Consultant contracts in England: how many SPAs do you have?

Authors: Timothy Barlow, David Barlow, Alison Edwards 

Publication date:  01 Jun 2012


Tim Barlow and colleagues ask how consultants spend their time on the job

Supporting professional activities (SPAs) are written into consultant contracts to offer time for “teaching, training, education, CPD [continuing professional development] (including reading journals), audit, appraisal, research, clinical management, clinical governance, service development etc.”[1] This is time that is considered necessary to maintain and improve the overall level of service within the NHS.[1] [2]

The Academy of Medical Royal Colleges and the Royal College of Surgeons of England have provided guidance for SPAs in consultant contracts.[1] [2] This guidance is to be interpreted with caution, given the extra, unquantified administrative burden that revalidation will inevitably carry. However, both institutions have suggested that it would be difficult for a consultant to complete the full range of professional activities with fewer than 2.5 SPAs a week.[1] [2] [3] In the consultant contract negotiated between the BMA and the Department of Health in 2003 (before the advent of revalidation), the recommendation for a 10 session job was to have 2.5 SPAs a week.[2]

In Scotland several health authorities offer full time consultant posts (10 sessions) only on a 9:1 split—nine sessions for direct clinical care and one for SPAs. A recent article in BMJ Careers has suggested that this will lead to a decrease in the overall quality of care.[4] A BMA analysis looked at the trend of jobs offering fewer than 2.5 SPAs from 2009 to 2011 by examining advertised posts and found a decrease in the number of SPAs advertised.[5]

We wanted to determine whether the current number of SPAs that new consultants in England secured was in line with previous consultant contracts and recent college guidance and also whether these posts were being approved by royal colleges. To do this we sent a request under freedom of information legislation to all 168 acute trusts in England on 8 February 2012, using the email addresses available from the NHS Choices website. The box shows the information requested.

Freedom of information request for data on SPAs and royal college approval of posts

  • How many substantive consultant appointments did your trust make in the year 1 September 2010 to 1 September 2011?

  • How many posts were advertised internally only?

  • How many posts had their job descriptions and timetables approved by the respective royal college?

  • Were all posts for 10 paid programme appointments with a 7.5:2.5 split of direct clinical care to SPAs? For those that were not, please state the split and the specialty this applied to.

  • Did all posts have an appointments committee, including a royal college adviser? For those posts that did not, please state the specialty.

We received 104 responses to our freedom of information request (62% response rate). Reasons for non-responders included that a fee was required, the email address on the NHS Choices website was obsolete, or the information was not held centrally by the trust. Data were missing in 8.2% of the dataset; we calculated percentages using only full datasets (that is, excluding missing data).

Table 1 shows the numbers of posts (and of trusts awarding them) that did not have approval from the royal college or for which the appointments committee did not have a college representative. Almost 99% of posts for which data were available were approved by the respective royal college, and almost 95% had a college representative on the appointments committee.

Table 1

 Consultant posts awarded without royal college approval or a representative on appointments committee

No (%) Total eligible No of posts or trusts*
Trusts awarding jobs not approved by royal college 2 (1.9) 103
Posts awarded that were not approved by royal college 17 (1.1) 1496
Trusts awarding jobs without a royal college adviser on appointments committee 17 (17.3) 98
Posts awarded without a royal college adviser on appointments committee 73 (5.2) 1411

*Those for which data were available

Of the total of 1516 posts included in our dataset, 1187 (78.3%) had 10 paid programme activities per week where the split between direct clinical care sessions and SPAs was known. Table 2 shows the numbers of posts according to the ratio of direct clinical care to SPAs. As the figure also shows, 32% of the total of 1516 posts were confirmed as having fewer than 2.5 SPAs. When jobs with an unknown split were excluded, this proportion rises to 40%.

Table 2

 Ratio of direct clinical care (DCC) and supporting professional activity (SPA) sessions in 1187 consultant posts where the split is known

Ratio of DCC to SPA sessions No (%)
7.5:2.5 697 (58.7)
<7.5:2.5 10 (0.8)
≤7.5:2.5 707 (59.6)
8:2 248 (20.9)
8.5:1.5 175 (14.7)
>7.5/2.5 480 (40.4)

No major differences were found between acute and foundation trusts in the allocation of SPAs.

Split between direct clinical care sessions and SPAs in consultant posts

The responses to our freedom of information request show that most jobs are being offered according to royal college guidance and in line with previous consultant contracts. However, a considerable proportion (perhaps up to 40%) of new consultants are being offered jobs where the number of SPA sessions is unlikely to enable them to complete the range of activities that SPAs are designed to allow.

It is interesting to note that in our study 480 posts offered fewer SPAs than the royal colleges in England would recommend but that only 17 posts weren’t approved by the colleges. There could be several reasons for this: college representatives may believe that they don’t have the necessary administrative power to alter job plans (foundation trusts do not require college approval to appoint posts); there may be internal pressure to appoint jobs quickly because of workload; and individual circumstances of posts may mean that some would not attract 2.5 SPAs in a 10 session job.

It has been suggested that new consultants need more time for SPAs to allow orientation, mentorship, and development of subspecialty interests.[2] It has also been argued that decreasing the amount of time available for SPAs for new consultants discourages them from participating in roles such as teaching, management, and clinical governance.[2]

An annual review of consultants’ job plans is common practice, and if consultants believe that they need more SPA time this can be negotiated. However, the practicalities of increasing the number of SPAs in an established job plan are well documented.[2] One of the concerns of the Academy of Royal Colleges is that the colleges are not regularly involved in this job planning process. However, as most jobs have already been approved by the respective colleges, it is unclear what would be added by involving them a year down the line.

Our approach had various limitations. Missing data are significant, with a 62% response rate from trusts. The quality of data that we received from the trusts varied. We examined posts recruited over only one year so could not evaluate a trend or examine ratios of SPAs among consultants already in post.

We have shown that as many as 40% of new consultant posts are allocated fewer than 2.5 SPA sessions a week. Most of these jobs have been approved by the royal colleges, which suggests that the implementation of their guidance is a challenge. Although the situation in England regarding the ratio of SPAs seems to be better than that in Scotland, there still seems to be a trend towards fewer SPAs for new consultants.

Competing interests: None declared.

References

  1. Academy of Medical Royal Colleges. Advice on supporting professional activities in consultant job planning. 2010. www.aomrc.org.uk/publications/statements/doc_download/9309-advice-on-supporting-professional-activities-in-consultant-job-planning.html.
  2. Royal College of Surgeons of England. Supporting professional activities (SPAs): policy statement. 2010. www.rcseng.ac.uk/regional/documents/.
  3. Royal College of Surgeons of England. Guidance for regional specialty advisers on approving job plans. 2005. www.rcseng.ac.uk/publications/docs/guidance_regional_specialty.html.
  4. Jacques H. Two thirds of newly appointed consultants in Scotland are employed on 9:1 contracts. BMJ Careers  2012; http://careers.bmj.com/careers/advice/view-article.html?id=20006802.
  5. Jacques H. Half of consultant jobs offer fewer than 2.5 SPAs. BMJ Careers  2012; http://careers.bmj.com/careers/advice/view-article.html?id=20003863.

Timothy Barlow academic clinical fellow  University Hospitals of Coventry and Warwickshire, Coventry, UK
David Barlow specialty trainee   University Hospital of North Staffordshire, Stoke-on-Trent, UK
Alison Edwards consultant orthopaedic surgeon  University Hospitals of Coventry and Warwickshire, Coventry, UK

Correspondence to T Barlow  timbarlow@doctors.org.uk

Cite this as BMJ Careers ; doi: