Table 3.
Among DGH consultants 4 believe workload will increase, 1 believes it will stay the same while 1 believes it will decrease. For teaching hospital consultants 13 believe workload will increase, 5 believe it will stay the same while 1 believes it will decrease and for academics 2 believe workload will increase, 4 believe it will stay the same while none believes it will decrease. Figure 3 shows responses to the question ‘comment on whether workload will increase, stay the same or decrease in future’. Almost all agree predicting consistent future increases of 10-20%.
Figure 3.
-I’ll be taking over the position of clinical lead for the unit July 2003.
-there is year on year increases in our clinical commitment.
-ever increasing referral rate, 2nd consultant would bring increased pressures, personal desire to fulfil research and teaching objectives.
-more patients have been referred & followed up but we plan to appoint another colleague.
-workload has always increased year on year.
-full shift system for SpRs comes in.
- increased service development
-delay in replacing colleague who is leaving
-I will not be returning to clinical work as I have a major academic workload
-Increase ->more GP referrals
-Increasing referrals, increasing number of patients requiring frequent follow-up.
-new patients. I see 200 new patients/year personally – 80% are GI.
-Increase – it has increased by 20% each year so far.
-INCREASE – SERVICE PREDICTED TO GROW AT 10%PA FOR AT LEAST NEXT 10 YEARS.
-decrease –1. likelihood of colleague appointments 2. my determination to reduce workload.
-unable to get management to agree to drop general paediatric 1 in 5 when doing 1 in 3 paeds gastro rota when the two cannot be combined day to day for me due to day time commitments.
-expanding tertiary service.
-increase – beds not strictly gastro usually have 3-4 at any time.
-year on year it just gets busier.
Figure 4 shows answers to the question ‘Comment on how teamwork functions in your unit. This represents a consistently positive response particularly with respect to consultant colleagues.
Figure 4.
-generally good teamwork with regular handovers, team discussions and meetings. Communication between various team members at all levels could be improved.
-community and acute services could be better integrated (separate sites) to remove some general paediatric work e.g. NAI.
-excellent team spirit & communication within existing team. However, number of personnel always under threat.
-close unit, good advice and co-operation good sharing of duties.
-good team with staff grade, designated reg. and SHO interested surgeons, radiologists, pathologists, dietetic time, nurse specialist, committed ward staff (not designated ward).
-teamwork difficult, different practices between consultants, too much work to share ward rounds/clinics etc.
-cross-cover for lists & ward rounds is good, everyone flexible, lots of expertise, interest, enthusiasm.
-we all get on very well personally.
-well – continuing problems re: SpRs off duty post on-call/partial shift.
-personable colleagues with good communication, cross cover, & joint responsibility.
-VERY WELL
-we invented the consultant ward week system 11 years ago. My colleagues trust each other.
-clearly developed multidisciplinary team
-(well) BUT LACK OF RESOURCES AND TIME A PROBLEM.
-We get on well and are happy to pass work on to those most suited to the problem.
-We meet 9 am Monday morning. Special interests do not overlap, Agreement never a problem. We generally get on well with each other. Good standard of junior staff.
-It works well because I bend over backwards to liase with my SpR (50% gastro/50% general paediatrics) and my dieticians and pharmacist. If I wasn’t so vigilant things may collapse.
-good communication
Teaching and academic responsibilities
The groups could be expected to have very different roles responsibilities and resources for research and teaching. Teaching responsibilities are shown in table 4.
Table 4.
