhere but if it were the OP is highlighting an issue that could save millions of pounds and make waiting lists considerably shorter. Why would you not care about that?

Scroll on, then.

I’m not at all interested in this detail.

They start with immigrants
Then people from other races
Trans people
The judiciary
Universities
Gay people
Women (who apparently should stay at home and have lots of children)
And doctors.

Aim to neutralise anyone who has the skills to disagree.

They’ll be coming for you one day, people.

Ah. “Unions and the left”.

Well I thought so earlier but I was too polite to mention it.

@Timeforabitofpeace I have! We all have! We fund the NHS. Training a doctor doesn’t stop after the degree stage. Who supervises? Who spends time doing CPD and guiding doctors? It’s a cost of around £250,000 per doctor. You don’t seem to understand the degree isn’t the end and that’s cheap too at £9,500 a year. Do you think that’s the real cost? Obviously not. Maybe familiarize yourself with true costs and then we could have a sensible conversation.

I think most people other than unions and the Left think the NHS is wasteful. It’s too big. It lacks controls and is poorly led. It’s under funded in some areas but we refuse to look at insurance. It’s madness. Unless we create a lot more wealth the current model is not sustainable and we all know that! Yet, we have politicians and stupid members of the public thinking it walks on water. It might for some users but many others think it’s inefficient and poor.

It’s allowing GPs and consultants to work part time. They want to do this because they have huge pension pots that will be taxed so they drop hours. They also then allow private working with no cost to the private provider. We (tax payers - well national debt!) also pay into doctors pensions at around 25% or more of their salaries. Is that value for money? Who else gets that? It just means they retire early and barely do 30 years of productive work . Then we hear all the complaints! We obviously don’t get value for money and we need much tighter contracts. It’s why dc scramble to become doctors though. No shortage of applications. Junior doctor is a sort of apprenticeship. You have to do it to get the best jobs later. Like just about any other career!

@Voxal isn't this what most of us call bureaucracy?

I definitely know that when somebody mentions an MDT, from a patient's point of view, I know that that means huge amounts of wasted time and arguments between the individuals forming the team. As a patient, I wouldn't want to be under an MDT. It just means that you get enormous delays to your actual care. I tend to see as a way of consultants getting out of having individual responsibility, but I only see that as a patient so I don't know if I'm correct.

And of course, if you're in hospital for a period of time, the fact that you won't see the same consultant two days in a row is a huge problem. But as users of the NHS, we can't do anything about it. We can only rely on somebody from the inside, or enough people on the inside, speaking up. And I guess nobody will because they would rather things were inefficient and be as removed from responsibility as possible.

I know a couple of professional medics who refer to the way that NHS runs as "the parallel universe". I tend to assume it's like what you've just described, I didn't particularly understand it and I don't know what the PA thing is.

But do we all know about wasted time on the NHS? Yes, I think we do.

I once walked off a contract job for the department of health. I mean, I was polite about it. But I could not do what they were asking me to do. It essentially meant nurses being asked to do more bureaucratic crap.

I should add they were very cagey about the job before I took it, and I sat around for three days before finally pushing someone's explain what the actual job was.

I was reporting to a man on 80 K and he had a team of people on about 50 K who apparently couldn't do the jobs sufficiently, so they called me in. This was years ago so I'm not sure what the salary would be now.

isn't this one of the reasons why many people are starting to want the NHS to actually be abolished? Rather than tinkering around with reforming it. It's some people believe that it actually just needs to be ripped up completely.

I don't pretend to know what the answer is.

According to OP 30 hours a week.

Similarly, clinical psychologists only see about 8 patients a week. While there was waiting lists of years to see them.

@OhDear111

When you’ve paid to train a doctor, come back to me.

So.... how much time do they actually spend with their patients?

Ive been cross about it all for years
Im at a sports club with lots of NHS consultants across various specialisms.

