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

[Voxal]

I will preface this with saying I’ve worked in the NHS for 15 years across a number of surgical specialities. I’m burnt out and frustrated with the obvious fixes that nobody wants to tackle:

• consultant job plans. A standard job plan is 10PAs. This is made up as follows:

• 1.5 SPA (supporting professional activities). Consultants do not have to attend site for these sessions. They are supposed to be used for reading, journals, appraisal work and continuing profession activities. In my years of working in the NHS I know that in the main, it’s just seen as free time. I’ve known countless consultants scrabbling around the month before their appraisal because they haven’t done anything to prepare over the last year.
• 1 PA admin. To be taken to look at scans, results, clinic admin and profiling surgical lists. Hit and miss depending on the consultant. Some consultants are excellent at doing their admin, some will happily leave scans and results for weeks before they look at them. Again; they do not have to attend for admin. They are supposed to contactable at home via phone/teams. I have tried to contact consultants numerous times during their “admin” session to chase results for patients to either no answer, or to be told they aren’t in front of their computer.
• 7.5 PA DCC (direct clinical activity). Ostensibly “hands on” clinical care. This is around 3 days of clinical care (clinics or surgery or on call activity).
• So in an average week a full time consultant may only be around for 3 days out of 7. Very few consultants are resident whilst on call.
• They can then pick up 0.25 PAs for being a named educational supervisor for a resident doctor. If you talk to the residents you find again that the consultants aren’t responsive, don’t engage, miss meetings and don’t sign paperwork off in a timely manner. Each consultant can have up to 4 residents they are supervising.
• Each PA is worth £12000 minimum depending on where they are on the pay scale.
• They can also pick up additional PAs for all kinds of “extra work” ie clinical leadership, education lead, MDT lead, governance lead (1PA each). The value of this work is negligible. For example MDTs which run ineffectually with patients being “rolled over” to the next week because they’ve run out of time. Governance meetings to which the lead never shows up. Education leads not running any additional education sessions
• What you invariably end up with is consultants of 12 PAs doing 2-3 days of clinical work a week.

Profiling of surgical lists.

Consultants are responsible for profiling and checking the patients scheduled for surgery with them. This runs the gauntlet of excellent surgeons who hold control of their lists and direct exactly who is on it and consultants who couldn’t care less; turn up on the day of surgery and end up cancelling patients because they aren’t ready for surgery or they need a different scan because the surgeon hasn’t bothered asking or looking at their list in advance.

And the thing that winds me up more than anything, surgeons profiling their lists as “full”. Yet when they come in at the weekend to do a private list, suddenly they can do twice the amount of procedures they can do on an NHS list. So on a Monday I can only do 2 of this procedure but on a Saturday suddenly they can do 4. With exactly the same staff as they have in the week.

Do not get me wrong, there are some excellent diligent consultants who we couldn’t survive without, who end up having to take on more and more work due to the failings of their colleagues who seem to think they are not employees and can act with complete impunity with regards to behaviours, rinsing the system whilst doing as little as possible and pulling the ladder up behind them with regards to training their residents.

I feel so worn out from the same issues across the NHS which nobody seems willing to do anything about

Of course we don’t understand this and I can’t see a scenario where I would care!

You are not being unreasonable to think that most people don't know that, they obviously don't - and I've read it and still don't know.

You are being unreasonable to think patients would want to know this. It sounds like you need to bring your grievance up with your employer.

Don’t know what a PA per week is for starters . Stop moaning and change your job if you don’t like it

Well, you’re right. Most people don’t understand this but I wouldn’t expect them to.
It’s the same for most professions. I’m a university academic and most people don’t understand how my job works and make huge assumptions about what we do (or don’t do).

Why would we know this or need to know? What is a PA?

Why would anyone WANT to understand this.
You appear to have some sort of delusion of grandeur.

I’m staggered by the first few responses saying that they don’t care. I guess this is why the NHS is so expensive if people aren’t bothered?

Thanks for the post. Very enlightening!

(It took me a few sentences to twig that a “PA” is essentially 4 hours of work, for which the consultant is paid £12k per year).

I think the problem becomes one of culture. That some unethical consultants are taking the mickey, but putting controls in for it would further increase admin and bureaucracy.

I don’t really understand all of that, but the bit that stood out to me was the admin - my dd’s consultant sat on a very important result for too long and during this lull she became so unwell that she was ventilated in PICU. Dick.

What a batty system! Sounds like a camel designed by a committee. Bureaucracy rules, and where that is so, canny people will play the system to their advantage.
I am hoping these charlatans are outnumbered by decent diligent consultants.