Three DGH, 5 teaching and 7 academic consultants had a role in medical school administration while 3, 9 and 4 from each group respectively run educational courses and 1,9 and 3 provide work experience for school students. When asked to evaluate their teaching skills DGH consultants reported themselves as; excellent n=1, adequate n=7, barely or inadequate n=0; teaching hospital consultants reported excellent n=5, adequate n=13, barely or inadequate n= 1; academic consultants excellent n=3, adequate n=4, barely or inadequate n=0. Figure 5 shows comments following the 5 point Likert question ‘how good are you at teaching’. Many have undergone training but even among those that have not most are fairly confident of their skills. The environment for research was assessed as follows: Among DGH consultants 1 found it regularly supportive, 2 occasionally supportive and 2 neutral. Three teaching hospital consultants found it regularly supportive, 5 occasionally supportive and 6 neutral, 1 occasionally obstructive and 5 frequently obstructive. Among academic consultants 2 found it regularly supportive, 2 occasionally supportive none neutral 1 occasionally obstructive and 1 frequently obstructive. Figure 6 shows comments following the Likert scale response on support from the Medical School. Only one is fully positive while 6 are strongly critical of the support they receive.
Figure 5.
-Have attended one formal course in how to teach/teaching methods but would prefer to attend further teach the teachers courses.
-I am employed as Director of an e-learning course in tropical medicine/public health.
-no formal training received.
-more time to devote to these areas would result in significant improvement.
-I have been on a number of courses for teachers. The feedback from my MRCPCH course is usually positive.
-I try to be imaginative but could always benefit from some teaching myself
-certificate of medical education, mentoring and appraisal courses
-I’ve 35 years of experience and am co-ordinator of 2nd and 3rd year teaching and paed teaching in 3rd and 4th years. I teach nutrition in university and overseas.
-I’m doing a masters in clinical education.
-Member of the Institute of Learning, Teaching and Higher Education.
-PROBABLY GOOD
-I get reasonable feedback from teaching sessions.
-I have done teaching course
-teaching courses attended regularly, peer review of practice, membership of institute of learning and teaching
Figure 6.
-very supportive environment with plenty of team meetings and research updates. All team members are encouraged to take part in some sort of research.
-research supervision additional to other responsibilities.
-no help at all.
-No help, support, protected time, admin support etc….
-There is no money, the medical school are reducing staff, publications are expected, and there is a culture of blame for!failure.
-ped GI is not in the strategic plan for the medical school so infrastructure, resources, admin, finance etc. withdrawn to a more central site.
-hard to convince clinically busy people that research is worthwhile
-little support to do audit.
-Environment supportive but inadequate time available on regular basis.
-No support for on-costs or facilities secretaries etc. from either University or hospital. Heat and light only!
-everyone wants to support this activity but it fits round everything else. This year I plan to be more rigid in the time I set aside for this.
-Severe space constraints in the department.
-Lack of time but research environment is improving.
-just too much pressure from clinical side.
Clinical governance, management and relationships
Two DGH, 7 teaching and 3 academic consultants had used methods such as a questionnaire to assess the patients’ and parents’ perception of their service. Five DGH, 17 teaching and 6 academic consultants had a management administrative role, with 6, 10 and 7 having representative roles on professional bodies. Other roles are summarised in Table 6, and time for clinical preparation is shown in Table 7.
Table 5. Management roles and skills
Teaching hospital consultants felt a lack of support from their hospital trusts in management.
Table 6. Sessions per week for preparation of clinical care
Those who found it sufficient all had at least 2 sessions.
Figure 7 shows answers to the secondary question ‘How much time do you have for clinical administration? Is it enough?’ It suggests that this important task is performed out of hours and as a final task. Together the data suggest that at least 2 and probably more than 3 protected sessions are necessary.
Figure 7.
-too much admin etc.
-most of this kind of thing is done out of hours.
-I do 12-15 hours/week administration
-correspondence/literature searches usually extend to out of hours.
-This isn’t formalized. It just gets done around everything else.
-constantly answering patient queries, chasing results writing letters etc.
-approx 16 hours additional time per week – evenings, week-ends, in place of CPD
Table 7. Clinical governance
Table 7 shows that respondents use approximately 1 session per week for the elements of clinical governance but it is rarely protected. Figure 8 shows comments on the question ‘Is clinical governance working?’. Respondents are evenly split as to its value overall but comments are doubtful.
Figure 8.
