28 November 2011 Maximising the Potential from the Consultant contract in g Wales The Wales Audit Office Perspective p David Thomas, Director, Health & Social Care
Issues covered Audit involvement – a brief history Scope & approach of our most recent audit work Scope & approach of our most recent audit work What we found Some perspectives on what “good looks like” in relation to job planning Slide 2
Audit & the Contract – a brief history • Audit Commission in Wales asked by WG to support implementation of new consultant contract in 2004/05 • Audit work focused on robustness of job planning j p g • Assurance that bids for additional session had a sound basis • All NHS Trusts reviewed & audit “ratings” used: – Robust Robust – Acceptable – Some key concerns – Significant concerns • Work supported by all Wales job planning database Slide 3
Audit & the Contract – a brief history • All Trusts had recommendations for improvement but most were rated as “acceptable” & some as “robust” • Auditors had “some key concerns” at 3 NHS Trusts y • WG followed up with annual review process • • Wales the only part of the UK to use audit to provide assurance on Wales the only part of the UK to use audit to provide assurance on basis for additional session payment • Subsequently there has been work by NAO & Audit Scotland to review consultant contract implementation in England & Scotland review consultant contract implementation in England & Scotland • At the end of 2004/05 work we said we would come back to review realisation of intended benefits Slide 4
Our most recent work • All Wales review of “benefit realisation” f “ f • Originally scheduled for 2008/09 but deferred as a result of NHS re- organisation • Undertaken in new Health Boards and Velindre & PHW NHS Trusts during the 2010/11 audit year • Again focused on job planning • Wider benefits associated with: – Recruitment & retention – Working environment g – Supporting the modernisation agenda • Audit included – consultant questionnaire – 580 responses (25%) consultant questionnaire 580 responses (25%) – Job planning database Slide 5
Findings – some headline figures g g • Some £40m spent introducing the new contract • Some £2.5m spent on the ultimately abortive Outcome Indicators Some £2.5m spent on the ultimately abortive Outcome Indicators project • • 35% increase in consultants employed between 2004 & 2010 35% increase in consultants employed between 2004 & 2010 • Consultant pay bill has increased from £250m in 2004 to £331m in 2010 2010 • Vacancies have reduced significantly since 2004 Slide 6
Findings – consultant working patterns tt • On average, consultants’ working week has shortened: – 2004 = 46 hrs, 9.3 DCCs & 2.2 SPAs – 2010 = 42 hrs, 8.3DCCs & 2.6 SPAs 2010 42 hrs, 8.3DCCs & 2.6 SPAs • Overall: – DCCs increased by 3,160 – SPAs increased by 2,129 SPAs increased b 2 129 • Long hours still an issue: – Only one third of consultants have 10 session contracts – 1 in 6 working 12.5 sessions or more – 23 part time consultants working 10 or more sessions • Differences in job plans inherited following NHS re-organisation still Differences in job plans inherited following NHS re organisation still evident Slide 7
Findings – job planning g j p g • Not applied consistently • Significant numbers of plans not reviewed annually • Information to support job planning is often lacking Information to support job planning is often lacking • Manager involvement varies • Too much focus on the number of SPAs without looking at the quality and outcome of this investment quality and outcome of this investment • More work needed to identify outcomes • Appraisal and job planning are not always linked or co-ordinated • Engaging partners (ie universities and other health bodies) in the job planning process has been challenging Slide 8
A need for clearer definitions • DCCs – some problems with definitions in areas such as diagnostics, mental health & public health • SPAs – often included “management” and “other” activities • • Management - use varies significantly across NHS bodies Management - use varies significantly across NHS bodies • Other – often poorly defined, with variable use Slide 9
Focus on SPAs • Important investment • “Typically” 3 sessions a week but.... • ... precise number & content should reflect the specific needs of the ... precise number & content should reflect the specific needs of the consultant & service • 1 – 1.5 SPAs needed to meet CPD and revalidation requirements (Academy of Medical Royal Colleges, Feb 2010) (Academy of Medical Royal Colleges, Feb 2010) • Variation within & between organisations in quantity & content of SPAs – reflecting position pre NHS re-organisation • Need to move debate from numbers of SPAs to what these sessions Need to move debate from numbers of SPAs to what these sessions are used for & how their value can be demonstrated • Pressure on service delivery can squeeze SPA time • • Location of SPA activity often not considered Location of SPA activity often not considered Slide 10
The consultant perspective p p % Consultants who felt the contract & job planning: Response Clarified what was expected from them 65% Provided the right balance between DCCs and SPAs o ded t e g t ba a ce bet ee CCs a d S s 55% 55% Provided opportunity to discuss service modernisation & new 47% ways of working Accurately reflects hours and work commitments Accurately reflects hours and work commitments 40% 40% Resulted in better planned working week 32% Helped tackle excessive workloads 19% Has helped improve medical workforce planning f 13% % Has improved patient care 28% Slide 11
Have the benefits been realised...? • Consultants have seen their: – Pay increase – Working week decrease (on average)...but some still work long hours but.... only 20% said the contract had changed the way they worked for the better e be e • NHS organisations: – Have seen improved recruitment & retention Have seen improved recruitment & retention – Reduction in vacancies – Contract not being used to shape & drive service modernisation – Job planning not being used to best effect Job planning not being used to best effect Slide 12
Moving towards better job planning g j p g • • Guidance training & “champions” Guidance, training & champions • Don’t forget the practicalities....enough notice, appropriate venue, allow sufficient time, get the right people there • • I f Information to support the discussion ti t t th di i • Consider team job planning • Have clear & measurable outcomes • Links between job planning &: – Service modernisation & transformation – PDP & appraisals • Ensure the job plan is agreed & signed off • Communicate any chances in sessions to finance & HR • Periodic quality review of JP outputs & shared learning Periodic quality review of JP outputs & shared learning • Maintain a database of sessions Slide 13
What does good look like? g • For the consultant effective job planning would: – clarify the consultant’s commitments and the resources needed to deliver them; – prioritise work and better manage excessive workload; – promote flexible working; – support where appropriate a phased approach to – support, where appropriate a phased approach to consultant careers; and – together with appraisal, provide evidence of current continuing professional development (CPD) activity that continuing professional development (CPD) activity that could form part of the evidence for General Medical Council (GMC) revalidation procedures. Slide 14
What does good look like? g • For the health boards and trusts effective job planning would help in: – planning the best use of resources; p g – supporting compliance with working time regulations; – agreeing and providing transparency as to how consultants’ work can most effectively support delivery of the work can most effectively support delivery of the organisation’s objectives through identifying possible changes in capacity, skill mix and ways of working; – agreeing the time and resources needed to support clinical agreeing the time and resources needed to support clinical governance, quality improvements, teaching, education and research; – A key element of the clinical engagement agenda A key element of the clinical engagement agenda Slide 15
The End • WAO local reports on our website: http://www.wao.gov.uk/reportsandpublications/localhealthboards.asp http://www.wao.gov.uk/reportsandpublications/localhealthboards.asp • National summary report currently being finalised – publication early 2012 2012
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