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

Yep..I didn't know...and not sure how I'm going to use that information in the rest of my life.

@Nameychangington thanks for putting the other side forward. Good to see other perspectives too.

Could we have a TL:DR please. I've tried to wade through all that but don't really understand what point you're making.

I hope the incidents of slackness you describe aren't typical, OP. I assumed that most consultants are worked off their feet.

Google informed me that PA stands for Programmed Activity, a block of four hours. It would have been easier to understand if you'd explained that.

Why would anyone other than a consultant or someone who works in HR at a hospital know any of it?

It's unnecessary information that the general public have absolutely no control over or influence over.

All we need to know is the doctor or medical person we see at any pay grade is competent and experienced and capable of the task at hand.

So who is monitoring all this? Who makes sure that a Consultant has carried out all their clinic hours?
Or supervision hours?

Can other staff report them?
What happens if they don't meet their obligations?

This enrages me as a wife of a gp who busts his guts keeping on top of pathology, test results, management of staff etc etc. And yet consultants are seen as 'better than a gp. No wonder consultants generally all look healthy, well dressed and balanced in life.
I shall now await the responses from consultants/ family members who tell me i am very wrong

Thank you @Nameychangington for your post. My one was written with pure emotion

The OP isn't writing this so we understand the role of a consultant, but so we see how much time is at best non clinical or at worst wasted! OPs opinion is that a lot of time is wasted.

I think it's fairly widely appreciated that most public bodies waste inordinate amounts of money on consultants. I am sure it's even more frustrating from the inside I work a lot with the European Commission, and the waste of time, money and resources is phenomenal. It's also probably fair to say that most people won't concern themselves with the details for each public body they cross paths with though.

I think you’re talking crap. Most consultants are utterly swamped and are these days working as hard as young doctors, because there are fewer of them than there were, and a huge caseload. I think your post has an ulterior motive.

Why would they understand? People don't have the mental bandwidth or interest to be informed about jobs that aren't their own. No one understands my job either, why would they?

Well in fairness OP, you're not exactly making it clearer.

I think she means medical consultants, not "consultants" of the KPMG sort.

But that reminds me, I worked in the civil service for a while, we were told to reduce the number of consultants. So we brought in a consultancy to look at that for us.......

What a strange thread! I can assure you that large proportions of the population don’t understand how my job works either.

I do not find this remotely surprising or interesting.

There will be a mixture of good and bad consultants. I disagree with Consultants using NHS facilities (private wing) and having a mix of private and NHS patients. I think it is a conflict of interest and no other NHS profession is allowed this privilege. Or are they? I don’t know of any.

I've worked in hospitals and all I've seen is Consultants juggling a hundred tasks. I'm in hospital with my DD2 right now. She's been examined by 2 junior doctors. They took 20 minutes or so to examine her. They were diligent. They both identified priorities for her care, and reassured me that her chest was clear.

The Consultant came along. Less than 5 minutes. Brisk but through examination, clarifying history, showed the junior doctor where she would hear the crackles of her chest infection, and listed the plan.

That's because he's done it a million times. He's spent his time taking histories, listening to chests, palpating abdomens, working through differential diagnoses, etc.

I don't want that Consultant to be doing all the work. It's not his job. His (or her) job is service delivery. That means that the Consultant is ensuring the patients get what they need, including a next generation of competent doctors/surgeons. That takes time. You can't be doing and teaching and doing admin, strategically planning, assessing referrals, etc., all at the same time.

I've met great doctors who I would trust with my family but wouldn't want to chat to them socially. I've met doctors who are really nice but not actually that good, and everything in between. None of them have been undercutting the NHS.

How many people understand the minutiae of other people's jobs? Do you? And what's a PA when it's at home?

1 PA admin. Don't make me laugh.

In nearly 20 yrs of being a consultant, I don't think I've ever had an admin session. I've tried a few times but they immediately get trashed by an emergency.

No, I'm not great at doing my admin. Because there aren't enough hours in the day to do it.

It is interesting to read, even if I didn't really understand all of the terminology, I get the gist of what you're saying I think.

Tbh it doesn't surprise me, human nature is generally pretty selfish and in most lines of work (as well as chosen unemployment) people do what suits them. So it isn't a surprise that a consultant works less hard for the NHS, compared to a private waiting list which presumably they get paid for per patient, per procedure.

Most doctors are probably just as selfish as the rest of society!

From Google...

Sorry wrong post!!

i think it’s quite possible that the NHS is the most toxic and inefficient organisation in the world. This is just one of many examples. My experiences with it have been shocking and when I talk to others it’s seems completely normal to experience ‘care’ that leaves you with PTSD. People here are so willing to accept treatment that would not be acceptable in other countries. I guess unless you have experienced health systems in other countries you don’t realise what it can and should be like.

The only consultants I know are my age (40) and female and I can promise you the old fashioned cliche of the older male consultant on the golf course does not apply at all.
They all that I know work their asses off all week for full time and more hours while their partners take on most of the family responsibilities at home. it’s a tough job, after many tough years qualifying and most are overachievers since their school days with a crazy strong work ethic.

YABU to think that it would ever occur to people to even think they might need or want to know about this! Why would they?