-not for me at the moment. The sessions should be protected but often ‘disappear’ taken up by clinical work, discussions etc. On the other hand it is not difficult to get time off to go on a course or attend conferences.
-we are beginning to think differently about our relationships with patients, parents and other professionals.
-CG not working yet as masked in paperwork
-just a doctor bashing exercise, occasionally works for some things e.g. risk
-no- never going to be perfect.
Table 8. shows feeling of effectiveness in a management role and previous management training. There was no correlation. Training therefore is not associated with feeling effective as a manager. It is not clear whether management was not effectively taught to these doctors or whether it awakens a realisation of the nature of the problems at least as great as the skills provided to solve them, particularly as there were lower feelings of effectiveness in the teaching hospital group who had the highest proportion with management training. However this is the same group who feel least supported by their Trust in management (table 5.) and with poorest relationships with Trust managers (table 9.) suggesting that management training cannot compensate for poor relationships.
Table 8.
Figure 9 shows comments on the feeling of management effectiveness as in table 8. Responses are mixed but generally doubtful.
Figure 9 .
- progressive development of service with development of infrastructure by trust
-only just starting to get to grips with things. Still some management courses to go to. Meanwhile I am learning on the job.
-difficult to understand management structures, processes and speak.
the NHS is poorly funded with no real management structure and constant irresolvable conflicting priorities. Our trust management does its best, I feel in a difficult situation.
-time constraints limit effectiveness I will hand clinical lead role onto a full time colleague soon
-I feel that a significant amount of what I am trying to do is working out and I am learning how to make things happen without upsetting people.
-no resources for development – basically because income stream for tertiary paed specialities is not identified. Therefore when anyone moves on e.g. specialist nurse need a new business case to replace giving delays of many months.
-I’d like to be more on top of things – I have university, faculty, dept and college roles.
-I am able to make policy for the dept.
-Too little time to do it all properly.
-Conflict over inadequate resources to meet clinical demand creates tension.
The directorate/trust does not support any initiative financially, which is demoralising.
-lots of plans – little action
Table 9. Quality of relationships
There is a trend to worsen with distance in professional culture and reduced likelihood of day to day interactions.
The numbers of respondents who held themselves accountable to patients by the methods shown appear in table 10. None circled ‘not at all’. Most regard accountability as part of the job and within the interaction with parents. It is impossible to determine from the data how it works in practice.
Table 10.
Figure 10 shows comments on the responses to table 10.
Figure 10.
-good communication and network for parents to call in and contact team members.
-much rather than via an official body (Than trust).
-service and commitment I hope focused round patients’ needs – more than my own!
-I am trying to develop a way of working that empowers patients to feed back directly what is satisfactory and unsatisfactory and also use regular feedback through satisfaction questionnaires.
-I am responsible for their care and the buck stops with me.
-It’s part of the job.
-The standard of practice is underpinned by the professional body.
-generally the service is very well liked by patients and referring consultants.
The best and worst of the job.
All respondents found their jobs rewarding. Among DGH consultants 2 always and 6 often, teaching hospital consultants 12 always and 8 often while academic consultants 3 reported always and 4 often. Work related quality of life (QoL) and reporting stress are shown in Table 2.
Figure 11 shows responses to the question ‘How rewarding do you find you job?’ It is clear that all find it worthwhile despite the sometimes considerable difficulties.
Figure11.
the medical side of my job is generally very rewarding. The management side is rewarding to a certain extent. Having more time to focus on this side of the job and having the feeling that I am making a difference rather than just keep up to speed with things would be far more rewarding.
-I feel we deliver a high quality clinical service to our patients despite usual constraints.
-constant positive feedback from referrers/patients.
-I enjoy having ideas and trying them out. Every day is different. There are lots of opportunities for achievement. I like being with people.
- a service that is new developing improving and appreciated by colleagues
-usually rewarding
-management is a far cry from clinical work that I enjoyed – that was the most satisfying part of my working life.
-despite less support I am still able to provide a good service to my patients.
