President's column - Halting the great time grab

HCSA President Dr Claudia Paoloni explains why HCSA is pressing to reverse an SPA squeeze which is selling the profession and patients short

The piecemeal reduction of SPA time for Consultants is a symptom of the financial pressures faced by Trusts, but the long-term impact on medical staff, training and ultimately patient care is an unacceptable consequence.

The NHS at national level – aside from the honourable exception of Wales, where 3 SPAs forms the standard job plan – is making a disastrous error by turning a blind eye to this rampant erosion.

Part of the blame for the assault on SPA time lies in the 2003 Consultants Contract, where the wording accepted by the BMA stated only that the split “should typically” include an average of 7.5 PAs for direct clinical care and 2.5 PAs for SPAs.

We know that increasingly this split is far from typical. In fact, 1.5 or even 1.0 SPAs is the new norm. In some Trusts individual doctors are asked to bid for more than 1.0 SPAs against a list of “approved” activities. If they are unsuccessful then they must shoehorn everything necessary for GMC revalidation, general CPD, and teaching and basic service provision into a handful of hours. Ever greater statutory and mandatory training to meet governance targets place further pressure on non-clinical time.

Yet SPAs are a vital component of professional development, let alone the revalidation process, for which 1.5 SPAs is the baseline stated by the Academy of Medical Royal Colleges.

Less-than-full-time Consultants are often additionally penalised by having the core SPA pro-rated down further by Trusts, in direct opposition to the Consultants Contract and Academy of Royal Colleges recommendation, which is again in order to allow doctors to maintain revalidation requirements.

The Academy assessment on SPAs is extremely clear, stating: “A contract that includes only 1.5 SPAs and 8.5 Programmed Activities would have no time at all for other SPA work such as teaching, training, research, service development, clinical governance, contribution to management etc.

“It is unthinkable that a consultant could be employed with absolutely no involvement in management, if only attendance at departmental meetings, reading and responding to messages from management etc. Similarly, it is difficult to envisage a post that never involves any teaching or training of any sort.

“A post that does not permit any involvement in service development or clinical governance would be contrary to our concept of the consultant role. From this it follows that 1.5 SPAs in total would be inadequate and that the original recommendation in the Consultant Contract of 2.5 SPAs as typical seems reasonable.”

How deceitful it then is for NHS Improvement to state in job planning guidance to Trusts that the AMRC calls for 1 to 1.5 SPAs for revalidation – a grand lie made worse in an accompanying bullet-point list of “core activities” covered by this basic allocation, several of which the Academy explicitly says cannot feasibly be included.

The annualisation of contracts and the introduction of inadequate e-job planning tools such as Allocate inject a touch of the bizarre, with some members reporting fractions of time earmarked for supportive or learning activities squeezed into their working patterns – sometimes barely enough to log in to a computer and gather one’s thoughts. Many doctors now carry out vital activities in their own time.

The squeeze on SPAs is yet another example of professionalism, and the quality of care, being sacrificed in the scramble to plug rota gaps and meet financial targets.

Hospital doctors as a profession have both an individual and a collective responsibility to push back against this virulent trend. At a local level this means working as individuals and collectively in teams to diarise the work that is being done outside of the allocated time – and what is not being done at all. HCSA nationally continues to press for increased SPA time.

We want to see national standards implemented, and the NHS Improvement guidelines rewritten to reflect the need for 2.5 SPAs as core.

The aspirations of the Long-Term Plan, if they are to have any chance of succeeding, will only be met through the increased involvement of medical staff in service design. That requires SPA time. We shall be making this point loud and clear.