BMJ  2004;329:929-930 (23 October), doi:10.1136/bmj.329.7472.929

Editorial

Reforming the consultant contract again?

Issues related to financial incentives have changed little and need to be addressed

The first 150 words of the full text of this article appear below.

After protracted negotiations, the BMA and the consultant body voted in favour of a new contract, implemented with effect from April 2004. This contract applies to new practitioners and existing consultants who choose it. During negotiations, the Department of Health sought, but failed to obtain, professional support for a system of fee for service payments, for surgeons in particular. Despite this rejection, professional support among surgeons may now be emerging for the introduction of such a system.

The government's NHS Plan requires considerable increases in medical and surgical activity.¹ This can be achieved by changing the size of the medical workforce or by using incentives to stimulate existing doctors to produce more activity. Contracts of NHS hospital consultants include systems of reward and regulation, and both influence activity. Regulation has developed with the evolution of job plans and appraisal, and it will develop further with revalidation and more performance management . . . [Full text of this article]

Department of Health Sciences, University of York, York YO10 5DD (akm3@york.ac.uk)

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This article has been cited by other articles:

• Morris, S., Elliott, B., Ma, A., McConnachie, A., Rice, N., Skatun, D., Sutton, M. (2008). Analysis of consultants' NHS and private incomes in England in 2003/4. JRSM 101: 372-380 [Abstract] [Full text]  
• O'Connor, R. J, Neumann, V. C (2006). Payment by results or payment by outcome? The history of measuring medicine.. JRSM 99: 226-231 [Full text]  

Rapid Responses:

Read all Rapid Responses

Why advocate flawed fee system - failure to learn from other's mistakes?

Nigel Dudley
bmj.com, 22 Oct 2004 [Full text]

We hear you Professor Maynard

John Hopkins
bmj.com, 22 Oct 2004 [Full text]

Applied in partnership the contract works for both consultants and patients

Jonathan M Fielden
bmj.com, 22 Oct 2004 [Full text]

Fees for service - ? new terminology for waiting list initiative payments

Roger W H Skilton
bmj.com, 24 Oct 2004 [Full text]

We still need a contract with healthy incentives.

Dr Adam P Fitzpatrick
bmj.com, 25 Oct 2004 [Full text]

Surgeons' fees for items of service

Ewen F Flint
bmj.com, 28 Oct 2004 [Full text]