-the demands often overwhelm my enjoyment
-Desperately short staffed to cover case load. Work not distributed equally among the three consultants in dept.
When asked to give the 3 best aspects of work respondents gave answers which were classified into headings as shown in table 12. The number of respondents for that answer is given by institution type on the right hand corresponding column.
Table 11.
While all groups regarded clinical work as among the best aspects of their work research was the commonest response for academics, patient feedback the second commonest response by teaching hospital consultants and team and colleagues the second by DGH consultants.
When asked to give the 3 worst aspects of work respondents gave answers which were classified into headings as shown in table 12. The number of respondents for that answer is given by institution type on the right hand corresponding column. Bureaucracy, resources and time were a significant concern for all. However, when data were reallocated according to 3 groups according to QoL scores <7, 7 - 7.5, and 8 –9, those with highest QoL regarded time as the greatest adverse aspect while those with the lowest regarded resources as the most adverse aspect, suggesting locus of control was an important association (external with poor and internal with good QoL).
Table 12.
Table 13. Predictors of QoL score from data collected.
Figure 12 shows answers to ‘Any comments?’ (section 13.).
Figure 12.
-QoL was about 2 when I was full time!
-I feel a conflict between clinical and academic pressures and between work and home life.
-we have been highly successful in consultant expansion (1 in 8 rota) hence few grumbles
-the difficulty of getting access to adult services makes teenagers keep coming back.
-Thanks!
-I am a very part-time paediatric gastro doing all the local gastro but a small part of my work. Enjoyable and productive relationships with adult colleagues for procedures, IBD clinic and clinical meetings.
-I am employed by the university and the majority of my duties do not concern GI.
-inadequately supported by my trust with a difficult case that carried a lot of stress. Will probably retire at 60 because of that.
Discussion
Most consultants are extremely committed to their jobs which they enjoy. They like their colleagues, medical and multidisciplinary, and have fairly good relationships with their trust and its managers. They work longer hours than the EWTD or the new consultant contract allow. They often struggle with aspects of the current NHS changes, with conflicts within their roles and the complexity of their environment and responsibilities. Academic work and administration are often pushed out by pressure of clinical work that is continuously increasing. Most are under stress as a result. Many appear under-resourced and most feel they could benefit from a variety of resources. Academic consultants are surprisingly similar except in the allocation of their time. Given the data, it is hard to see how the current changes can result in anything but greater levels of individual conflict and worse services to patients.
The response rate of 45% of eligible consultants is only moderate but typical of postal questionnaires and must imply a bias in the results from the decision not to contribute. There was also a bias in favour of replying by academic and teaching hospital gastroenterologists, while dissatisfaction seems to be most evident among clinically based individuals and concerning management matters. Despite being presented as neutral, if the questionnaire was interpreted as a means to protest or change the current direction of the development of paediatric gastroenterology, individuals relatively satisfied with the progress towards the new contract might not wish to protest. There might be doubt over the importance or influence of any report generated. Other possible explanations include the size and complexity of the questionnaire itself, non-respondents being too busy, the questionnaire being seen as serving the purposes of the council or academic gastroenterologists rather than, for example, district general paediatricians, or perhaps being subject to the purposes of the individual who organised it. Nevertheless, we have collected comprehensive experiential data from a almost half of UK paediatric gastroenterologists at a critical time in the development of the profession.
It appears that need for additional consultants is indicated by the data. Accuracy of prediction of the number is limited by data only from 37 of 83 consultants (45%) who replied. Since 23 were working a mean of 17% in excess of 48 hours per week, 4 consultants are required to conform to EWTD. If trusts intend to reduce hours to 40 per week all consultants except one part time were working on average 37% in excess making 13.5 extra consultants necessary. At worst if the study is representative of the whole UK 9 or 30 consultants are necessary to reduce to 48 or 40 hours respectively. The argument for more consultants assumes there is some way to distribute their hours among the subspecialty throughout the UK. Unfortunately, the resources and infrastructure are not in place to simply employ more consultants, for example, the teaching hospital consultants, who evidently need hours of consultant assistance most, work in units with very high in-patient bed occupancy, so beds would be a barrier to effectiveness of extra consultants in those units. In addition, at present 14 prospective GI consultants are in training at various levels, but only 5 will be fully trained within 6 months. The projected needs therefore could not be met for at least 2 years without significant restriction in workload and services with consequences for the quality of service and its patient experience. While consultant expansion is essential, it cannot solve the problem of hours and quality of professional life, especially in the short term.
