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The Big Lie

Back in 1948 when the NHS was born, it was said Aneurin Bevan, Former Secretary of State for Health and Social Care of the United Kingdom, had to ‘stuff the consultants mouths with gold’ to persuade them to join in. Ever after, governments had wished to clip the consultants wings in terms of their remuneration and gain more control of what they did day-to-day.

In 2003, the government finally got its way and rewrote the consultant contract. Unfortunately the contract was predicated on a lie. The government believed NHS consultants were exploiting the NHS by doing private work for extra remuneration on NHS time, that is when they weren’t on the golf course. Consequently the government felt it achieved a great victory by securing 40 hours a week of consultant time and the first four hours of any overtime were to be offered to the NHS. Unfortunately, the wealthy golf playing cads were largely a creation of the tory press and most consultants were already going above and beyond for the NHS. The new contract was to be policed by medical managers sitting down with the consultants and working out a job plan usually for 10 programmed activities (PAs).

Only the NHS could come up with a new unit of time: the PA.

As a young medical director back in 2003, I immediately realised what the problem would be. My first job planning meeting was with a hard working conscientious consultant psychiatrist currently carrying the caseload of a sick colleague as well as his own. He didn’t play golf, he rarely got home in time for dinner, and regularly worked four PAs (16 hours in old money) more than I paid him for. Back in those days, the salary was pretty good so we both turned a blind eye to the elephant in the room… the fact that I gave him a 10Pa job plan and he worked 14 PAs.

And so the myth of job planning began.

According to the initial guidance: ‘Job planning should not be carried out in isolation. It should form part of a dynamic, patient-focused process which incorporates organisational, team and individual objectives and in the case of consultant clinical academics is always undertaken jointly with the university employer.’

Well it wasn’t, we had neither the time, nor the tools for that so at best we had embarrassing annual meetings where we danced round ‘the big lie.’ At worst, both sides found excuses not to meet and last year’s job plan had its date changed.

We have now been engaged in this meaningless paper chase for 20 years and the goodwill that was based on the decent salaries and pensions of yesteryear has evaporated. The bank of NHS goodwill is severely overdrawn and staff are flooding out of the NHS citing poor pay and undoable jobs. It’s time to end the meaningless paperchase and do job planning properly, the way it should be done as part of a dynamic, patient-focused process incorporating the needs of the organisation, the team and the individual doctor.

SARD has created a number of tools to help achieve that objective. We are able to provide you with the expertise and staff required to turbo charge a trust into having meaningful demand-based job plans delivered across the organisation. Get in touch with me to find out more and stop living the lie!