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

According to OP 30 hours a week.

@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.

@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!

Ah. “Unions and the left”.

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

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.

I’m not at all interested in this detail.

Scroll on, then.

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?

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.

@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.

You lot are only looking to improve your bank accounts.

OP you present the work as seeing patients only 3 days out of 7. What are you on about? Do you work 7 days a week? Does anyone? So you’re biased, for a starter. I couldn’t then believe this was a post in good faith.

I followed the explanation but, in essence, your gripe is that to you some seem inefficient. Not a word of praise for those who work hours and hours on top? Oh dear, some leave the tedious appraisal stuff till the last minute.

Please ignore the twatty people op. Your post was incredibly interesting. Makes a lot of sense why nhs care can be so variable, and quite depressing really!

I get paid for 11PAs/week ie 44 hours.

I’ve worked 50+ hours already this week and I’ve got more work to do. None of that is SPA. By Monday am I’ll have done 55 hours minimum. This is a typical week, no crisis etc.

Yes, there are some who don’t do enough but very many who work very hard indeed.

Like in any job there will be people who don't pull their weight.
My dh worked between 60 and 80 hours a week for 30 years. The NHS is a very challenging workplace where the goal posts are constantly shifted by people who have no idea what the consequences of cost cutting and poor management will be.
For example:
Management announce they want a ward round done by a consultant every morning at 08.00 hrs. But they closed the specialist wards, so 20 patients are spread in general wards all over a huge hospital. It takes hours. Then they complain the consultant is late for the clinic that is scheduled for 3 mornings a week. So they want to move the clinics. Then they complain that the afternoon teaching sessions are delayed.
Then they announce that every consultant must do a business case to justify how many support staff are needed to run clinics, including out patient procedures. Arguing about the cost of a part time nurse to run one clinic goes on for weeks, in meetings that disrupt everybody's schedule.
The next thing is that now everyone has email, 3 consultants must share one secretary, deal with all their own correspondence and type their own clinic letters.
In between all of this there are clinical governance meetings, interviews, incident reviews, clinical audits, research, as well as being on call 24/7 every 4th week.
The number of hours that a consultant can be paid for is strictly controlled and salaried. An awful lot of work is done outside of salaried hours late at night and over weekends.
I am sorry that OP has only met lazy consultants.
My experience has been a huge workload that can, at times, be overwhelming.

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.

This. The part time working thing really is a problem, it means the NHS bears the full cost burden of training up doctors only for the private sector to cream off the most profitable areas.

I work in a private company, and my contract has language in that essentially blocks me from taking on another job without agreeing it with my line management. I understand why - if i spread myself too thin, I'm not going to do as good a job for them.

I don't understand why we allow a consultant on a full time contract to do another 12-16 hours a week elsewhere. Let the bloody private sector train its own resource.

Yes, the MDTs are very important and time consuming.

I do 10 PAs and I don't earn 120k. I do at least 4 clinics every week and the state of the system with so few kids being supported by inadequate services, means that I spend at least 4 hours following the clinic just doing admin generated from thar clinic. That means dictating a letter using a dictate system that I need to correct afterwards because they have cut admin staff to the quick and making multiple referrals on multiple systems all of which require me to enter the patient details multiple times and all of which have impossible passwords. That is before I even start triaging and the huge amount of phone messages and results I need to respond to. I am in the hospital every day, 5 days a week, as I am there to supervise juniors. If I'm not (i.e at a conference) I'm directly available (on my personal mobile as I'm not given a work one). My SPA time is inevitably sucked up into admin and extra clinics because I run behind in my follow ups (too few staff, too many referrals) and kids hit crisis point before their follow up comes up and I need to bring them in earlier. Oh and because I'm now several months behind on follow ups, every child I see has got into a right state and needs even more of a sort out, which means more admin and more referrals.

I spend the first day of every annual leave on catch up. Most consultants I know are really busy. I make the job work around my family but that means I'm often finishing admin at the end of the day. I really think the days of consultants disappearing off to the golf course or to private practice are behind us!

When I worked in the NHS, any private clinicians I met were astounded at how hard NHS staff actually worked. That’s always been said.

This thread is plainly politically or commercially motivated, and not at all about NHS doctors in reality.

We pay alot of money for people to manage this in our health systems. So, no, we don't understand it like you won't understand how other professions operate.

the consultants can do whatever they flipping want on their days off (which is of course when they're doing their private work).

This, exactly.

Sorry this is your experience but it's not mine.. emails get answered out of hours, on annual leave etc. Admin sessions are a theoretical concept but emergencies and urgent cases and over flow clinics mop them up. Consultants very stressed. Of course they need admin time. How else do they read results, write letters, research difficult cases etc.
I honestly don't see what you describe in my sector. However....I can imagine in less acute specialities you will get some slack.

A consultant on 10PA who wants to do private work must first offer an 11th PA to the Trust they work for which the Trust can chose to take up or not.

You have described my dh's working life to a tee! Hes supposedly on a 10 PA contract but working at least 12! 1 PA to do admin in theory would mean 3 hours a week to do his admin - he doesn't get it! All admin is done on his own time! Ward rounds are not just all over the hospital, its worse than that, it's over 2 bloody hospitals! 🤦‍♀️ All his clinics are overbooked, all his Endoscopy lists are overbooked. He has zero control over the bookings. Hes working himself into an early grave 🙁 oh and he's seeing a counsellor for anxiety, insomnia and burnout, all whilst still working many more hours than he is paid for.

OP you definitely do not describe the average Consultant's working week!