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.

NHS medics must face the issue of productivity