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Report on Consultant Contract

10th May 2006

10052006_consultant1.jpgA new report from the King’s Fund; 'Assessing the New NHS Consultant Contract - A something for something deal?' is the first independent report on the impact of the consultant contract in England, based on a case study of five NHS trusts in London and interviews with key national figures.

It says that the new contract for senior hospital doctors in England has cost a great deal more than anticipated and as yet there is little evidence to show it is benefiting patients.

The new consultant contract, implemented in 2003, has seen large increases in consultant pay and pensions, but the study found little evidence so far to show consultants' working practices have changed, says the King's Fund.

It concludes that a combination of a serious underestimate of existing consultant workloads, rushed implementation and a lack of national guidance has made it difficult for hospitals to use the contract to bring about improvements for patients.

Consultants’ pay has increased substantially over the last four years with starting salaries rising by 36 per cent since 2001 (from £50,810 in 2001 to £69,298 in 2005). The increased costs have put considerable pressure on hospital budgets and have contributed to the size of deficits faced by some trusts, according to the report. It highlights evidence from the Department of Health showing the contract cost £90 million more to implement than was planned.

The report does identify potential advantages from the new contract; it supports the increased recognition of the amount of work carried out by consultants in the NHS, and welcomes greater transparency about the hours consultants work in the NHS and the duties they undertake.

Professor James Buchan, the Report author, says that several aspects of the contract do not appear to have been delivered as intended. For example, the report says the idea behind the contract was that consultants would sit down with managers and discuss how to plan their work around the future needs of the service. The reality so far of job planning has shown it to have been mainly an exercise in filling forms showing what consultants have already been doing, says the King's Fund. Assumptions around how much work consultants do for the NHS have also meant that new rules designed to make sure that consultants put the NHS before their private work have also not been particularly effective, it adds.

Niall Dickson, King’s Fund chief executive, said that consultants are at the core of the NHS and deserve to be paid well for the work they do. However, he added, 'the government promised that this contract would also bring benefits to patients and so far that does not appear to have materialised.'

He acknowledged that this is a limited study and these are early days but says it raises profound questions about the effectiveness of the deal and what now needs to be done to ensure that it delivers greater productivity.

The report concludes by saying lessons can be learnt from the consultant contract when looking at the implementation of other pay reforms such as the GP contract, Agenda for Change, and the new contract, currently being negotiated, for staff and associate specialist doctors.

In response to the publication of the King’s Fund report the BMA claims that the new contract cost more than anticipated because consultants are working harder for patients than the Government expected.

The Chairman of the BMA’s consultants’ committee, Dr Paul Miller, said that the new contract pays consultants for the work they do, something that was not done under the old contract. The harder consultants work, the more they get paid. The Government got its sums wrong, he says, because it underestimated just how hard consultants are working for the NHS. Furthermore the King’s Fund report finds that consultants still continue to work unpaid hours, on top of their contractual arrangements. It is NHS consultants who have led on delivering reductions in waiting times and continue to innovate new treatments for patients, he adds.

The King’s Fund report is restrictive, Dr Miller says, based on a small sample size and is, in places, inaccurate. The report focuses on the opinions of senior managers in only five NHS trusts which were based in just the one location, London. The BMA has received encouraging feedback from across the country that the contract is working well, he says, adding that 'Contrary to the report’s findings, there has been substantial advice and information available as well as the offer of implementation teams to aid those trusts in difficulty.'

The BMA states that where trusts implement the contract in partnership with their consultants they see clear benefits for the trust, consultants and most importantly patients.

The BMA adds that the blame for the NHS funding crisis lies with an incoherent and inconsistent health policy, riddled with errors and misjudgements, not with the consultant contract.

There is always room for improvement, says the BMA, and the report makes some helpful recommendations, 'many of which are already being pursued.'

NHS Employers' Deputy Director Alastair Henderson, commenting on the report, said that
implementing the new consultant contract had been a major task and a major achievement, but that it 'remains a good tool for rewarding consultants and planning their work to best deliver and improve local patient services.'

He added that the Kings Fund itself acknowledges its report is based on a limited study and that it is not surprising at this early stage that the contract hasn't fully delivered the potential benefits for patients.

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