Trends in consultant clinical activity and the effect of the 2003 contract

I read with interest the above article but was confused by the parameters used and the final conclusion that the new contract had failed to realize any increase in consultant clinical activity. This is clearly not the case. Consultants are working harder than ever but in roles that are not captured by measuring their workload as finished consultant episodes (FCE).

The new contract has been good for patients:

1. (1)

   The new contract brought in the concept of supporting programmed activities designed to improve the quality of the work done by consultants.

2. (2)

   At a time when reliance on junior doctors has needed to be reduced because of the European Working Time Directive, the contract has been used to redefine the role of consultants from merely directing healthcare to being the primary, hands on, providers of healthcare as well.

Although modern consultants still maintain their traditional role as clinical supervisors, they have increasingly become the main providers of medical treatment in the outpatient clinic and the operating theatre and many have extended working days covering wards. Consultants often see all the patients attending an outpatient session themselves or perform all operating lists personally rather than sharing these duties with a junior as was the case in the past and as a direct result, consultants have less time and can manage fewer patients.

I am surprised that Bloor et al. did not find a greater fall in FCEs because the modern consultant has taken on time-consuming roles that used to be the almost exclusive domain of the doctor in training and this is not something that would be picked up by assessing FCE activity. Thus the Bloor paper significantly underestimates and to some extent misrepresents the clinical workload of the modern consultant.