Analysis: Surgeons' productivity

Surgeons' productivity has dropped by 20% since 1995

By Ray Dunne BBC News Online health staff

Bed shortages, bureaucracy and the demands of junior doctors' training are just some of the reasons why medical productivity has fallen in recent years, according to surgeons.

Figures obtained by the BBC show that NHS surgeons are treating far fewer patients than they did just six years ago. In some specialities, the drop is as much as 20%.

Few doctors appear to be surprised by the findings. They say they have less time to carry out operations on patients than they did in the mid-1990s. More meetings, more paperwork and more demands on their time generally are the causes.

Some operations have become more complex and take longer to perform

Dr Peter Hawker, BMA

Operations have also become more complex and medicine has become more defensive prompting surgeons to go more slowly than they may have in the past.

The perennial shortage of NHS beds means that many elective procedures continue to be cancelled in hospitals across the country.

Bed shortages

Mr Winston Peters, a consultant surgeon at Poole NHS Trust in Dorset, believes his productivity may have fallen by 20% in the past few years.

"My hunch is that my productivity has dropped to about 80% of what it was in 1995. The problem is a shortage of beds," he said.

Poole NHS Trust is one of the better hospitals in England. It received two stars in Department of Health performance tables last year - failing only because it was cancelling too many operations.

"We should have between nine and 10 beds but we have so many medical emergencies that we often have to cancel procedures because they are occupying the beds," said Mr Peters.

"Sometimes, that means cancelling one or two elective procedures but there have been times when all of the operations have had to be cancelled."

Dr Mark Porter, is consultant anaesthetist to the neurosurgery team at Walsgrave Hospital in Coventry. He too has seen operations cancelled because of bed shortages.

In the case of his team, the problem is a lack of critical care beds for patients who undergo brain surgery.

"We are woefully underprovided in terms of critical care beds. Standard provision in the UK is between 1% and 2% compared to the US where it is in the region of 20%."

He said: "We often have to cancel operations because of a lack of critical beds."

Training changes

But there have also been changes to the way surgeons work. In the mid-1990s, many NHS operations were performed by junior doctors.

It takes longer to do everything because we try to provide more quality

Prof Tony Mundy, University College Hospital London

Mr Richard Rawlins, an orthopaedic surgeon at Bedford Hospital, said: "A few years ago consultants were not as present in the operating theatres as they maybe should have been.

"A high percentage of emergency surgery was carried out by a relatively junior doctor.

"But now experienced surgeons are present more often and longer which is good but it means we are doing less. We cannot be in two places at the same time."

Other changes to way junior doctors work have also affected the overall productivity of surgeons.

Dr Peter Hawker, chairman of the BMA's consultants' committee said: "Juniors doctors are rightly no longer routinely working over 100 hours a week and consultants are spending more time in delivering their training."

But he added that other pressures meant surgeons did not have the time to operate on patients that they may have had just six years ago.

Dr Hawker said: "Some operations have become more complex and take longer to perform. There are more meetings and administrative burdens on their time."

Prof Tony Mundy, a consultant surgeon at University College Hospital in London, said the fall in productivity may also be linked to changes in medicine since the mid-1990s.

"It takes longer to do everything because we try to provide more quality," he said.

"This has gone almost overboard to the extent of being defensive. Indeed, if you are working on minor cases you can spend almost as long waiting in between cases as you operating."

Unclear future

While surgeons are aware of why they are treating fewer patients, few believe the situation will improve in the years ahead.

New limits on the working hours of junior doctors and proposed restrictions on the amount of time a consultant should work for the NHS may simply exacerbate the current problems.

Mr Peters said: "The big pressure is going to come when trainees are limited to working 56 hours per week and if the government decides to go ahead with introducing a 48 hour maximum week that will make a huge difference.

"The implications of this will be quite severe for some hospitals because they simply won't be able to provide an adequate number of staff."

He added: "It is all particularly worrying because not only has management not realised the implications of this but neither it seems has the government."