Speech: Dr Paul Donaldson warns of 'deplorable' squeeze on SPA time


Speech by Dr Paul Donaldson, Hospital Consultants and Specialists Association delegate, to TUC Congress moving Motion 53 on Hospital Consultants’ continuing professional development.

A culture of education is vital within the NHS. But I’m sorry to report today that there is a growing threat to this vital aspect of hospital doctors’ work.

A standard full-time consultant’s week comprises of 10 programmed activities, each of four hours.

According to the current Consultant Contract, agreed in 2003, a “typical” allocation should see 10 hours set aside for Supporting Professional Activities.

This is the time when Consultants are teaching, learning, developing services, managing their teams or carrying out often ground-breaking NHS research.

The Academy of Royal Medical Colleges rightly describes these activities as “essential to the long-term maintenance of the quality of the service.”

Just to keep our General Medical Council licence to practise it is estimated that a minimum of 1.5 SPAs is required – six hours for a standard full-time Consultant.

Yet the 2003 commitment is now being torn up locally by Trusts across England. Some have reduced it from 10 hours a week to six. Some have even reduced it to four.

Six years ago in Scotland we saw the same trend. But the Scottish Government realised the value of SPA time and reversed it. This seems now to be a distinctly English matter.

Trusts see lower SPA allocations as a way to get more clinical work out of Consultants.

More clinical work equals more throughput equals better value for money.

This, however, ignores the value of the work that is done in SPA time, which in many ways is what defines a Consultant.

HCSA’s own polling shows that half of our members have seen a reduction in SPA time. In eight out of 10 cases this has been imposed.

Sixty per cent of our affected members said their level of research has fallen as a result, 70 per cent now do less teaching and training and more than 70 per cent have had to cut back on personal professional development.

Nearly two-thirds said they are trying to keep up their SPA activities in their own time.

Comments from our members detail the impact that this is having on hospital doctors.

One said the SPA squeeze had “helped me along my journey from being totally committed to my Trust and its work to feeling that I cannot retire soon enough.”

Many others echoed this picture.

As one consultant stated, the net result is that “the NHS will lose out as Consultants don’t do the extra we used to do.”

Congress, this situation is deplorable. It is not good for Consultants, it is not good for the future of the NHS, and it is not good for the patients we treat.

Doctors in training will suffer as learning is squeezed, and what can be shoe-horned around clinical care is delivered by increasingly demoralised Consultants.

For the NHS as a whole it means reduced levels of clinical governance, auditing, teaching and research.

And ultimately all this is bad for our patients, now and increasingly in the future.

So today, as a Consultant who has worked in NHS hospitals for over 35 years, I’m here with a simple message.

For the future of our health service, this squeeze has to stop.

Congress, I move the motion.