Most respondents felt they could be more effective with more resources, and almost all expected workload, individual and departmental, to increase based on experience of referral patterns. Their perceived requirements were varied but included more senior colleagues (3), more nurses including specialist nurses (3), dieticians (2), junior doctor (1), clerical support (1), social worker (1), and psychologist (1). Out-patient waiting times at 10 weeks (and up to 26 weeks) are clearly far from ideal especially for children. However, 4 consultants had waiting times of 4 weeks and 4 of less than 4 weeks (0,2,2,3 weeks). Maximum 2 outpatient sessions and 1 procedure session per week is typical of current workload and seems a reasonable benchmark. In-patient bed occupancy rates for teaching hospitals are clearly well above the levels at which care can be given most effectively and with optimal patient experience and the report should serve to alert Trusts to the inappropriate level of use of in-patient services with potential adverse effects for staff and patients. A minimum 2 and probably at least 3 PAs are needed to manage administration (Table 6 & Figure 7). Additional sessions including those for clinical governance need to be protected (Table 7). Suggested benchmark standards are shown in table 14, although they were only met by 5 (13.5%) consultants from 1 DGH and 4 teaching hospitals, who were working 48, 48, 50, 55 and unspecified number of hours per week.
Many individuals felt a conflict between clinical and academic work and with the pressure of administration most have resolved it in favour of clinical work. Despite this effect, DGH and teaching hospital consultants still managed to teach the equivalent of 1PA per week and teaching hospital consultants managed 1 PA of research per week with DGH consultants managing 0.5 PA. These medians seem reasonable as benchmarks. However, it appears to be those whose academic role allowed them to resolve their time conflict in favour of research sessions that had the best work related Quality of Life, despite mostly critical comments about support from medical schools (figure 6). Academic consultants taught the most individuals but did not devote the most time to undergraduate or post-graduate teaching. They did not assess their teaching skills as any better than other groups. They also claimed to work the least hours per week and had the most protected time for committee work. Their relationships with their employers were similar to the other groups (table 9). These findings are in keeping with the new medical school agenda of priority for grants and peer-reviewed publication.
Relationship with one’s employer is known to be a major determinant of motivation and job satisfaction. It is also a key factor in maintaining the high morale necessary for achieving the changes currently in process as modernisation in the NHS, improving services and retaining staff. They may make the investment in management skills for doctors more effective also.The data do not describe particularly bad relationships, except in 2 cases, (table 9) but there were correlations with work related quality of life at several levels (table 13). Positive relationships with employees are an essential feature of high quality management, with responsibility lying more with management than employees. The new consultant contract seeks to treat consultants more like other employees than in the past, and the data suggest the need for new skills and willingness to develop more effective working relationships with doctors on the part of Trusts and academic employers. Two recent tragic suicides among consultant paediatricians related to pressure of work illustrate the level of stress possible in the current NHS and the risks that Trusts have a duty of care to minimise.
While resources are clearly stretched and likely to be stretched further by the effects of the consultant’s contract and increasing workload, it is highly unlikely that sufficient resources will ever be devoted to paediatric gastroenterology as defined by consultant expectations. Paediatric GI is not a recognised NHS priority or a particular priority within Children’s Services. While paediatric gastroenterologists must campaign for more resources, such a campaign has a better chance of success if it can be seen that current resources are being used as effectively as possible. Waiting times for out patient appointments, the major environment for hollow-organ GI services are generally suboptimal, while some consultants have short waiting times. Only 12 consultants have formal feedback as to the experience of their service, and accountability is to the patient directly almost universally as ‘part of the job’ but without any way of assessing the equity or patient centredness in the interaction. Much remains to be done towards the ideals of the National Framework for Children’s Services. Despite the difficulties it is therefore essential that paediatric gastroenterologists show that they have the collective vision to develop optimal services for children with GI diseases in the UK.
