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Powering ahead to energise the staffing of Scotland's NHS

DR Nikki Thompson says she's tired - and on this occasion the NHS is not to blame.

She was out later than usual at a British Medical Association function in Edinburgh the previous evening and then went home to Fife because the five chickens and four springer spaniels (and I forget what else) are a bit much for her consultant husband to handle on his own.

Dressed elegantly and smartly, she doesn't look knackered, but it is not the first time Dr Thompson, the first female chair of the BMA's Scottish Consultants' Committee (SCC), has talked about fatigue.

At the start of the summer, she was among a number of Scottish doctors who spoke out about the toll their job was taking. Dr Thompson, a consultant anaesthetist for NHS Tayside, said then that after a busy weekend on call, it could take 10 days for her to feel normal again. She said there was "no way" she could maintain her current pace until she retired.

Stories of exhausted doctors are not new, although they tend to be associated with junior medics - not consultants. Dr Thompson, 49, says when she was a trainee the cases were more straightforward and she could often attend to them on her own. Today, she explains, there are more elderly patients with complex conditions and younger people who have survived devastating illnesses or accidents, and they require specialist attention.

She says: "There is an increased intensity of work, there is an increased standard expected, quite appropriately, and there is, thankfully, to go with that a willingness for people to say, I am tired, this is too much."

This is a hint at a bygone macho culture which discouraged people from talking honestly about long hours and night shifts. However, the overriding message from Dr Thompson is that she rose to chair of the SCC without side-stepping male bravado or sexism.

"I know there are women in medicine who have found it a struggle, but I have never felt there has been a glass ceiling," she says.

In her first consultant job she anaesthetised for a previous SCC chair, obstetrician and gynaecologist Dr Peter Terry. He "gradually drew" her in to the BMA world and she found the work both interesting and useful. Her description of the way BMA Scotland colleagues support one other make it sound like an extended family - and she fell for her husband, Dr Charles Saunders, Fife public health consultant and BMA Scotland officer, discussing dogs and medical politics on the train to the body's Edinburgh HQ.

While she doesn't have children herself, she notes that times have changed so that these days it is just as likely to be a man who has to leave a meeting at a set time to collect the children.

Nevertheless, at the first SCC session she ran as chair, a venerable orthopaedic surgeon asked what she would like to be called. "Madam Chairman" and "Ma'am" were among the suggestions. Dr Thompson replied that with the tough challenges ahead, they might want to hang fire before agreeing what they might call her.

Like most families, BMA Scotland is not without its rifts. Just over one year ago there was a ballot for strike action over pension reforms and the consultant members divided, with 756 voting against and 734 in favour. Stoppages were ultimately ruled out because there was not enough support.

Dr Thompson insists there has not been any kind of "falling-out" among colleagues over this heated issue, but admits the subject has not quite been put to rest. She says: "Unfortunately, people are still seeing the changes to their take-home pay and there is yet another hike in contributions coming next April, so there is more pain to come... There is a constant reminder to people that there has been a raid on their pensions."

There are plenty of other pressing issues though, and when I ask about the key areas she wants to address as SCC chair she is clear.

"One over-arching theme is about making consultant jobs in Scotland attractive," she says.

"At the minute, they are not - or they are not as attractive as they should be. The vacancy rate is about 4.7%, which doesn't sound hugely high but every rota that has one consultant missing from it is one where a group of colleagues are having to fill a gap and some of the harder pressed specialities, such as A&E and acute medicine, have much higher than a 4.7% rate."

Significant shortages of middle-grade doctors in these fields is also a serious issue, both when it comes to delivering hospital care now and filling consultant jobs in the future.

One particular obstacle Dr Thompson highlights is the way health boards are structuring jobs for new consultants in Scotland, which she feels makes them less appealing than similar vacancies in England.

The current consultant contract splits the working week into 10 four-hour sessions. Around 7.5 are dedicated to clinical work and the rest "supporting professional activity" (SPA), which covers a range of tasks including teaching, research, keeping skills up to date, auditing performance and helping improve NHS services.

However, Dr Thompson says "the majority" of posts for newly qualified consultants in Scotland are now being advertised with nine clinical sessions and one block for other work. South of the Border, the split is closer to the original, at about 8.2 clinical, and the rest SPA. "I think it is to do with trying to meet a huge clinical demand," she says.

Dr Thompson's concerns about the practice are multiple: the political uncertainty of the referendum may already be deterring some candidates from elsewhere in the UK from considering a move to Scotland, and other factors, such as a lot of evening and weekend working, mean some jobs are particularly hard to fill. Scotland needs to make jobs more appealing, not less, to draw the best people. In addition, while the SPA sessions don't involve face-to-face patient care, they are all about making services better and new consultants full of ideas want to contribute.

Dr Thompson says: "This is adding to the things that are making jobs unattractive and [it means] services are not run as well as they might be and it means that you are losing out on the benefits of innovation, leadership and maintaining quality and driving that agenda forward. It is a huge waste of enthusiasm."t

Dr Thompson is enthusiastic about making a difference too, although this is well-grounded in experience. Maybe this will help her achieve some of her goals and then she will have the energy to keep going for longer in her post.

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