News

Zircadian Director Angus MacDougall comments on latest health news: "Lucrative overtime payments for consultants questioned", Nick Triggle, BBC News Online, 13 January 2011.

 

"It came as no surprise to learn that trusts are paying significant sums to consultants for emergency unplanned activity. From patients' perspectives minimising waiting times is clearly a good thing but the costs of these payments is eye-watering. Are these payments an inevitable consequence of increasing demand on the NHS or are there simpler reasons?

The 1997 Labour Government introduced into the NHS a system called Payment by Results where trusts receive a fixed sum for each patient treated. Prior to the start of a new financial year a trust needs to agree with their PCT commissioners the type and quantity of the services that they would provide. Clearly before trusts enter these discussions it is vital for them to understand how much of a service their consultants can actually deliver. To help trusts get a better understanding of these capacity issues, the new consultants' contract was introduced in 2003 that was meant to provide more transparent accounts – called job plans – of a consultant’s yearly activity. If these contracts are detailed and accurate it is very easy for service managers to plan their department’s activity. But still in many trusts job plans lack detail or the information that sits in them gets consigned to dusty cupboards. So one cause of these overpayments is that trusts agree to activity levels without even knowing whether they have the capacity to deliver or not.

However I have a suspicion that a more significant cause of these increasing waiting lists and emergency overpayments is planned activity that is never actually delivered. Again, accurate job plans, giving expected activity totals for the year, can highlight where consultant delivery is behind agreed levels and where requested “overtime” should more correctly be seen as normal time. For example, a surgeon's job plan should detail how many surgical lists they commit to in the year. It takes account of their leave and bank holidays to give an expected number that they will perform. I believe that most consultants in the NHS would see it as fair that until they have worked the number of sessions they agreed to at the beginning of the year then they should not benefit from additional payments. So again, through job planning, if a trust has an accurate tally of how many lists a doctor commits to work and how many they have actually worked, additional payments are only paid once those commitments have been fulfilled.

So whether these £100,000’s of extra payments are due to poor initial planning or poor monitoring of activity they both have a common cause – poor job plans. Some medical directors seem to believe that rigorous accurate job plans are a threat to the organisation because on balance their consultants do more work that they are paid for. They believe transparency is a bad thing but in reality lack of knowledge in this area can be extremely costly. Consultants should be paid fairly for the work that they do and without accurate job plans this is impossible and, as yesterday’s evidence shows, weak job planning can have significant financial implications."

 

If you have any comments or questions about this blog post please email info@zircadian.com