Trust plans to slash one in three consultant posts

BMJ 2013; 346 doi: (Published 24 January 2013) Cite this as: BMJ 2013;346:f484
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}

Norfolk and Suffolk NHS Foundation Trust is planning to slash the number of consultant posts by a third and that of staff, associate specialist, and specialty (SAS) doctor posts by 40% in a bid to cope with 5% year on year spending cuts over the next three years.

The mental health trust aims to reduce the number of whole-time equivalent consultant posts from 99.76 to 66.7 and the number of SAS doctor posts from 39.42 to 15.92 by 2016.

A total of 500 clinical and non-clinical posts and 20% of inpatient beds at the trusts are expected to be cut as part of a service redesign that aims to deliver more care in the community and avoid “expensive hospital care.”

The trust’s chief executive, Aidan Thomas, said, “If we reach people at an earlier stage of their illness, if we develop a robust personality disorder strategy, if we reduce multiple assessments and work effectively with social care support, then we would be able to provide people with some real alternatives to hospital admission.”

He added, “We will see a reduction in the number of posts we have over the next four years, but because of careful vacancy management and natural turnover, as people leave or retire, we hope to bring this about without compulsory redundancies.

The BMA has raised concerns that the unprecedented level of cuts to medical staff will negatively affect the quality of care provided to patients. The secretary of its Eastern Regional Council, Rob Harwood, said, “It is difficult to see how the trust, which provides vital mental health services to thousands of patients, can cut staffing levels on this scale while continuing to provide services.

“We believe that it is inevitable that these plans will lead to a decline in the quantity and quality of service provided and that this will result in significant risks to patient safety.”

The trust already has a high level of vacancies in its medical staff, with around one in 10 consultant and SAS grade posts vacant as at 31 August 2012. Further staffing cuts would exacerbate the problems caused by current vacancies and would call into question whether the trust could maintain its out of hours cover, the BMA said.

The trust is seeking to cut posts through voluntary redundancy and natural wastage, and it plans to redeploy staff where possible. However, redeployment opportunities were limited for highly specialised doctors, the BMA said, meaning that this group would be disproportionately affected by staffing cuts.

The association has also argued that the trust’s consultation with staff, stakeholders, and service users, which closed on 21 January, was not “robust” and that it had begun implementing some of the proposed changes before it closed.

Chris Jones, chairman of the local BMA negotiating committee, said, “It seems clear that the trust has already determined many of the critical features of future service design . . . While not underestimating the scale of changes required by the Nicholson challenge [for the NHS to save £20bn (€24bn; $32bn) by 2015], we call on the trust to reconsider the approach so far adopted, to recognise that quality services cannot be provided without a commitment to maintaining both the quantity and quality of clinical staff, to acknowledge that reducing clinical staff to the extent proposed is non compatible with maintaining those services, and to engage meaningfully and honestly both with its staff and its wider stakeholders.”

The BMA has written to MPs in the region calling on them to contact the trust and urge it to agree “a better way forward” with staff and stakeholders.


Cite this as: BMJ 2013;346:f484

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