Consultant activity and the 2003 contract

To submit a letter in response to a JRSM article, please visit: http:lljrsm.rsmjournals.com to find the article concerned, then click on the ‘send a quick comment’ link found in the article information section. Quick comments will automatically be considered for publication in print.

Consultant activity and the 2003 contract

The authors are correct in their statement that the 2003 contract awarded consultants more money for work they were already doing, because the Government ignored the available statistics.

A major factor was missed. Over the same period, the Senior Registrar grade was abolished. In military terms, this was equivalent to the abolition of the sergeant's mess. At a stroke a cadre of newly qualified, up-to-date, highly motivated specialists was removed from the NHS. In many specialties, particularly surgical, inpatient care revolved round the SRs. Skilled scheduling, expert ward care, and the emergency surgical service were all hit without the provision of extra resources for the consultants to take these tasks over. As a result, ward care deteriorated, managers booked surgical admissions into impracticable lists, and consultants did the emergencies at the expense of the day job.

This is the result of political manipulation of medical education to move from the highly qualified and experienced consultant to a “good enough” specialist who has to gain experience on the job.

In the absence of adequate records for the crucial period, we will never know whether the loss of the SR grade was an important factor.