Image caption NHS cuts are taking their toll

The Tories have promised to protect the NHS budgets.

But in this week's Scrubbing Up Dr Paul Flynn, consultant obstetrician and gynaecologist, warns there is a risk of 'hidden' cuts to doctors' behind-the-scenes work, which could affect the care patients receive.

The NHS was never going to be immune to the financial crisis and patients are noticing some of the symptoms already.

Rationing is on the increase - if you have a hernia or varicose veins, your GP may have been instructed not to refer you for treatment considered too expensive.

Deep cuts

Many hospitals are freezing recruitment, planning redundancies, and postponing new services.

But just as damaging, and possibly more so in the long term, are the cost-cutting measures that don't immediately appear to target front-line services.

Those are the cuts to the 'hidden' work of medics - the protected time we are allowed.

Without this time we are too swamped by NHS work to always be innovative.

My role as a consultant involves a large amount of clinical work - in a typical week, I'll carry out between five and 10 operations, spend eight hours in clinics and supervise up to 20 deliveries.

But arguably some of the time I spend in meetings, at my desk, or in the university is just as valuable.

However many hospitals - under massive pressure to achieve cost savings - have this time in their 'cost-cutting sights.'

Keeping up with paperwork

The life of a consultant is busy. They are expected to keep up-to-date with the latest developments in their speciality, carry out research, train junior doctors, and, increasingly, to keep a record of their achievements to comply with the new system of regulation.

All of this takes up a lot of time, which is why the standard NHS contract allows consultants a set amount of time for "supporting professional activities".

Some of consultants' most important work for their patients does not involve direct contact with them Dr Paul Flynn

Unfortunately, there is increasing evidence, both anecdotal and statistical, that hospitals are arbitrarily reducing this time - over a fifth of consultants who responded to a BMA survey this year reported cuts.

During my protected time I recently worked on a project to allow our hospital to provide hysterectomy as a day-case operation. This has meant a much better service for our patients, who avoid a long hospital stay, and significant cost savings for my Trust.

Indeed, some of consultants' most important work for their patients does not involve direct contact with them.

As the most senior clinical staff in hospitals, they play a leading role developing services to improve quality of care and cost-efficiency.

These might be ideas such as drawing up a contingency plan for an infectious disease outbreak, setting up an outreach clinic to reduce rates of HIV, introducing a new technique to reduce blood loss in caesarean sections or carrying out research showing the most cost-effective treatment for glaucoma.

While cutting protected time for non-clinical work may seem like an easy target for cash-strapped trusts, the potential long-term consequences are serious.

It will mean poorer training for doctors - as every newly graduated medical student and every new consultant appointed to your local hospital are the result of the investment of hundreds of hours of consultants' time - time that they will soon not have.

It will also mean the NHS struggles to find the savings it needs - any private sector organisation trying to cut costs would start by drawing on the expert knowledge of its most highly trained staff.

Standing still

But the worst case scenario is the long-term stagnation of the NHS.

Preventing consultants from doing anything other than direct clinical work is an example of working harder but not smarter.

It will mean that the NHS stays stuck where it is, unable to make the most of changes in medicine, and that new life-transforming services for patients never see the light of day.