Published: 08/01/2004, Volume II4, No. 5886 Page 9

Too many consultants are having their clinical priorities ignored by managers, the British Medical Association has claimed.

Speaking following a senior doctors committee meeting in December last year, deputy chair Dr Ed Borman said: 'We have been getting an increasing number of reports from consultants around the country raising very real concerns about the extent to which they find that their ability to make clinical decisions based on patients' needs - on patients' priorities - are being infringed and sometimes effectively trampled on by managers.'

Dr Borman and other senior doctors' leaders said they intended to contact the Department of Health with a portfolio of evidence on the issue and ask for a meeting with health secretary John Reid.

Committee chair Dr Paul Miller said: 'The sorts of things are cancelling operating lists in order to bring in someone who's about to hit the target deadline; [and] consultants turning up to clinics for follow ups and finding that they've all been cancelled and replaced by new patients who were about to hit a target deadline.'

Pressures on managers to deliver on targets, he said, did not justify the increasing number of incidents consultants were feeding back to the BMA. 'We have had examples where, quite frankly, irrespective of what profession that human being might be engaged in, their behaviour is utterly unacceptable and no form of pressure would justify the pressure that they have engaged in, in a working setting, ' Dr Miller stated.

Dr Borman added: 'We are deliberately dealing with this, and this stepped-up approach, because we feel that there would be little to be gained by simply blowing up individual cases, having a bit of a to-do, having the usual picking of sides and glaring at one another across the battlefield. We'd like to see if we could perhaps diffuse a lot of this before it really starts getting unpleasant.

Having said that, in some individual cases It is pretty damn unpleasant already.'

The senior committee was also reported to be unhappy about the lack of planning for treatment centres. Dr Miller said: 'Our concerns about treatment centres remain about training, training junior doctors particularly, and about case mix. [By this] I mean the potential for destabilisation of NHS trusts if treatment centres are able simply to take the most straight-forward, more routine, easier cases - the day cases, elective surgery - and leave the NHS with all the much more complex, the complicated, difficult and emergency surgery, which is more expensive, obviously, and where the NHS financial flows formulae are just not sophisticated enough to recognise that.'