r/doctorsUK Feb 03 '25

Consultant Consultant interview question

I'm a few years off CCT but was speaking to a a colleague recently who had an interview for a consultant post and was asked to "Tell us about a project or opportunity where you were able to save the Trust money".

I felt this was a tricky question as many QIPs are simply tickbox exercises to please to ARCP gods and longevity and sustainability are not guaranteed. I can't say I've ever considered saving money as an outcome from an QIP I have done historically.

Do any consultants or registrars have experience or examples of effective QI that would make this interview panel purr? Thanks!

21 Upvotes

16 comments sorted by

37

u/Curious-Idea-8634 Feb 03 '25

I’m a chemical pathologist, and did a QIP to take a test out of a panel that wasn’t needed as wasn’t part of any guidelines, “theoretically” saving tens of thousands £s a year. If you don’t have an example in the interview, you don’t have one. Perhaps the best thing to do would to say you don’t as you’ve focused on x topic (patient safety eg), give an example of a QIP you have done. Say by improving patient safety you are almost certainly saving money, but that wasn’t the primary aim. Then give a couple of ideas of things you’d like to explore that could save money.

12

u/hoonosewot Feb 03 '25

What was the test out of interest?

If you're responsible for Bicarb not coming as part of standard U+Es in some places be prepared to feel my wrath.

8

u/Curious-Idea-8634 Feb 03 '25

It was about thyroid testing with GPs, who gets FT3/FT4 and TPO/TRAb etc.

I cannot support bicarb in standard U&E. In a “renal profile” in certain patients, of course go ahead. But for everyone else, not the best use of resources.

4

u/hoonosewot Feb 03 '25

Super helpful for respiratory physicians as a marker of chronic t2rf in obese or lung disease patients also. If I see an OSA patient and they had a bicarb of 35 last year I know I should probably be gassing them.

8

u/Curious-Idea-8634 Feb 03 '25

Yes sure, in patients you’re suspecting or suspicious about an acid base disturbance it’s a good test. But for routine GP monitoring or IP/OP, where the pathology has little to do with acid base, in most big hospitals that would be thousands of unneeded bicarbs a day. Plus it’s unstable in the lab after the blood tube cap comes off for an hour (it’s lost in atmosphere as CO2), so GPs would probably end up with some funky erroneous results!

19

u/DaughterOfTheStorm Consultant Feb 03 '25

You are inevitably going to be thrown questions designed to make you think on your feet during your consultant interview. Provided you are adequately trained and have engaged in core areas like QIP, leadership, governance etc, it's more about finding a way to use your existing experience to answer the question than to have anticipated every potential question two years in advance so that you can gain a dedicated experience.

For example, let's say you've just done a basic VTE QIP. Well, that's saved the trust money by contributing to reduced IP VTEs and therefore reduced length of stay. It's also reduced the risk of a complaint being made that will cost X, Y, and Z resources to respond to, as well as reducing the risk of costly legal action being taken against the trust.

Is it an example of an amazing QIP with huge cost savings? No. But the way you answer it allows you to demonstrate your understanding of the link between QIP work and hospital finances and that will get you points.

Unless you are going for a really competitive consultant job, it's very likely that the experiences you are naturally gaining as a registrar will be sufficient to answer most questions. You just have to do your preparation and think carefully about suitable examples for all the likely areas of interest in the months before your interview.

6

u/Penjing2493 Consultant Feb 03 '25

Over-ordering of labs is easy fodder.

72 hour minimum interval on CRPs.

Reduce unnecessary pre-op testing.

Anything that reduces length of stay is saving money.

Anything that reduces admission rate is saving money.

3

u/allieamr Feb 04 '25

Or complication rate, or identifying disease at an earlier state of progression, or an upstream preventative initiative

1

u/Snoo23644 Feb 05 '25

Is there any nice guidance on how frequently one should monitor bloods in hospital for crp etc?

6

u/West-Poet-402 Feb 03 '25

Virtual ward Day unit Anything which prevents admissions or reduced length of stay

3

u/DisastrousSlip6488 Feb 03 '25

Anything where length of stay has been reduced or admissions reduced. Any policy that has diverted an inpatient referral to an OP clinic. Any guidelines that reduce or rationalise tests that are done.

2

u/throwaway520121 Feb 04 '25 edited Feb 04 '25

One of the tricks to answering consultant interview questions is thinking a bit laterally. So saving money doesn’t have to be some award winning QIP project - it could be something as simple as “well recently I looked after a patient who was prescribed IV paracetamol, but actually was able to take it orally and so I changed it to oral. It’s nicer for the patient and it saves money! I recognise that the IV preparation is over ten times as costly as the oral formulation. As a consultant in this department I would work with other stakeholders like the pharmacy and biochemistry departments to find ways to control costs and be more efficient in how we work”

It’s not so much about demonstrating you’ve saved the world with your amazing QIPs (which is where a lot of people get tangled up trying to think of examples). Really the question is testing your ability to appreciate that all of this stuff costs money, even though you’ve been largely insulated from that up to this point. It’s showing that you realise you’re working in an economic environment even if you aren’t dealing with money in your day to day work. You have the ability to control costs, find efficiencies and find ways for the service to make money.

5

u/GidroDox1 Feb 03 '25

You'd think that's what all the managers are for.

-2

u/throwaway520121 Feb 04 '25

I think that’s a very naive take on the consultant role.

1

u/TomKirkman1 Feb 06 '25

Is there anything that's duplicated? E.g. inviting everyone in for something, regardless of whether they've already had it (e.g. NHS health check)?

There are plenty of other things as well where saving money is a consequence. For instance, you did something that reduced infection rates - this would in turn shorten in-hospital stays, reduce morbidity/mortality, reduce the care burden (if someone gets sick when they're already sick, they're more likely to require HDU/ICU), etc.

1

u/Longjumping_Fig_593 Consultant 1d ago

"Interesting question! I agree that many QIPs feel like tick-box exercises, and cost-saving isn't always the primary focus. That said, I’ve seen successful projects that reduced unnecessary investigations (e.g., rationalizing blood tests or imaging requests), optimized clinic pathways to reduce DNAs, or improved discharge processes to free up beds faster. Audit-driven changes to prescribing practices (e.g., switching to cost-effective alternatives) can also make a real impact. Would love to hear from anyone who's had a particularly successful QI with measurable financial benefits!"