HCSA chair CLAUDIA PAOLONI looks at unprecedented pressure on consultants’ time and warns of dire future consequences
This morning, as I was standing in the corridor waiting for my next patient, my concerns over the insidious destruction of Supporting Professional Activity (SPA) time were confirmed.
One of my colleagues was called upon to provide support to the paediatric service, for which she has no allocated direct clinical care (DCC) time but which now regularly takes up a large proportion of her SPA time.
In fact, as a surgeon in a small expertise field, she routinely has to give up her SPA to meet clinical demand.
There are not enough consultants available to be able to annualise her clinical work, meet clinical demand and all maintain their SPA, while the Trust’s financial situation means there is no scope for consultant expansion in that field.
While I applaud my colleague for her professionalism and commitment to her clinical role, I also feel that we as individuals are losing the ability to recognise the importance of defending SPA time or the need to join the negotiating battle to ensure adequate resources to meet clinical demand and individual SPA need.
The 2003 consultant contract implemented SPAs to reflect essential activities that an individual needs to undertake to ensure the long-term assurance of quality of service provision, but which are not directly related to patient clinical care.
This includes activities such as teaching, training, education, CPD (including journals), audit, appraisal, research, clinical management, clinical governance, service development and dealing with non-clinical e-mails.
Consultants should have enough time in their job plans for non-clinical work to improve their skills, research, innovate, develop techniques and build new services.
Yet while the 2003 contract detailed 2.5 SPAs as the standard allocation, this position has become increasingly eroded as Trusts find themselves under financial pressure.
This trend has seen a reduction by many Trusts to 1.5 SPA, and worryingly more recently a move down to 1 SPA.
It is apparent that Trusts have also moved towards splitting SPA into a “core” allocation plus an “additional” portion which needs evidence to support its award.
The core initially seemed established at 1.5 SPA to cover everything necessary for GMC and revalidation, general CPD and teaching and basic service provision, with the additional portion often set against a list of “acceptable” activities.
But the overall trend remains a steady ongoing degradation of SPA allowances.
Added to this in many cases is the loss of professional leave or external duty leave allowances, where all activity outside SPA has morphed into a reduced study leave, often spread over a three-year period.
It is becoming increasingly common for consultants to be utilising their study leave to undertake external responsibilities rather than to maintain their CPD through conference attendance or improve their skills on training courses.
In some Trusts this approach is even advocated by the HR department. So we find there is a further gradual erosion of time for maintaining or developing skills for the wider NHS.
When we surveyed HCSA members over the summer the results reflected this concern.
Around half of our survey participants did not feel they were allocated a reasonable amount of SPA time to undertake their duties.
Six in 10 undertake SPA activities that are not paid for.
Four in 10 reported a reduction in their SPA allocation over the past five years, which was enforced rather than negotiated in the vast majority of cases.
In the meantime, however, demands on our SPA time have only increased. Revalidation has been introduced, while CQC inspections mean further governance targets, invariably requiring more paperwork and extra training exercises.
The Royal Colleges are increasingly setting up functions with individuals undertaking peer assessment roles. Research has become ever more protocol driven with increased bureaucratic buoys to navigate.
The demands of training are greater too, with more paperwork, clinical assessments and competencies to formally sign off according to deanery requirements.
With Jeremy Hunt announcing an increase in medical school places, time pressures facing existing consultants are set to increase still further in future.
But these roles and responsibilities are often overlooked by many hospital managers, for whom the financial survival of their Trust outweighs the interests of the wider NHS.
External activities are less likely supported, whether that be inspections for CQC, peer assessments for the Royal Colleges, external memberships of advisory appointments committees, or roles for National Clinical Activity Assessment authorities, government bodies, the GMC or trade unions.
While Trusts and consultants need to minimise the impact on services and the ability to deliver negotiated job plans, Trusts must accept that undertaking duties such as these are essential for the wider NHS.
In 2010 HCSA noted that “SPA time is critical for reasons of clinical governance and patient safety. That was the case accepted by the government in 2003 and is as relevant perhaps more so, today.” Six years on and this is increasingly pertinent as the SPA allocation is whittled away bit by bit.
While as clinicians we want to do the best for our patients, it is clear to me that we also have a duty to ensure that we protect our own and departmental SPA – not only to benefit the wider NHS but also for our own professional interests and job satisfaction, which can only improve our working life experience and by extension the patient experience.
To do this it is necessary to individually collect evidence to take to job planning to strengthen our negotiating positions.
With an impending modified consultant contract it is even more important to be able to demonstrate what we actually do by diarising all the roles we undertake and seek support from our colleagues or the HCSA team, if necessary, to ensure our job plans reflect our working practice and protect our SPA time for the demands of the future NHS.