The contract could help the minority of single handed consultants who do
office hours plus regular Saturday mornings (although they may find
themselves having to do more direct clinical contact and do the admin in
their own time- 12 hours for admin and CME isn't really enough) and do no
medicolegal work. The rest of us may find ourselves pushed into more out of
hours cover (Mind you, even single handers could be pushed into more out of
hours work. There's nothing in the contract to stop a manager taking the
attitude that admissions could be avoided by more consultant input so why
not have your A and E consultant around in evenings and a weekends which is
when most admissions via A and E usually occur- and also when consultants in
the more important specialities are less likely to be around). A 4
consultant department allows 12 hour a day cover 7 days a week with
prospective cover plus coming in for a couple of hours every night on call.
It becomes possible to provide a shop floor consultant 26/ 7 with 6
consultants without prospective cover (if you have prospective cover you can
do it with 7 provided you add the extra session you are allowed to). Makes
it tempting for trusts to drop the overnight SHO and use the consultant
first on. I'm not saying this is necessarily a bad thing, but I would bear
in mind the amount of ill health suffered in previous attempts to have a
consultant 24/ 7 (officially for resus only) with 8 consultants- the extra
points at the top of the scale are a bit pointless if we're all going to
retire on ill health at 50.
> An increase in payment for out of hours work may mean a lower
> increase in
> the basic salary... I suspect? Any thoughts?
I'd still rather have the increased payment for out of hours even if it
means overall pay is the same- it's not about the money, it's about the
value put on our time. I would note that in my own trust surgeons and
anaesthetists are offered 5 times basic rate for evening and weekend waiting
list sessions- at 3 times there were no takers.
> But, if the Consultant Body does reject the Contract we need
> to do some fast
> PR (Public Relations) work with the newspapers and TV. You
> can imagine the
> headlines "fat cats reject 20% pay increase" .
Depends on the spin put on it. The spin in the newspapers is that we have
avoided any private practice ban and been offered a 20% pay increase- makes
us look greedy by accepting it. To me it would look less greedy if we asked
to keep the same basic pay but with the ability for trusts to ask us to
switch to unsocial hours sessions, work longer hours or do on call at a
reasonable premium.
Andres, I agree with most of your points, but one issue:
> 5- The BMA is lying saying that the ban in private practice has been
> avoided. For the first 7 years (if Trust feels like it) a
> consultant will
> have to work 48 hours a week to practice privately. The
> European Working
> Time directive stipulate that 48 hours a week is the
> maximum time allowed
> to
> work, This is not actively enforced, but many competent
> lawyers must be
> waiting just for a doctor to make a mistake outside this
> limit; we will
> see
> how we can defended it.
Simpler than this: you are allowed to do private practice only if there is
not a 'real or perceived' conflict with your NHS work. Thus your managers
(who I can see as being under pressure to institute a de facto private work
ban) can say they perceive a conflict and ban it on a whim. They would
certainly be well advised to ban it if your total hours exceeded 48
(managers are easier to sack than doctors. If a consultant makes a mistake
that could be attributed to tiredness- or even is rude to a colleague or
patient when tired and there is a complaint- how would you defend your
decision that private work had not conflicted with NHS work? Safer to
introduce a blanket ban on the basis that there might be a problem.
Matt Dunn
Warwick
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