• Karen Bloor, Nick Freemantle, and Alan Maynard.
• Senior Research Fellow, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
• J R Soc Med. 2012 Nov 1; 105 (11): 472-9.

ObjectivesTo explore trends in the clinical activity of hospital specialists in English National Health Service (NHS) hospitals, and test the effect of contract reform.DesignRetrospective secondary analysis of hospital episode statistics, describing trends and testing for a contract effect using multilevel interrupted time series analysis.SettingTen 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.InterventionA new contract offered to NHS consultants in October 2003, with higher pay alongside job planning and appraisal.Main Outcome MeasuresInpatient finished consultant episodes (FCEs) per consultant per month, with and without accounting for case-mix differences.ResultsIn 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.ConclusionsConsultant 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.

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