It is possible to establish a BSPGHAN website open to GI referrers with simple data such as time to next outpatient appointment and time to admission for basic investigations such as endoscopies for each participating unit and suitable for the majority of straightforward GI referrals. Families willing to travel could choose earlier appointments in association with their referrer depending on geographical location, clinical need and parent preference. Standardisation of investigation and treatment for the diagnoses representing the majority of referrals, combined with good communication would ensure that once started, treatments could, if appropriate, be transferred closer to home. This project could be organised on the model of the ‘Patient’s Choice’ programme, which is currently being extended by the government as a model for future care with resources allocated to units who can show sufficient capacity and the ability to provide high quality care. Contracts for this solution will need to continue for at least 3 years to justify the employment of additional staff.
To prevent the deterioration of paediatric GI services strongly suggested by the respondents in the next 2-5 years brought about by the current changes, pre-emptive action is necessary. We propose the following strategy:
- All recognised paediatric GI consultants to have resources as described in table 15 and to have those standards incorporated into their job plans. Allocation should be pro rata for part time posts except those marked * to the same standard as full time consultants. DGH consultants should also have the same pro rata resources, but all need to have at least 3PA/week for GI with 1 for outpatients, a proportion of at least weekly ward rounds (e.g. 0.2 PA), 1 PA for administration, 0.5 for CME & clinical governance and 0.5 for procedure lists. Similarly clinical academics should have 3PA per week as clinical sessions.
- All consultants who are currently working at least 48 hours to have the option of 12 PAs and paid as such with review of the need for this part of the strategy by diaries for each individual after 12 months.
- Need for 9 new posts accepted and allocated to departments of greatest need within 12 months. Greatest need must be decided equitably and representations made to the employing Trusts.
- Establishment of a managed clinical network for paediatric gastroenterology to promote patient choice and referral of new patients between units for optimal use of resources as above.
- Establishment of a web-site to record and make available current waiting times so that units with excess capacity can offer care to patients referred to those with long waiting times and referrers can choose to send patients where resources are least stretched.
- Additional PAs for DGH consultants to take on additional work where possible supported by their Trusts.
- Making an application to the Department of Health for an allocation of funds to support new consultant posts with appropriate support and also to run a programme equivalent to ‘Patient Choice’ whereby business plans for the care of a fixed number of patients over 1 year is accepted and funded in units that can show the capacity and organisation to provide care rapidly and to a high standard.
Table 14.
Apendices
Appendix A
Questionnaire.
Appendix B
Anonymised email responses to request for feedback 10 months after first circulation of questionnaire.
Appendix C
Excel spreadsheet of data.
Appendix D
Conflicting interests.
Alastair baker has received research grants from Novartis Nutrition, been reimbursed for attending an international conference by Novartis Pharmaceuticals, and has received sponsorship for conferences he has organised from Fujisawa Pharmaceuticals, Roche Pharmaceuticals.
Appendix A
Questionnaire to assess quality of service & lifestyle in the BSPGHN
Dear Member
You may recall when I was elected liver representative to BSPGHN council I provided a submission in which I undertook to provide a report as a resource and benchmark toward better services for patients and better professional lifestyles for members. Reflection on the purpose of the questionnaire may assist you in how to provide data. Please provide as much data as you feel is helpful and also indicate the source of quantitative data e.g. departmental audit etc if possible.
