Published: 25/07/2002, Volume II2, No. 5816 Page 20 21

The new consultant contract introduces job plans for hospital consultants. Full-time consultants are to have a working week made up of 10 'programmed activities' of 'typically four hours each', seven of which will be 'devoted to direct clinical care'.

The contract also states that 'NHS consultants' commitment to the NHS must take priority over any work undertaken for other organisations'.

The implication is that consultants, because of their perceived focus on earning private income, are one of the causes of inefficiency and long waiting times, particularly for elective surgery.

In November and December 1997 we carried out a prospective audit of all elective general, vascular, urological and breast patients scheduled for preoperative assessment or admission to Southampton University hospitals to establish the proportion of - and reasons for - operations cancelled. There were no 'red alerts'.

Of 851 patients identified, data was available for 847 (99.5 per cent). Of these, 106 (12.5 per cent) received urgent planned admissions, the remainder being asked to attend a preoperative assessment clinic. Of this remainder, 61 (8.2 per cent) did not attend. Of those that did, 30 (4 per cent) had their procedures postponed or abandoned, 22 because of medical problems and eight because of social problems or patient preference.

Including those receiving urgent planned admission, 756 patients were scheduled for admission. Of these, 123 (16.3 per cent) were cancelled before admission, 85 (69.1 per cent) because of lack of a bed. Nine (7.3 per cent) were cancelled due to lack of theatre time, and six (4.9 per cent) due to further medical problems.

Thirteen admissions (11 per cent) were cancelled by patients and in only 10 the reason for cancellation was not recorded.

A further three patients failed to attend hospital on the due date. Of the 630 admitted, a further nine (1.4 per cent) were cancelled, three because of lack of theatre time.

No cases on which data were available were cancelled due to lack of availability of a surgeon to conduct the operation.

Although this study was carried out in 1997 there has been no material change in the service provision in most NHS hospitals since.

Anecdotally Southampton University Hospitals trust is typical of most large teaching hospitals.

Lack of beds and theatre time constitute by far the largest reasons for cancellation of planned surgical admission. Increasing available time of surgeons will accomplish little without a corresponding increase in the number of available bed days and theatre hours.

It is NHS infrastructure that needs attention, not consultant contracts per se.

Private practice is unlikely to be a significant cause of long waiting lists.

Steve George Reader in public health Southampton University Health Care Research Unit, John Primrose Professor of surgery University Surgery Southampton General Hospital