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

Universities, local governments, the judiciary, medical professionals-they all seem to be unpopular these days, don’t they?

Why would an ordinary member of the public, not in your profession, be aware of any of this?

@museumum the OP knows this. She’s stirring up trouble. Welcome to the world of the Reform (or similar) thinker.

Look I am a consultant and I find this boring as hell. It’s pretty self centred to think the general public give a shit about the intricacies of medical job plans. I don’t know anything about teachers or lawyers jobs.

@FateAmenableToChange in some areas I totally agree with you. Care on elderly wards I have witnessed is awful. We don’t complain enough but we also want something for nothing. We need insurance to supplement NHS. As nearly everywhere else does. Even Australia that takes our disillusioned doctors. They take nhs training and then zoom off to a mostly pricately funded system.

Well if you can't be arsed to reply to your clear as mud post I can see why things never change or get any better for you...

7.5 PAs of clinical activity is 30 hours - that’s 4 days a week doing 7.5 hours a day. That feels about right surely?

I don't think people outside any profession understand the nitty gritty of how a profession works.

I'm a nurse, my job role entails 50% direct clinical work, with the rest broken up into teaching, planning and research. I can empathise with the fact that I always, always end up having more clinical work that needs doing than fits into half my week, and so things like my research or training gets squeezed or pushing into my personal time. It isn't fair, but things are pretty tricky in the NHS right now, and I think those of us with seniority have to take a hit to try to hold things together.

I don't agree with your calculations about days at home if 75% of your job is direct clinical work, I'd expect someone in 4 days in that case.

You are also talking in a very niche way about essentially surgical jobs. I guess you are some surgeons secretary or something. There are a million different consultant jobs across many different specialties and in the community as well as in hospitals. YABU to apply your experience of one very niche area as though it applied to all of us. What you say has zero relevance to me in a community job where I do not do ‘procedures’

Of course the job entails more than just seeing patients. Admin is essential as otherwise how will letters get written and replied to, patients and GPs called back, results reviewed, onward referrals made. This all takes time and for most of us way more time than is job planned. I usually wind up using my SPA time on supporting clinical activities like that.

The other thing that takes up time is leading and supervising my team, MDT meetings etc. Obviously the most senior person does not just do all the direct work as this would be inefficient. They supervise and lead others doing work which means you need to talk to them and go over their cases. This takes time but less time than if I did every single thing myself. I am line manager for any of the junior Drs as well so I have to deal with their leave requests, sickness, grievances, performance management etc etc as well as teaching and training them and the med students That takes way more time than is assigned in the job plan.

and yes consultants are required to do non contact stuff to lead the service. Who do you think replies to complaints, conducts investigations when things have gone wrong, audits outcomes to make sure they are on track and makes and monitors plans to address deficiencies and improve things? Are these not things you think Drs should be doing?

I am on site working clinically 4 days out of 5 but I am not back to back seeing patients all of that time as I have all the rest of that stuff to do. I can assure you that I work solidly 8-6 at least and often longer with no lunch break and have done for the entirety of my career because there is always something that you could be doing. There is a bottomless pit of need which we are all painfully aware of.

Obvious that OP has an ulterior motive here and is not a medical consultant, someone allied but not necessarily clinical. What OP describes is not my experience at all and allies to what @Nameychangingtonsays.

And yes a PA is a ‘programmed activity’ which is a half a days work that job plans are divided up by.
The fact that OP thinks that Mumsnetters at large will understand that niche piece of info is very odd and socially unaware.

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

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

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.

@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.

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.

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 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

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.

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!

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.

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

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

@OhDear111

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