Thursday, October 10, 2013

SPA...what's the worth?



It's one of those things which sharply divides people, one of those topics which brings out the doctors trade unions out in a froth, hospital management barely conceals their disdain and as time has passed, as the squeeze for money has escalated, the battle lines have become more vivid, the cries more shrill, the antagonism even higher. 3 letters...also known as SPA...short for Supporting Professional Activity.

So let me explain what in simple terms that means. When the Consultant contract was redrawn, it was decided that 10 hours per week would be needed (in a standard 40 hour week) for this work. That would involve among others teaching your juniors, making sure your own knowledge and competence was up to scratch i.e. you were keeping up with the changing world of medicine etc, clinical governance,research and in some cases, time for management roles. All sounds easy so far..but as we moved into the NHS world of money, profit, revenue...what dawned on all concerned was that this time actually brought little or no money back to the Trust. You could see the Trusts point of view...depending on your seniority, that could be anything between 25-40 K/ year investment by the Trust..without any return whatsoever. And which business in their right mind would want to invest that amount of money without any return? Crazy isn't it.

So flip the coin...back to the argument that health should never be about money and profit...in which case, how do you NOT allocate a Consultant time to teach juniors, be their educational supervisor, have a pastoral role..develop the next generation? The argument that this brings no money is also a bit faulty as medical schools actually pay Trusts to deliver education to medical students, so steady with the argument that this brings no revenue. Same for Deanery...money does come, though perhaps nowhere near what clinical activity based on PbR will bring..but there is the responsibility to teach. I did not take this post just to do clinics and go home..I also did so because I have a passion to help build generation next.

Same argument for revalidation...in this day and age, who wouldn't want their doctor to be properly revalidated? Yes, no money comes back for that...but if you don't get yourself up to scratch, how do you ensure good clinical care is being delivered? Consultants also argue that time spent on SPA helps to develop services which indirectly translates to increased revenue for Trust...catch 22,isn't it?

The problem however, in my opinion, isn't there. The problem lies in all quarters. Firstly, lets pick the Consultants. It would absolutely be fine if all Consultants actually did what their SPA asked them to do. They may get that money but show no interest or time in teaching, being a good supervisor or even engaging on issues such as governance. 2 reasons for that...group one..their clinical work is so huge that there is little time for such work and group two...they go and do something else. Job planning of Consultants haven't been as robust as they could have been for group 2....thus group 1 keeps bailing out group 2, gets more tired, frustrated,bitter at the unfairness of life..while group 2 carry on regardless. The circle is complete.
Here's a few things...if someone says they are educational supervisor to 4 juniors, then their measure should be what those juniors actually say..is that individual there when needed, was he/she good etc? if that's not the case, then fine...thats for the job planning panel to decide where to use that individuals time. The issue being that group 2 are in a minority but that minority is enough to tarnish the majority...what was that again about rotten apples?

Second problem? National bodies. For Gods sake, stop eating quail eggs in plush rooms and say something robust rather than putting out wooly statements which doesn't help Consultants and management. Say clearly how much time an individual needs for revalidation...the present statements are so wooly..no wonder everyone gets confused. Is it 2, 4 or 6 hours for revalidation? BMA..calm down when you say everyone MUST have 10 hours/ week for SPA..if they don't want to teach, doesn't have much time for much education, then surely it needs to be asked what those 10 hours are for? Educational gurus..come out and say something..don't whimper in the background but make the case strongly why education is important, why it is so critical we do not forget generation next. Part of being here today is also about preparing for tomorrow, isn't it?

And finally, as regards management...don't make it sound like Consultants are doing nothing in those 10 hours. They didn't individually negotiate those terms, its a national contract..they are just following the rules. Have an understanding what SPA means, attend a few courses if need be and then go and challenge if those are not done. Don't arbitrarily scattergun...if its a business you want to run, then like it or hate it, without those Consultants, you have no business. If you are not happy with your best player, you don't just go and whip him, you make sure you get the best out of him. SPA shouldn't be a term of disdain, it should be a term which actually means something..it should be something which can be flexible. can we be brave enough to give each Consultant, say, 4 hours for revalidation and then negotiate with local educational leads, governance leads, research leads,clinical managers as to what else should be given in SPA time? Then actually measure whether thats being done rather than give them that time in perpetuity? Some may need more than 10 hours, some may need less...but can we have that flexibility and discussion based on what that Consultant wants and department needs? Till we feel grown up enough to have that discussion, we will continue to stumble along along sharply divided lines.

I write this blog today as a manager (Clinical Director), an educator (Royal College Tutor and Teaching Liaison Clinician) as well as a clinician who loves to teach ( am educational supervisor to 6 trainees). And I worry what the shrill divided lines are doing or going to do to our generation next. We must get these discussions going as soon as possible..otherwise we risk engulfing even noble stuff such as educating into a simple profit-loss equation.

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