Everyone is aware of the ongoing financial challenges being faced by the NHS. In the absence of any opinion polls we can only guess at the general public reaction to the BBC report of a Consultant at Lancashire Teaching Hospitals Foundation Trust being paid £374,999 in overtime over the past year.
Public sympathy for doctors has been strong during the the long running junior doctor’s contract dispute, which is, of course, about more than just pounds shillings and pence. Could this massive overtime payment and other stories which may arise during the negotiations for the new consultant contract shift public opinion from support for doctors to the reactions observed toward so called ‘fat-cat bankers’?
What is the alternative to the £375,000 Consultant’s bonus?
Being able to answer that question requires a broader understanding of the circumstances than initially considered by many who saw the headline.
Its not that long since the media focus was upon the vast amounts being spent on locums. Jeremy Hunt claimed that staffing agencies had been able to “rip off the NHS by charging extortionate hourly rates“. As a result, a spending cap was brought into effect from November 2015 onwards – a spending cap which Trusts have struggled to work within.
The reasons that doctors have been able to negotiate astronomical overtime and locum payments is directly linked to the fact that the NHS, as the world’s 5th largest employer, is facing a staffing shortage. For patients and their relatives, how can you put a price upon it? They simply want access to a doctor. The real question has to be:
How do we address the shortage in doctors within the NHS?
Overtime and locums are one obvious option. Another is the recruitment of doctors from other countries – in February of this year some 69% of Trusts and Health Boards said they were pro-actively engaged in doing so. One wonders how the health systems of other countries feel about the loss of their clinicians to the UK. Or we could spread our resources thinner with each doctor caring for a greater number of patients within normal working hours. Initially this may seem unrealistic. Thinking outside the traditional models, however, can lead to innovative solutions where functions are delegated to pharmacists, optometrists, nursing practitioners and so on. If only there were enough nursing practitioners.
The search for the solutions has to go beyond those at the top level and for senior management. Sir Bruce Keogh has emphasised a doctor’s “moral and professional responsibility to understand the system“. Doctors of all levels have a vital part to play in forging new solutions. This requires arming yourself with the facts about the NHS and applying this knowledge to everyday leadership and behaviour.
Of course, the placing of the apostrophe in the title of this post tells an important story. The headline grabbing £375,000 overtime bonus is a one off and there are incredible variations in the way which individual trusts, health boards and hospitals negotiate these matters. Though circumstances vary dramatically from one part of the country to another organisations need to learn from one another.
