Royal college acts to temper workload of consultant psychiatrists

Authors: Helen Jaques 

Publication date:  30 May 2012


Consultant psychiatrists are increasingly under pressure of time and resources as a result of the financial cutbacks in the NHS, the Royal College of Psychiatrists has said.

Job plans and job descriptions need to be drawn up in such a way as to ensure that consultants have the time to deliver the high quality care that is needed and also the time and resources to fulfil their non-clinical roles in service development, innovation, teaching, and management, said Laurence Mynors-Wallis, the college’s registrar.

“Consultant time is under pressure and will become even more under pressure as the financial difficulties that the country faces worsen,” he said. “In addition, trusts and providers are under pressure financially, and the only way the NHS can save money is through cutting staff, not just medical staff but also nursing staff and other professions . . . So there is a concern that consultants are going to be asked to do more and asked to go beyond what enables them to deliver safe high quality care.”

Furthermore, said Mynors-Wallis, consultant psychiatrists’ jobs are more specialised and complex than in the past, and patients have higher expectations of their consultant, both adding to pressure on their time.

The college emphasises that organisations should have enough consultant psychiatrists to provide the range of activities needed but also to provide cover for out of hours work and for rota cross cover.

Consultant psychiatrists also need enough administrative and clinical support to allow them the time to deliver the activities for which they have been trained. For example, it is unlikely that consultants in general adult psychiatry inpatient posts can manage more than 15 or 20 beds without additional support from another senior doctor, either an approved specialty doctor or a years 4-6 specialty trainee, says the college.

It is consulting on draft guidance on reasonable workload expectations for consultant psychiatrists. This will outline how consultants in the various subspecialties of psychiatry should split their time to balance their clinical, leadership, and education roles.

Consultant psychiatrists should ideally have a 10 programmed activities (PAs) a week contract, of which 7.5 are for direct clinical care and where one or 1.5 of the remaining 2.5 supporting professional activities are for continuing professional development to count towards revalidation, the college has recommended.

The guidance also outlines how consultant psychiatrists in various subspecialties could best split their time. For example, a full time consultant working in a general adult psychiatry inpatient post who has no specific educational or leadership role should each week have five PAs for ward based clinical activity, which includes clinical decision meetings and interviewing patients and carers; two PAs for Mental Health Act work; and half a PA for clinical administrative tasks.

The college is inviting responses to the draft guidance. Please send any feedback to  registrar@rcpsych.ac.uk by 6 June.

Helen Jaques news reporter BMJ Careers

 hjaques@bmj.com

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