They all work "full time" for the NHS AND do 0.4 or 0.5 of private work on top. Several have been quite honest with me that the work that is supposed to fit in the 0.3 or 0.4 non clinical part of their role, does not need the time & this is how they fit the private work. They earn a lot, they all have either children in private schools or are affording to have a spouse not working. One told me he had to offer the nhs extra time before doing private, he was given a task of redoing some sort of student timetable, he is given half a day a week for it and does it in minutes using AI.

Despite working "two jobs" they manage to be at the sports club a remarkable amount of time......

I do genuinely feel for junior doctors though. They really do seem to do all the work for relatively poor pay. Its an odd model where its a bit shit until you make consultant, then BOOM, gravy train. DH dad was consultant as well and it was exactly the same for him. He was bring home about £230k a year over 10 years ago.

Trying to resist the urge to guess which specialty it is!
doesn't sound like any department I’ve worked in or with…(as a non-consultant anaesthetist that has never had an ‘admin’ session in my life and who regularly see the surgeons (both consultant and non-consultant) in before their shifts start/after they end). There are good’uns and bad’uns in every single profession - I suspect there are some more details about the working lives of the majority that the massive chip on your shoulder is obscuring!

Yes, this is the problem with giving so much control to doctors on the grounds that 'they know best for their patients'. So are absolutely dedicated and conscientious - but too many are out to maximize earnings and dont give a shit.

I totally agree with you OP. I have lots of consultant friends who basically work part time. 2.5 days a week but get paid a full time salary of 120k minimum.

what annoys me more is they complain all the time about their salary and how it’s unfair that their school friends who went into banking or law get paid so much more. All the lawyers I know work 14 hours a day and also have 0 job security

First post nails it, love it!

my job is actually NHS doctor recruitment and I don’t even know all the information in full that the OP put, and nor I do care - and I’m not sure why they thought anyone here would!

also they left out what an actual PA is which considering how much they wrote is odd, Programmed Activity which equals 4 hours. Though WHO CARES 😆

I can't understand the people saying they don't understand or care. The OP is explaining how it is possible for consultants to do far less than the public thinks they do or they could do. Most people would agree the NHS is struggling. Most people have a theory as to why people are waiting too long for care or the care they recieve is inadequate. The theories are typically concerned with under funding and over use. The OP is bringing other information to the table to say that there is also an issue of waste in the system as it enables consultants to under perform. I thought it was interesting OP.

@Timeforabitofpeace Not quite sure what you mean. Doctors have student loans like everyone else. That’s not the full cost of training. They have accepted nhs input into their careers and lots then clear off so not working in the uk for very long. We paid for the training then do not get the benefit. Maybe aquaint yourself with the real cost of training a doctor as opposed to the loan.

Obviously millions of grads have loans! Consultants start on around £110,000. So yes,they pay the student loan as anyone else would earning this! They pay it off fairly quickly though - as they should but that money doesn’t go back into the NHS.

There in fact are very plausible reasons why consultants might be able to operate on more patients on a private list than an NHS one

1. someone already mentioned having to train juniors on an NHS list which really slows you up
2. patients on a private list are usually the straightforward ones that you would supervise the registrar to do on an NHS list . The difficult stuff with multiple complexities and comorbidities is all on the NHS list. They are not doing 8hour head and neck cancer surgery with 3 different surgeons on a private list ever but the NHS does.

I am not a surgeon but in an analogous way in my field I only ever personally see the most difficult complex cases on the NHS because someone less experienced than me can do the easier ones under my supervision. My cases take me longer because of this. If I ever accidentally do get booked an easy one (or when the junior Drs were on strike) it’s like a holiday to me and I can get through them in half the time. However if I worked privately (which I never have and never will) I would see whoever wanted to pay to see me and I expect it would be pretty easy and quick and chill compared to my NHS work.

I work in retail and I doubt you understand what I actually do unless you work in the specific store I work in on the specific department I work in. Nobody will truly understand a job unless tgey do it

@OhDear111They don’t take anything; they pay for it. A lot, and over many years.