'I couldn't resist it: 'Have you thought of taking up golf?' I quipped'

&Quot;You see, it began like this. The Department of Health thought consultants were spending all their time doing private work or playing golf. They genuinely felt, by specifying in the contract how much work consultants should do, they'd get more out of us. Or 'increase our productivity'&Quot;. Geoff and I looked through the bay window towards the coastline. The after-dinner conversation had finally come round to the consultant contract. It had, after all, largely paid for the extension in which we sat.

'It's costing plenty, &Quot;I said, but it was always bound to cost plenty. Let's see: 30,000 consultants in England,£3bn a year - that's£100,000 per consultant, give or take a few grand. That's gross, but even before the new deal consultants weren't exactly skint. I always reckoned it would take around 5 per cent to get the British Medical Association interested, plus another couple of per cent to clinch the deal. The cost was always going to be a bit over£200m.

'The real question is, what's the NHS getting in return? Your trust colleagues, for instance? Are they any more &Quot;productive&Quot; now?'

Geoff smiled. 'It's never really been about money. Whatever you think, it's more than that. Actually we weren't particularly excited at first. Negotiations on the contract had been going on for years.

'But we knew our interests would be looked after. The history of negotiations between the BMA and the government is that the doctors always come off best.

'I think you will agree most consultants are not stupid. And the guys who run the BMA and royal colleges are the cream of the cream. They have always run rings around the poor old DoH civil servants.'

'What about the recent King's Fund report on implementing the contract?' I asked. 'It describes consultant job planning as an exercise in form-filling, showing what consultants are already doing. Has that been your experience?'

'It works like this', explained Geoff. 'Basically we now have to do 10 programmed activities a week for the trust. That's seven clinical sessions - ward rounds, outpatient clinics, theatre lists - and three sessions of supporting activities like clinical meetings and continuing professional development.

'So when the contract was agreed, we each had to fill in a diary giving the details of our working week over an on-call cycle. In my case that's eight weeks. And when human resources analysed all the diaries, it came as little surprise that most of us were working well over 40 hours a week. That golf course jibe was always rubbish.

'Then one of the anaesthetists somehow got hold of an Excel file listing all the additional sessions awarded to consultants on the basis of the diary returns, and e-mailed the file to all of us.

'As you can imagine it was very divisive. Some of us had been awarded no extra sessions; others had received six. With the extra sessions backdated well over a year, some folk were getting lump sums of over£40k. I got one session, which meant about£8,000 after tax. Better than a poke in the eye with a blunt haddock, or whatever the expression is, but if I hadn't been so scrupulous about listing the time I spent doing work as the trust research and development director - paid for separately and so doesn't count - I'd have got a lot more.

'But here's the best bit,' he added. 'Have you heard of the escalator?'

I shook my head. Geoff was warming to his subject.

'This bit's rich. As I say, the diaries showed that lots of us were working well over 40 hours a week. The NHS had been getting that extra time for free, of course, and I suppose we'd come to see it as part and parcel of being a doctor.

For instance, some of my colleagues were quite shocked when the GPs were allowed to opt out of evening and weekend work. They felt it simply wasn't professional.

'And once management knew we were working long hours, they had to do something. That's where the escalator comes in. It means our trusts have to pay us progressively more for sessions in excess of 10 per week. It's to encourage trusts to get all consultants down to 10 sessions.

'So I had a meeting with our division chair and a manager to go through my job plan. I was told that to get down to 10 sessions I'd have to drop a clinic, so we agreed I'd end my Wednesday afternoon medical clinic. I didn't really want to, but I didn't have much option.

'Now, this particular clinic was to review patients who had recently been discharged from hospital. And now that I no longer have a medical follow-up clinic, early discharge becomes more difficult. Previously I could discharge patients rapidly and at the same time arrange for outpatient investigation and follow-up. It worked. But now I'm more inclined to keep a patient in a day or two longer to get all the investigations done.'

'Ah,' I said. 'But the trust saves money on the Wednesday afternoon clinic it has cut?'

'Not so,' said Geoff. 'These sessions we're all losing as we reduce to 10 are being lumped together by the trust to appoint additional consultants. Whether we need them or not.

'And it gets better. The time we spend in hospital as part of our on-call duties now counts towards our 10 sessions per week.

This means after each weekend on-call I have to take two working days off, some time in the eight weeks before the next on-call. This, with my now free Wednesday afternoons, means that for the first time I can remember I have free time during the week.'

I couldn't resist it: 'Have you thought of taking up golf, Geoff?' I quipped.

Geoff smiled broadly. 'Mmm. Yes, there is a certain irony in the situation, isn't there?

'But I hate golf. Actually a few of the guys have been buying boats and spending lots of time down at the harbour or out on the bay. I think that's where I'd rather be.'

Noel Plumridge is an independent consultant and former NHS finance director.

Topics