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

That is true, but that also takes hours of recording and justifying every single thing you do and explaining it to people who don't understand why you have to do it. It is pretty soul destroying.

From conversations I have had with friends and colleagues, the current funding for GP practices is restricted with regard to its use. This is why GPs can't get jobs and practices now have paramedics and Physician Associates/Assistants in post. Personally I would rather they had another GP.

Its what they do in my Trust. I was shocked.

Are you sure the same person isn't working across more than one location?

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

My point being that it isn't their days off is it. Not really. My friend is a consultant surgeon. He spends his 4PA "admin" etc time doing school runs and family time, which facilitates him fitting in 2 days a week of private work. Compared to my similarly paid finance job, he gets a full time wage for part time hours - he's quite candid that what he's supposed to do in the 4pa non clinical time does not take the time.

Im just not buying it, sorry. There's no other job paying £100k a year plus where you can manage to fit in a second job around what is supposed to be a full time job, yet i know loads of consultants who do exactly this. The structure has been set up to faciliate consultants getting extra pay for private work without dropping from full time nhs pay.

Who the hell gets 4 PAs for admin??! Sorry but I call B.S! No one in dh's team gets more than 1PA admin

I absolutely hate my ex husband for how he has treated me so I have no reason to stick up for him but he is a surgeon, and I know a great many surgeons through him and my sibling (an anaesthetist). I know of absolutely no profession which comes close in terms of hours, responsibility and pressure. Of course there will be bad eggs and lazy fuckers but your suggestion that it’s a general truth half filling lists and taking the piss is so wide of the mark I don’t know where to start. They’re treated like shit in the NHS so more and more of them are leaving and we have no one to replace them with.

I don’t know what axe you’re trying to grind but you’re talking total shit.

That’s simply not possible. No one would jeopardise their license getting in effect paid twice for the same hours. I don’t think you’re getting the full picture or someone’s winding you up.

maybe your friend's one of the 'bad'uns' then. Don't think i know any consultants important enough to get that much admin time but if your friend is spending 16 hours/week DCC time doing the school run or working the golden nugget he will eventually get busted (when something's being done in his name at the NHS and he's nowhere to be found so his colleagues have to bail him out). There is a little bit of flex in the system re. SPA time (because it's not direct clinical contact time) eg. I don't have to be on site for all my SPA, but if the rota goes tits up I'm likely to get called in to cover DCC... if I were nowhere near/still in bed/had my phone off then clearly that'd get found out and it's so not worth the chance that I don't know many people who take the chance. To some extent though, so long as that work gets done at some point it doesn't matter when so much. It's also probably not that big a secret that a lot of consultants with active private practice are men with supportive wives - they 'manage to fit it in' because they may not be doing that much at home.

There is something in the way we job plan for on-calls. I know acute medical consultants and anaesthetists who will have a clinical day made of 3PAs and so work full time contracted hours but have a day off a week. Likewise general medical consultants may have 2PAs to account for evening and weekend on calls through the year so they’re either on 10PAs and have a day off in the week or they’re on 12PAs.

I work on a well staffed and less intensive rota, so my on-call comes out as 0.25PAs full time, but as I work less than full time it’s pro rata and they won’t pay less than 0.25 so I essentially do the evening and weekend on calls for free, which I only recently realised.

Agree. My 15 year NHS experience in our local acute care hospital is that ALL clinical staff work very hard and often put in extra unpaid hours (as do a lot of NHS staff whatever their role) because there are not enough hours in the day - dealing with the constant backlogs due to understaffing, funding, sheer volume of patients, etc.