Two thirds of newly appointed consultants in Scotland are employed on 9:1 contracts

Nearly two thirds of consultants appointed in Scotland in the past year were employed on contracts with only one supporting professional activity (SPA) a week to nine direct clinical care programmed activities, an approach that the BMA says is “hamstringing” the most senior staff in the NHS.

A total of 63% (147 of 235) of the consultants appointed between December 2010 and December 2011 at the 12 health boards in Scotland that responded to a freedom of information request were on 9:1 contracts. Three boards only employed consultants on 9:1 contracts.

Nearly half (44%) of those appointed on a 9:1 contract were newly qualified consultants who had received their certificate of completion of training (CCT) within the past three years.

Consultants already in post at the 12 health boards were contracted on average to do 2.25 SPAs to 7.53 direct clinical care programmed activities.

The consultant contract in Scotland—and the respective contracts in England, Wales, and Northern Ireland—split up consultants’ time into four hour slots called programmed activities. Full time NHS consultants usually spend 7.5 programmed activities a week on direct clinical care and the remaining 2.5 (10 hours in a standard 40 hour week) on SPAs. Any variation from this standard split has to be agreed between the employer and the individual consultant and be stipulated in the doctors’ job plan.

The BMA’s Scottish Consultants Committee has been concerned for several years about the erosion of SPA time for consultants in Scotland, in particular for consultants at the start of their career. The committee has cautioned against contracts with fewer than 2.5 SPAs, advising that consultants with less SPA time would struggle to take an active role in teaching, training, or management.

“If you’re only on one SPA, by definition all you can do in that time is some audit and some continuing professional development in order to make sure you can fulfil the requirements for appraisal every year,” said Lewis Morrison, chairman of the Scottish Consultants Committee. “To be strict, if you’re only on one SPA you should refuse to teach anyone aside from interaction in a ward round, you would have to decline to attend meetings, and if your hospital is in the middle of a reconfiguration or development you would not be able to volunteer to do any of that work.”

Consultants contracted on only one SPA a week would struggle to meet the bare minimum requirements for appraisal and might struggle with revalidation, he added. The Academy of Medical Royal Colleges has estimated that consultants need a minimum of 1.5 SPAs a week to complete all the tasks required for revalidation.

The Scottish government and medical employers agreed in 2010 that they would not advertise any consultant jobs with programmed activities in a 9:1 ratio, but many employers instead stipulate these conditions at interview or in the negotiating period after a job offer, said Dr Morrison.

Health boards are recommending 9:1 job plans to get more clinical work out of consultants and in theory better value for money from their senior staff, he added. “More clinical work equals more throughput equals better value for money,” he said. “This, however, ignores the value of the work that is done in SPA time, which in many ways is what defines a consultant. So to some extent employers are actually hamstringing their most senior staff.”