NHS medics must face the issue of productivity

15 April 2010 | By Richard Vize

Trusts are taking tentative steps into the landmine riddled territory of their consultants’ productivity.

Many have exerted only the loosest grip on their most important clinical staff. Performance measurement is avoided in the interests of a quiet life.

Crashing through a consultant’s door armed with a checklist will not extend the sum of human happiness

That has to change. Acute sector productivity is key to delivering the savings the NHS needs, and that means making the most effective use of top medics.

Consultants are expensive, costing up to £180,000 a year. This is money well spent, but it is still a big bill. Productivity matters.

There are limitless ways to approach this issue ineptly. Many consultants have intense, stressful workloads which take them well beyond their formal hours. Crashing through such a consultant’s door armed with a checklist will not extend the sum of human happiness. It is one of the more enduring mysteries of the NHS how so many hospitals have failed to build effective partnerships between their medics and managers. A relationship of trust and mutual respect is a prerequisite for finding an agreed way to improve productivity.

Of the few trusts addressing this issue, there is a focus on the most contentious area of consultants’ contracts - the clause in the 2003 deal allowing them to spend almost a quarter of their time on “supporting professional activities”. It includes training, research, audits and clinical governance, although there are rumours it has on rare occasions extended to working on one’s golf handicap. Trusts want this time cut so more hours are spent with patients.

There are sound, patient centred reasons why the activities time was set aside. While a minority may be abusing it, many will be using it to ensure they stay at the forefront of clinical practice. But it is still reasonable for trusts to work with consultants to ensure this time is being used appropriately and effectively, and cut where possible.

The British Medical Association missed - or rather ignored - the point. It launched into its ritual irrelevant attack on the private sector, saying there are other places the NHS could save money such as “commercialised facilities”. The BMA has apparently failed to grasp that over the next four years every part of the health service will have to offer up savings.

Readers' comments (3)

Clive Peedell | 18-Apr-2010 12:02 pm
A couple of points, Mr Vize.
What is consultant productivity and how can we meaningfully measure it? (Any comments from NHS managers who read the HSJ would be helpful on this one). There seems to be plenty of evidence that NHS productivity has not increased in line with increased NHS investment, but medicine is much more complex these days. We can't just rely on measures like FCEs and numbers of procedures completed. The complexity and type of work also needs to be taken into account. This is much more difficult to assess.

I don't think the BMAs attack on market based reforms is irrelevent in the context of needing to save money. The costs of the expensive purchaser-provider split, PFI, excess capacity of ISTCs, addressing information assymetry (i.e NPfIT), and managerialsm (NPM) put any notion of NHS consultant productivity being a problem into the shade.

The BMA supports that view that market failure in healthcare is so problematic that we cannot support the current policies that are promoting it.
This is not suprising since market based policy rejects the trust model of healthcare delivery i.e it rejects the professional service ethic. This is because doctors control access to the healthcare market, which is anti-market in itself. At the same time it is well recognised that medical leadership id critical to delivering a successful healthcare system. The market therefore creates a difficult paradox - its needs medical leadership but rejects professionalism in favour of NPM. Hence, Mr Vize, policy makers and Trust CEOs should heed the words of Professor David Marquand:
"Professionals are in a profound sense not just non-market, but anti-market".
The BMA campaign against market based reforms confirm his thinking.
We will continue to call for an end to market based healthcare for as long as BMA members want us to. Until that point we will continue to work within the democratic system, but the criticism will continue as we are democratically entitled to do.
Ultimately, politicians will fail on the NHS until they start to listen and engage with the majority of doctors i.e the BMA. We want to return to the double bed along with teh other professional health groups) of policy making.
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Clare Rogers | 22-Apr-2010 12:08 pm
What is productivity and how is it measured? Are we measuring numbers of patients per consultant? Numbers per member of staff? Has the complexity of care been included in these calculations? Has quality of care been included?
I graduated in 1994 and find it hard to believe that productivity is down - in surgical oncology, many more patients are being treated resulting in huge numbers of patients requiring follow up and support. The survival figures are there to support this. Each patient receives support from a health care team addressing a variety of physical, emotional and psychological needs. Patients receive a host of expensive and time consuming investagations before highly complex and time consuming surgery, often including reconstruction. Care is carefully audited to ensure that quality improves constantly and complications are kept to a minimum. The peer review process supports this (but also takes key clinical staff away from patients).
This care is more expensive and could sometimes be given more efficiently but this care is of a higher quality and I cannot accept that productivity is down when quality is taken into account.
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Clare Rogers | 22-Apr-2010 2:19 pm
What is productivity and how is it measured? Are we measuring numbers of patients per consultant? Numbers per member of staff? Has the complexity of care been included in these calculations? Has quality of care been included?
I graduated in 1994 and find it hard to believe that productivity is down - in surgical oncology, many more patients are being treated resulting in huge numbers of patients requiring follow up and support. The survival figures are there to support this. Each patient receives support from a health care team addressing a variety of physical, emotional and psychological needs. Patients receive a host of expensive and time consuming investagations before highly complex and time consuming surgery, often including reconstruction. Care is carefully audited to ensure that quality improves constantly and complications are kept to a minimum. The peer review process supports this (but also takes key clinical staff away from patients).
This care is more expensive and could sometimes be given more efficiently but this care is of a higher quality and I cannot accept that productivity is down when quality is taken into account.
Unsuitable or offensive?