The questionnaire will be distributed by, and should be returned to my secretary, Emma at King’s College Hospital by post or by e-mail to <emma.wynne-hurley©kingsch.nhs.uk> who will pass the forms to me for assessment in anonymised form. All questionnaires sent will be allocated a respondant’s number so that to prompt non-returns more than once if necessary.
The report will be circulated to all BSPGHN members and to professional and governmental bodies at the discretion ofcouncil. The value and influence of the report will be directly related to your commitment to complete and return the questionnaire.
I thank you for your time and attention to this important matter.
Alastair Baker – Mar 2003
1. Anonymous personal details circle as appropriate Number/YES/NO Post: consultant (hon), associate specialist, SpR, SHO, research fellow, other
Contract: full time, max part time, other................
Clinical institution: teaching, DGH, community, other ..............
Total weekly sessions nnnn
Number of GI sessions
Number of academic sessions
Number of consultants involved in Paed GI work
Medical teamwork/clinical crosscover works
a. Very well, b. Well, c. Variably, d. Poorly, e. Very poorly (please circle)
Please explain:
-
Details of clinical workload Number/YES/NO
Frequency of on call (1 in),
Estimate total weekly hours worked including on call
Estimate hours per week in hospital
Estimate total hours in clinical work
Estimate on call phone calls
Estimate frequency of being ‘called in’
How much protected time do you have?
Have you kept a diary or made other accurate assessment?
Are you under pressure to reduce in line with EU directives?
Estimate:
Number of patients seen as in-patients per year in your unit
Number of beds available to you
Bed occupancy
Number of patients seen as out-patients per year in your unit
Number of patients seen as day-cases per year in your unit
Number of procedures performed per year in your unit
What proportion of procedures are performed by you?
What proportion of procedures are supervised by you?
In the next year I expect my workload to:
- Increase, b. Stay the same, c. Decsease
Please explain:
3. Teaching, training and clinical supervision
Typically, how many hours per week you allocate for:
Undergraduate teaching
Postgraduate teaching
Supervision of junior doctors
How many students /SHOs/SpRs/others do you teach/year?
Do you have any administrative roles for:
Your Trust?
Your Medical School?
Any professional body?
Running courses?
Are you involved with school work-experience?
‘My skills in teaching and training are:’
- Excellent, b. Adequate, c. Barely adequate, d. In need of training myself’
Please explain:
- Research & Publication
Do you undertake or supervise laboratory research?
Do you undertake or supervise clinical research?
Do you supervise researchers?
Do you have grants?
How many hours per week are required for your research role?
The current environment for research is closest to: a. Frequently supportive, b. Occasionally supportive, c. Neutral, d. Occasionally obstructive, e. Frequently obstructive, f. Other.
Please explain.
Number/YES/NO
5. Management Roles
Do you have any management roles?
Do you perform any clinical lead role?
How m any trust committees do you serve on?
How many protected sessions do you have for this work?
Have you received any formal training in management?
Do you feel you receive adequate support from the Trust?
Do you feel you receive adequate support your colleagues?
Are your relationships with Trust managers a. Good, b. Fair, c. Neutral, d. Poor, e. Terrible?
‘In my management role I feel a. Highly effective, b. Variably effective, c. Poorly effective, d Highly ineffective’
Please explain:
- Clinical Administration
How many sessions per week do you have for:
Preparation of clinical care, getting results, correspondence, literature searches etc.?
Is it enough?
- Clinical governance
How many sessions do you have in total for continuous (personal) professional development, meetings and courses professional revalidation, audit and implementing the audit cycle, risk management processes and NCEs, evidence based practice – setting, delivering and monitoring standards.
Are the sessions protected?
Have you been appraised?
Do you think CG is working?
Number/YES/NO
Number/YES/NO
8. Patient and carer experiences
How many patients are on your waiting list?
How mant months does a patient typically wait for an appointment?
How many days does a patient wait for admission?
How many minutes does a new patient get in clinic?
How many minutes does a follow up appointment take?
Have you used satisfaction questionnaires or other tools?
How many complaints do you deal with per year?
