Education And Debate

Reforming the contract of UK consultantsCommentary: To increase consultants' activity should not be the main aim

BMJ 2001; 322 doi: (Published 03 March 2001) Cite this as: BMJ 2001;322:541

Reforming the contract of UK consultants

  1. Alan Maynard (, professora,
  2. Karen Bloor, Medical Research Council research fellowb
  1. a York Health Policy Group, Department of Health Studies, University of York, York YO10 5DD
  2. b Department of Health Sciences and Clinical Evaluation, University of York
  3. Central Consultants and Specialists Committee, BMA, London WC1H 9JP
  1. Correspondence to: A Maynard
  • Accepted 20 October 2000

See Editorial by Riordan and News

The NHS Plan expressed the intention of government to “fundamentally overhaul” the national contract for UK hospital specialists to “reward and incentivise those who do most for the NHS.”1 How can this be achieved?

Summary points

The contract for UK hospital consultants has been criticised by the BMA, the House of Commons Select Committee on Health, and the current government

It has failed to deliver consistent activity and accountability in both the NHS and the private sector

If the NHS Plan is to be carried out, existing variations in performance by consultants have to be better managed

A new contract could involve a basic salary supplemented by bonuses and a fee for each “item” of service

The contract would require appraisal and management of consultants' activity

Informed debate about the design of a new contract is essential, as is its evaluation once it is introduced

Current contract

The current UK pay system for hospital consultants is a fixed salary with selective bonus payments (distinction awards), which were introduced early in the existence of the NHS to reward “excellence.” UK consultants with a full time NHS contract can undertake limited private practice (with remuneration no higher than 10% of their NHS salary); those with a part time contract (including the “maximum part time” contract, in which consultants receive 10/11 of a full time salary) can undertake unlimited private practice.

Criticisms of current contract

Contributing to the renegotiation of consultants' contracts, the House of Commons Select Committee on Health published a report aiming “to examine NHS consultants' contracts in terms of their accountability, effectiveness, and efficiency” and to examine the impact of private practice on the NHS.2 The committee expressed surprise that “the contract managing the work of these vitally important professionals remained, in essence, unchanged since the formation of the NHS …

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