BMJ  2004;329:1343 (4 December), doi:10.1136/bmj.329.7478.1343

Letter

Reforming the consultant contract again?

Applied in partnership, the contract works for both consultants and patients

EDITOR—Maynard and Bloor show no benefit of financial incentives, rather their limitations, divisions, and distortions, with regard to the consultant contract.¹ Most recent changes in health have not been driven by such incentives.

Overall, 85% of consultants have signed up to the new contract. Surveys show that a third are already seeing improvements. Monitoring will indicate where adjustments are needed, but there is no planned revision.

The contract gives transparency and ability to manage performance. Trusts that have negotiated job plans, including objectives and supporting resources, in partnership with consultants reflecting the number of programmed activities required will see this to the benefit of patients and consultants. To omit proper job planning misses a fundamental feature of the contract

There is little evidence of support for fee for service payments. Consultants realise the limitations, as shown by the refusal to bow to pressure from the last health secretary.

It is a shame that the widely disputed NERA report is quoted,² but the accusation of cartels is of concern. Thorough investigation by the Office of Fair Trading failed to find any evidence. If the authors know of any insurer cartels, implied by their statement, they should make evidence available or rescind their comments.

The final paragraph states any changes should be piloted, an action rarely taken by policy makers. The effects are likely to be minimal compared with the policies of payment by results, practice based commissioning, and patients' "choice." Politicians need to be ready for the entrepreneurs, reconfiguration of services, and probable closures that will inevitably result.

Royal Berkshire Hospital, Reading RG1 5AN jonathan.fielden{at}rbbh-tr.nhs.uk

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Competing interests: JF is one of the negotiators for the new consultant contract.

References

1. Maynard A, Bloor K Reforming the consultant contract again? BMJ 204;329: 929-30. (23 October.)
2. Bramley-Harker E, Aslam S. Fees for medical specialists: how does the UK compare? London: NERA Economic Consulting, 2003.

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