How many letters or other tokens of gratitude or appreciation do you receive per year?
‘I regard myself as accountable to patients / parents a. Directly, b. Indirectly through my Trust, c. Indirectly through my professional bodies, d. Indirectly by other means, e. Not at all’
Please explain:
9. Assistance and facilities
How many of each of the following assist or are available to your GI service and what proportion of their time is allocated to you and to GI.
secretary,
specialist nurse,
dietitian,
pharmacist
other (please describe role)
theatre/endoscopy sessions
+/-anaesthetist
‘I could be more effective with access to more clinical support – Agree/Disagree’
Please explain:
Number/YES/NO
10. Personal satisfaction
Do you take all your annual leave?
How many days’ study leave do you take per year?
Are you planning/considering a sabbatical?
Do you feel under stress caused, precipitated or compounded by your job?
Are your relationships with your multidisciplinary colleagues
a. Very good, b. Good, c. Neutral, d. Poor, e. Very poor?
Are your relationships with your employer generally
a. Very good, b. Good, c. Neutral, d. Poor, e. Very poor?
‘I find my job a. Always rewarding, b. Occasionally rewarding, c. Rarely rewarding, d. Never rewarding.’
Please explain:
11. Please reflect for a couple of minutes on your experience of work and score your own current professional quality of life on a scale 0-10: 0=extremely bad and 10=excellent.
12. Please list the 3 best things and the 3 worst things about your job in the two columns
13. Please add any further relevant comments/opinions beneath/overleaf.
Appendix B. Feedback April 2004.
- As one of the single-handed DGH people I do not have a colleague to devolve GI work to. Job plan discussions are taking place but have not been signed off yet. My paediatric colleagues and I are regularly doing 14 or 15 PA's per week. My clinical director wants me to cut back to 12 PA's this year. It has come down to a straight choice between cutting clinical sessions or reducing the teaching I do (which I greatly enjoy, think I'm good at and don't want to cut back on!) His suggestion is to halve my number of endoscopy lists and halve the GI clinics I do at another hospital in our trust. This will inevitably mean longer waiting times for patients since this work cannot be picked up by anyone else.
- Pressure is to reduce below 48 hours. Our trust - foundation trust - is keen
to see us all get to the 40 expected of 10 Pas. Nothing over 12 is being
allowed in region without going to the startegic health authority. My
average hours are 53 - an understimate as it only includes 1 weekend on call
so far in the weeks I have diaried.
I am happy to move to 40 -48 hours if it is realistic and by increasing
consultant numbers. I have an odd posta s it is half time clinical/half time
education and I am regional adviser as well and at present there is no way
I can do everything expected in that time scale. If held to 12 that is what
I am going to do. I have said that the only regiular activity I could effect
is clinic work as everything else is driven by other people's demands. I
have included 1 PA per week for my regional adviser work in my job plan. I
haven't heard back yet.
I have submitted an annualised job plan to allow for my non standard
activities, based on 9 regular Pas and 3 for supporting activities.
- I just wondered whether you would be happy to compare notes. The whole process is in full swing and, although no formal agreement has been reached between trust and staff, we have been informed that all gastroenterologists will be paid 10PAs as a baseline, +/- an extra PA, depending on our work diaries. In addition we have been told that our on-call supplement will be Category B (ie identical to adult pathologists, dermatologists, etc!!)
Obviously we disagree with this and will appeal. However I think it would be
helpful if I knew what is happening in your trusts. I imagine the
intensity/complexity of clinical work we all do out of hours is quite
similar and it would be bizarre if some Trusts agree on Category A, whilst
another Trust will only agree Category B for on-call activities.
- For the record in reply...nothing has changed so far. I have certainly not agreed a job plan.The message from our acting HR Director,who for your interest has had to replace the Director who has just resigned, is that even though our work record diaries were agreed by our Directorate managers to show 13+ PA`s we are likely to be told to accept 10 with another one on a short-term basis. As ever the implications for patient care are imponderable to say the least!
