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

Very interesting post and I learned a lot. Some frankly stupid responses here.

Why would anyone not care about our NHS?

It affects us all.

I am under the care of five separate consultants and the service I get is extremely variable from excellent to one who is bewilderingly disorganised and doesn’t seem bothered about his patients at all.

I am one of those patients you mention who arrived for a procedure which could not go ahead because this consultant had not checked it’s suitability to my specific needs.

A complete waste of my time and nhs resources and some other poor patient who could have used my slot missed out.

The disorganised consultant is your stereotypical superior middle aged bloke with a minor god complex and the efficient others are all down to earth normal approachable people.

This really isn’t the quick issue and solution you seem to say. It’s frustrating when people not actually doing a job assume that they know what people who are doing it are doing with their time. You actually have no idea about research admin etc that individuals may have done unless you are on intimate terms with a lot of people you seem to dislike who simultaneously are sharing every detail of their contracts and working day with you.

You clearly feel that some consultants are lazy, and perhaps you have met some who are, but I’m not convinced by your evidence that this is something you can extrapolate to the whole of the NHS, as I know many consultants and the last thing they are is lazy—often they’re supporting and teaching as well as working on their own careers. I know a couple of retirees who went back during Covid and they were absolutely heroic in what they did. I don’t generalise and say all consultants are heroic, and I’m wary of someone doing the opposite.

Yes you will always get some people who aren’t great in every profession but this is like saying all teachers leave work at 3 PM and don’t do anything in their long holidays….

If you want to talk about inefficiency in the NHS how about the lack of GPs when we have an oversupply of trained GPs but no posts for them, or the huge cost of trusts using locums long term to fill jobs rather than funding posts that would be cheaper instead, the equivalent of using permanent supply teachers rather than recruiting good people who want jobs.

And whilst being slagged off as lazy by idiots. It must be demoralised.

Bollocks. I’m paid 11PAs. My diarying consistently proves I work 13 PAs. I’ve never done any private work. Oh, and most of us aren’t surgeons.

@cunningartificer GPs are partners or employees. If the partners will not employ more GPs, who will make them? No one.

Im sure consultants are not lazy - many have 2 jobs.

Most people working with consultants think the consultant only does the bits they see. They have no clue that the consultant is still working till 7 or 8 pm in the evenings and most of the weekend when they are at home. Also that they are not allowed to do any private work during their contracted NHS hours.
One of the biggest waste of everybody's time is the utterly shameful NHS IT systems and the appalling design of new buildings and facilities. Examination rooms with only one electric socket, printers that never work, no paper because it is rationed, it is endless.

Im a retired consultant who worked 10 PAs . My salary was never anywhere near £120,000. I worked 9 till 6 or 7 most days. I did no private work . I regularly had no breaks and didn’t get lunch. Not all my time was spent with patients. I had to supervise medical students and trainees. I had to attend management and mdt meetings . I had to check results and do admin. It could take 2 hours after a clinic finished to write up notes and dictate letters to GPs.
Reading journals, preparing for appraisal, writing up complex cases all happened at home. No chance of having enough time to do that at work even though I was supposed to have time allocated for it.
Either you work in an unusual setting op, or you have a chip on your shoulder/ want to stir up feelings against hospital consultants.

Not my experience. Out of the 20 or so consultants I worked with for years there was 1 who was an absolute nightmare, 2-3 who were hit or miss and the rest worked their butts off. Some to an absolute extreme. Only 5 ever did private on top of their NHS work.

Admin sessions exist theoretically but more often than not they are lost to extra clinical work with people doing admin in their own time.
I do agree there is so much inefficiency in the NHS and most of the consultants are just as frustrated by those inefficiencies as the rest of us - if not more so.

Professional Activities

8 patients a week for a full time role? How do you know this? With best wishes from a slightly aggrieved and definitely overworked clinical psychologist 🥲

Most corporate employers do not allow people to work additional hours and particularly in a job where there is a conflict of interest.

One of the good ones.

There isn’t as much of a conflict of interest as you might imagine and iirc (am not a consultant) you have to have do an agreed number of PAs in the Nash before you can skip off to the golden nugget (think a pp explained the rules further up).

