Lots of people talk about dropping PAs as the obvious way to regain control. For those who actually did it, any regrets? Did the workload genuinely reduce, or did the same amount of responsibility just leak into fewer paid sessions? Interested in both positive and negative experiences.
Any one have any experience with inserts? Do they degrade quality or are cumbersome Vs prescription TTL loupes
Every specialty has problems, but some consultant jobs seem much more sustainable than others. Which specialties currently have a decent balance of pay, workload, OOH, autonomy, PP options, admin, and long-term sanity? And which look good from the outside but are actually grim?
What activities are routinely treated as “just part of being a consultant” but should obviously have dedicated SPA or admin time? Educational supervision? Governance? Service development? Audit/QI? Appraisal/revalidation prep? Complaints? Mortality reviews? Guidelines? Rota work? Curious what people have successfully negotiated.
What should a new educational supervisor know which experienced educational supervisors here got to know the hard way.
If a patient is not booked, a result is not actioned, an MDT outcome is not followed, or a letter is delayed because the admin system is broken, how much of that risk realistically lands on the consultant? Do people document/escalate this formally, or just absorb it because doing so feels safer?
How do people define the end of a clinic? Is it when the last patient leaves, when the letter is done, when results are checked, when follow-up is booked, when the GP letter is corrected, or when the inevitable patient query two weeks later has been dealt with? Some job plans seem to treat clinic admin as a small add-on. In reality it feels like a second clinic attached to the first one. How is it counted where you work?
Not “wellbeing webinars”. What practical changes would make people stay longer? Fewer PAs, better admin, less OOH, pension/tax fixes, more SPA, better offices, flexible working, proper secretaries, less governance burden, more autonomy, better pay? What would move the dial?
For those who have built some PP, is it still worth the effort? I’m not asking for exact earnings. More whether the admin, indemnity, letters, billing, patient expectations, tax, and loss of free time are worth it. Does it feel like a sensible escape valve, or only worth it in certain specialties/regions?
Consultant-delivered care sounds good in policy language. But in practice, does it sometimes just mean consultants personally doing or supervising work because the wider system cannot staff, train, administrate, or risk-manage properly? Where is the line between good senior care and using consultants as expensive glue?
What phrases in a job planning meeting should make a new consultant very cautious? Things like “we can sort that later”, “everyone does this”, “SPA is flexible”, “admin is included in clinic”, “just for now”, “the previous consultant managed it”. What else?
I do not really care if AI can generate another note, letter, summary or triage suggestion unless it removes work somewhere. What consultant task would have to genuinely disappear before you believed the productivity claims? Letters? Coding queries? Inbox triage? Results chasing? Discharge summaries? Revalidation paperwork? Duplicate forms?
The £100k zone seems to turn otherwise normal consultant life into a weird game of SIPP, childcare, WLI, PP, pension growth and “is this extra session even worth it?” What are people actually doing? Aggressively pensioning everything above £100k? Punching through? Dropping PAs? Avoiding WLIs? Just accepting the nonsense and getting on with life?
looking for some advice from anyone who has dealt with DNOs regarding Priority Services Register (PSR) customers lately.
Got a job looking at a property for a lovely elderly couple. The husband has severe mobility issues and the wife suffers from massive anxiety. Their current electric meter is a prepay setup buried deep inside a cluttered, uninsulated garage with zero disabled access. It’s an absolute trip hazard for them to get to.
They strictly want to stay on a pay-as-you-go setup for budgeting, but a smart prepay meter isn't going to work here. The garage is double-brick, quite far from the house, and the smart signal is non-existent. Plus, they have zero digital literacy (no smartphones, apps, etc.), and if the smart meter drops off the network, there is no way they can physically get into the garage to punch a 20-digit UTRN code into the keypad. They've also explicitly refused quarterly bills or having manual meter readers visit because of the wife's severe anxiety around strangers.
Basically, the physical meter has to move to an external hockey stick and box on the front wall of the house so they can actually access it.
Since the main service cable needs excavating and rerouting through the wall to the new external box, will the DNO wave the service alteration fee on compassionate/PSR grounds? Or are they going to slap them with a standard £1k+ connection charge regardless of their disability?
Has anyone successfully managed to get a DNO to absorb the excavation and cable alteration costs for a vulnerable customer in a deadlock situation like this? Any tips on the best terminology to use when speaking to them to get it pushed through?
Cheers in advance!
For those who are or have been CL/CD/management adjacent: would you do it again? It often looks like extra meetings, extra risk, more emails, less goodwill, and not much actual authority. What would make it worth doing properly?
Psychiatry is the obvious current example but this probably applies elsewhere. Competition at the front of training keeps rising while substantive consultant posts remain difficult to fill at the other end. That suggests the problem is not simply how many doctors enter the pipeline. For consultants involved in recruitment, what actually makes people leave or avoid these posts? OOH burden, geography, job plan quality, admin support, pay, leadership, or something else?
More importantly, which of those factors can a department realistically fix? Specialty and DGH/tertiary differences welcome.
Not trying to have a go at individual secretaries, because most are drowning as well. But does anyone still have a setup where secretarial support actually removes work from consultants? As in booking, chasing, forwarding, typing, sorting patient calls, managing basic admin, and not just acting as another inbox that needs supervision. What does good support look like now?
Customer has a British gas homecare subscription. They noted carbon and fuse base contacts and the fuse. Turned off main supply. Replaced the fuse board but wondering if British gas homecare with active policy would replace it for their customers having similar damage?
Yvette Cooper has taken over at DHSC. There will be plenty of talk about waiting lists, productivity and reform, but consultants usually find out what those words mean once the extra activity lands. The useful test is whether anything is actually removed or properly resourced. More clinics without admin time, SPA, secretarial support or workforce capacity just means the same risk being absorbed by consultants. If she could make one practical change to the consultant job, what should it be? Proper admin support? Protected SPA? Honest job plans? Better OOH recognition? Clearer limits on consultant accountability for work delivered by others? Specialty and PA context welcome. I suspect the answer looks very different between a DGH and a tertiary centre.
