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There is a great deal of discussion and debate about staff shortages and this is not just about nurses, it is also particularly relevant at junior doctor and consultant level. At the same time, locum and agency costs are rarely out of the spotlight.

You only need to look at recent comments from Jim Mackey, chief executive of NHS Improvement to see how charged the issue has become. Locum pay caps, he said, are often not being enforced rigorously enough, leading to increased costs whereas in-house bank systems are cheaper. According to Mackey, NHSI will be identifying trusts and services that are over-reliant on locums, especially from agencies.

When it comes to the consultant workforce, high demand is part of a longer-term staffing challenge. On the one hand, we know NHS hospitals find it difficult to fill key posts. On the other, it is still one of the least transparent areas of workforce planning in the NHS.

There are numerous challenges: leave and study leave plans are not shared, duty swaps poorly communicated with management and rotas are opaque. Take into consideration consultants working across multiple sites, different trusts, or in academic environments and the situation is made many times worse.

Consultants naturally value their independence, but trusts should also reasonably expect them to be where they should be, providing the services according to their agreed job plans. That does not mean holding consultant’s ‘feet to the fire’. It just means a fairer deal for the consultant workforce. Many of my consultant colleagues work hard, not only doing their own work, but covering for colleagues. Protecting them and preserving services can only be done by having absolute transparency in consultant staffing arrangements, including the details of rotas.

My own experience as an academic consultant, working on several sites it that I had to rely on three different diaries, a secretary and the patience of my wife to make sure I was in the right place at the right time. This secretarial support was shared with six others and diary management became increasingly done by me. If I made changes and especially tried do it on the move, or at busy times, it was often done badly.

We know that job planning, rostering and populated rotas could solve these problems. Making sure the right people are in the right place at the right time is at the core of efficient service delivery. Consultants can still organise duty swaps between themselves on their mobiles, but let the software inform everyone else of the changes. 

The march of STP plans and the Five Year Forward View refresh will inevitably have an additional impact on the consultant workforce. If we don’t sort out consultant job planning we will not be well equipped to meet their aspirations. My biggest concern is that we leave it too late to have effective systems in place.


Martin Elliott has also recently written for HSJ. Read his articleRight people in the right place and time is core to efficiency here if you are a HSJ subscriber 

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