When I was working part-time in a state job I had to tell my employer I wanted to do a similar job in the private sector. It wasn’t in direct competition and there were sufficient rest hours between the jobs. I did that for a couple of years. (Not consultant.)

PA is a programmed activity, so 10x4 hours is a 40 hour standard week
I think that lists are made by others though, not the surgeon, certainly in the NHS, I work with medics and my brother is a consultant in another role, but they all talk about their lists saying eg I’ve not had my list yet so I think it’s others who create their lists, not the medics themselves
also, with private work, other consultants don’t take over when they’ve gone home, eg I’ve been out with my DB who had been working one morning with a private list and he kept getting calls that afternoon when we were out for late lunch, it was the hospital asking for advice ref his patients on the morning surgical list, he said it’s different in private work as I’m essentially on call all the time the patient is in hospital still

@llamashoe you're not seeing the other aspects of the role. DD1 has a clinical psychologist. She only sees DD1 about once every 6 weeks, but in between times I might email to update her, she might email to see how DD1 is getting on. If she does an assessment, she has to analyse it and write a report. She's written letters to support referrals or transport applications, etc. Imagine she's doing that stuff for all her other patients - it all adds up.

I think you may have replied to the wrong person. I agree, we have lots of activities outwith the direct 1:1 patient facing work.

Sorry - sleep deprived in hospital with DD2. Yes, I was meant to address the person you were quoting.

Thank you for doing the job that you do - the psychologist has been the most helpful professional in DD1's life, really thinking about what she needs to move her towards a more functional life, which includes things like supportive letters for referrals which might otherwise be refused because they are looking at one element of her presentation.

That's really lovely to hear you have had such a positive experience with the psychologist. I hope your daughter is OK.

My consultant dr is amazing as a doctor but I do worry that the nhs can’t pay for their secretaries because every time I try to call or email, she’s away on annual leave. So maybe she only works part time but the other days are not covered? Which means they’re always trying to catch up on all the work which is why on top of everything, they’re overworked in their days But 12k already very low, so I can see why she’s probably not bothered

Thank you! Honestly, it's going to be a while before she's ok, but her psychologist is trying to help her to process her LD and autism so she's less distressed about her life. If we can get her to a place of acceptance, she might learn to thrive.

Yeah that one's nonsense too. In IAPT services they're expected to see 6 a day. Leaving 1 1/2 hours for meetings emails writing letters writing reports clinical supervision teaching sessions and everything else. Some people think that the bit they see is all there is to someone else's job.

most of the consultants i work with are sending emails and working after 10 pm.
the managers less so and spend so much time criticising the consultants it annoys me

Just wondered which of these supporting professional activities you think are pointless and which don’t actually take up any time?

Setting up new trials
Writing the protocols and SOPs and pathways for new treatments
Writing and updating guidelines
Applying for funding approval for drugs to be used in new ways according to latest research
Applying for equal funding across the country for medications you might need for side effects of said drugs
Writing business cases to try and get more staff
Teaching GPs/A&Es/ICUs about said new treatments
Teaching medical students
Supervising resident doctors/nurses
Setting up referral pathways so care is more streamlined
Looking at our patient outcomes so we can see how our use of treatment in the real world compares to the trials
Interviewing for new staff

Never mind that during the time I’m allocated to do the above I’m actually usually dealing with queries from nurses/gps/other hospitals/treatment units, seeing families, squeezing in the odd extra patient, attending incident reviews, dealing with admin that can’t wait.

I do have a bit of flexibility with time shifting some work if e.g. my kids have a medical appointment I’ll work into the evening. Overall the NHS is in massive net credit with the hours I work compared to the hours they pay me for. I may have left what looks like on vaguely on time but I routinely work hours after the kids are in bed. And I’m actively refusing NHS work because I’ll lose my 30 hours childcare. No private practice. Love the job but I don’t want to be financially worse off for doing more.

Also speaking to my colleagues I don’t think large proportions of the consultant body understand the consultant contract either! I’m on the ballsier end when it comes to job planning and trying to capture what I actually do.