I’ve worked in the NHS now for 25 years - in PCTs then NHSE and to be honest it’s only in the last year when I’ve been in charge of an area of secondary care that I’ve learned how they work. Prior to that I was in primary care areas and no one in secondary care knows how that works.
I get your frustration though as we’re feeling it too. We’re the scapegoats for crappy political decisions and I’m looking forward to the day when we finally merge with DHSC and they won’t be able to blame us.
sorry for derailing, but I get it. There are some really crap consultants out there who need to be sacked, but won’t because they yield too much power in the trust.

What a ridiculous comment. Even though I have no idea what a ‘PA’ is.. I have half a brain and the ability to understand that the OP is saying that. many consultants are taking the piss out of the NHS and working at about 50% capacity - on a salary of circa £120k pa .. and working at capacity and more at weekends doing private work… and you can’t ’imagine a scenario where you would care ?’ Really ? Never needed an operation or constant care ? Never had a relative needing an operation and had it cancelled or delayed multiple times ? If so you are extremely fortunate. Not the same for us all sadly .

I do care OP. It’s a ridiculous state of affairs. and needs urgent review and reform. There are many consultants who still have an ego the size of a house and have been treated like Gods instead of employees. They have become untouchable.. by years of misplaced reverence.

Sometimes when surgeons operate the will have a trainee with them for teaching. This takes longer which is why some lists are shorter than others. In private practice this is a less likely scenario which is why they can see more patients and move through a list quicker. (I work in postgraduate medical training.)

Of course we don’t understand, it’s not our place to be told and there is no need for us to know.

I admire your dedication to your job and you must be fantastic to get to that level so I applaud you for that. I also thank you for your commitment to the NHS and you have my upmost respect but hells teeth, I have no idea what any of those descriptions mean 😂

Of course the general public can’t be expected to know this, why on earth should they? Do they need to know the finer details and intricacies of every single job role?

Nor do they particularly care. They just want the system to function.

Thank you for the job you do, first of all. You are right, I don’t understand how your job works, and frankly having read your post I still don’t. Luckily I don’t need to, as long as you do! Lots of jobs are pretty incomprehensible to outsiders, plus there are frequently assumptions made, ie people think they know what a job is and does, but don’t in reality. I work in HR and it never ceases to amaze me what people think I and my team do and don’t do as a profession, lol.

On the flip side my consultant colleagues do not do private work, and I regularly see them in the department working on their “days off” or “annual leave”. Don’t assume what happens in your department is the same elsewhere!

You missed the bit where the consultant contract is nominally 40 hours a week but theatre staff are on 37.5 hours per week.

This.

Obviously large swathes of the public don't know how my job is structured.

I wouldn't expect them to.

Why would large proportions of the population know that?

Agreed

😂How much do consultants know about being a contract hospital cleaner? Or a TA in a busy run down primary school? Or working at a Recycling Centre.

This is just batshit.

Im sat here with my head in my hands.

I finally understand why we are haemorrhaging money to the NHS. And the problems the OP outline are a symptom, not the cause.

The root cause can be seen in the majority of the responses. It seems most people really just gleefully don’t give a shit.

They want NHS consultants to be the Wizard of Oz behind the curtain and just make it all work. And this is why some feckless consultants can play the system.

People can’t seem to read past your title and are having fun thinking they sound clever when they’re showing their lack of comprehension again.

This was really interesting OP and I appreciate you explaining it. It sounds like the brilliant and diligent ones work really hard but there’s a lot of wiggle room for those that are not to earn the same, or more, for doing less. Doesn’t that really piss off the diligent ones? Or are they too run off their feet to fully notice? Do they have to pick up the slack or is it always the patients taking the brunt? Presumably supporting staff taking the brunt too.

What you describe isn't anything like the actual working practices of any of the consultants In work with.

They runs clinics which are overbooked every single session, so in a clinic which officially runs 9-12 they are actually seeing patients 7.30-3, with no coffee break let alone lunch break. 3 times every week. Then all the work they should have been doing that afternoon has to be done afterwards.

They routinely stay way past their working hours to check on inpatients, to come back and see a patient who didn't take in the information they were given, to answer queries from regs, including advising over the phone while on holiday.

They spend their evenings writing applications to drug companies for compassionate access to drugs.

One part time consultant I work with comes to MDT every week on her supposed day off.

There's a lot wrong with how the system is set up (consultants don't really have a manager, so if they're, ahem, 'eccentric' in some way it's hard to address it) but laziness or taking the piss doesn't feature at my place of work. Maybe you need to move to a different hospital.

You’ve outlined the issues. What are the ‘obvious fixes’ that you’d put in place?