Trends in consultant clinical activity and the effect of the 2003 contract change: retrospective analysis of secondary data
An employment contract for NHS consultants introduced in 2003 and including a 27 per cent pay rise over three years failed to increase productivity. The findings emerge from this 10-year study which looked at the levels of consultant clinical activity rates between 1999 and 2009. The researchers found that, despite an expectation by the Department of Health that the contract would result in year-on-year productivity gains of 1.5%, consultant activity levels showed a downward trend. There is a heightened need for productivity improvements in the NHS, which has been asked for efficiency gains of £20 billion by 2014/15.
Objectives To explore trends in the clinical activity of hospital specialists in English National Health Service (NHS) hospitals, and test the effect of contract reform.
Design Retrospective secondary analysis of hospital episode statistics, describing trends and testing for a contract effect using multilevel interrupted time series analysis.
Setting Ten surgical and medical specialties in English NHS hospitals from 1999 to 2009.
Participants Hospital consultants on full time or maximum part-time English NHS hospitals.
Intervention A new contract offered to NHS consultants in October 2003, with higher pay alongside job planning and appraisal.
Main outcome measures Inpatient finished consultant episodes (FCEs) per consultant per month, with and without accounting for case-mix differences.
Results In most specialties there was a statistically significant downward trend in FCEs per consultant per month. On average in the surgical specialties, FCEs reduced by 0.14 per month (95% CI −0.16 to −0.11) and in medicine there was a smaller reduction of 0.08 FCEs per month (95% CI −0.1 to −0.06). NHS patients symptoms have increased in severity over time, and the downward trend is reduced after case-mix-adjustment, and reversed in general and geriatric medicine. The effect of the contract on clinical activity was minimal. In five specialties there was no statistically significant effect, but in five specialties there was a statistically significant negative effect.
Conclusions Consultant clinical activity, as measured by FCEs per month, has shown a general downward trend from 1999 to 2009. The consultant contract was not associated with an increase in consultant clinical activity rates.