31 January 2003
But Milburn's statement will have much further-reaching effects than giving burned-out medics a few months off work.
The new package of rewards is the health secretary's attempt to pick up the pieces of last year's failed negotiations. In November, consultants in England and Wales voted against a contract that had been backed by their leaders in the British Medical Association, which is not only their professional body but also their trade union.
Their colleagues in Scotland and Northern Ireland backed the proposed contract at the time but now – perhaps with one eye on developments in England – Northern Ireland's consultants say they don't want it.
Milburn is offering consultants in England three options, which will be funded with the cash that had been set aside to finance the contract. This is worth up to £250m a year by 2005/06.
If there is support from local consultants and pre-consultant specialist registrars, employers can introduce the contract negotiated last year. The Department of Health says around 50 trusts are interested in this option.
Alternatively, trusts can introduce annual incentive payments, based on consultants meeting pre-agreed objectives, or invest in a fairer clinical excellence awards system.
Consultants can also stick with the status quo and hold on to their current contract.
Milburn said: 'This package is designed to recognise and reward those NHS consultants who do most for NHS patients. Local NHS employers will be able to choose how best to use the resources I am committing to reward consultants, reform working practices and improve patient services.'
The department wants to introduce the new package in April and intends to limit the consultation period with doctors and employers to a month.
Whatever happens, Milburn is now trying to achieve what John Major's Conservative government failed to do in the mid-1990s – introduce performance-related pay for doctors. All three new options contain performance measures linked to pay.
Milburn also wants consultants to spend most of their time working for the NHS; a new code of conduct will include measures to limit their private work. Consultants who do not adhere to the code will not receive incentive payments.
The NHS Confederation said the package would give employers greater flexibility. 'We believe that the NHS will think this is a positive package of measures that should help trusts improve services locally for the benefit of patients and also improve the rewards to consultants for the work they do,' said policy manager Alastair Henderson.
'We think it entirely sensible to take forward the contract in those trusts where there is significant support from consultants,' he added.
A consequence of the package is that the BMA may be sidelined. National pay award negotiations could become less and less important as the contract options take hold. Whether this is intended is a matter for speculation but the DoH was angry that BMA leaders negotiated and agreed the contract but could not convince their members.
The BMA has reacted cautiously, though it has indicated it will fight any attempt to undermine national negotiations on contract terms and conditions.
Dr Paul Miller, the newly elected chair of the BMA consultants' committee, said: 'The health secretary's plans for local incentives do seem to be very strongly tied to government targets and consultants are very wary of having clinical care dictated by political priorities.
'I will be arguing strongly that preserving the national character of the NHS is best achieved by national agreement on a national contract.'
The plans must be discussed carefully, Miller insisted, although he doubted doctors would choose the new contract option.
'We remain opposed to local implementation of a contract framework that was clearly rejected by consultants in England and we doubt whether it would prove a popular option for consultants'.
PFjan2003
