News analysis Consultants agree to a flexible NHS contract

23 Oct 03
What a difference a year makes. Almost 12 months ago, senior hospital doctors in England rejected a contract that had been backed by their leaders at the British Medical Association.

24 October 2003

What a difference a year makes. Almost 12 months ago, senior hospital doctors in England rejected a contract that had been backed by their leaders at the British Medical Association.

But, following a year of hard bargaining and threats to leave the NHS, not to mention a new consultants' leader and health secretary, senior doctors voted this week to accept a new deal.


Around 60% of the consultants and 55% of the specialist registrars (doctors who are likely to become consultants in the next three to five years) who voted backed the contract.


There will be separate contracts in the other three UK nations. The result of a ballot of Scottish consultants will be announced on October 24, while the Welsh result is due on or shortly after November 12. No date has been set for a ballot in Northern Ireland.


The new English contract is a compromise deal. Last year, consultants threw it out largely because they feared greater managerial control over their work through the introduction of job plans.


They believed they would be forced to work evenings and weekends and new consultants would not have been able to work privately for seven years.


Under the deal, consultants will have to agree job plans, detailing where and when they perform NHS work. This should help managers change working patterns to better suit patient demands, although earlier this year the Department of Health assured consultants they would not be forced to work unsocial hours.


Now, all consultants must give the NHS four hours a week overtime before practising privately. If they refuse, they will not progress up the new pay scale, which will give them an annual salary of up to £88,000, before clinical excellence bonuses of up to £64,000. Salaries will rise by an average of 15%.


Trusts are now offering the new deal to consultants, who will have their pay rise backdated to April if they accept the contract by the end of the month. Consultants currently in post may opt to hold on to their existing contracts.


Alastair Henderson, NHS Confederation policy manager, says the three-month period to the end of January, during which the new job plans will be agreed, will be difficult.


'It's a considerable task and in some areas it's going to take longer. We should not underestimate what's involved if the process is to be done properly.


'Not everything has to be changed 100% now. It may make more sense to stick to the current job plan and come back and look at it in 12 months' time. But some consultants will want to remain on their current contract and that will be a difficult issue for some trusts.'


Henderson is keen to play down suggestions that the consultants have won a victory over the government and NHS managers.


'The changes made represent genuine compromises from both the government and the consultants. The changes on private practice are a good example of genuine negotiation and compromise.'


The confederation is now working with the BMA and the medical royal colleges to improve the relationship between doctors and managers. This includes developing opportunities for joint training and changes to the performance management regime.


BMA consultants' leader Paul Miller also wants his members to put behind them what has been, at times, an acrimonious dispute.


'It is time for consultants to move forward from any divisions or conflicts over the contract. We now need to begin the hard work of implementing it so that every current and future consultant benefits to the greatest extent possible,' he says.


But he adds that the BMA does not see this week's vote as the end of the negotiating process and it will continue to work to gain enhancements to the contract.


In England at least, eyes will now turn to the job planning process. Disputes between individual consultants and their employers are inevitable, and all sides will have to work hard to ensure individual grievances do not grow into wider discontent with the contract.

PFoct2003

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