New consultant contract marks huge step forward

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7359.334 (Published 10 August 2002) Cite this as: BMJ 2002;325:334
  1. Peter Hawker, chairman, Central Consultants and Specialists Committee (consultantcontract{at}bma.org.uk)
  1. BMA, London WC1H 9JP

    EDITOR—You report that your 22 respondents were unanimous in their condemnation of the proposed new consultant contract.1 As the regional roadshows roll out and the detail is explained, views are changing.

    We have succeeded in securing a contract that gives consultants a substantial pay rise, a time limited contract, recognition of emergency work, payment for being on- call, extra payments for working beyond 40 hours per week, protected time for teaching, research, audit and continuing professional development, and a major boost to their pensionable salary. There is a lot at stake here. I make no apologies for trying to persuade my colleagues that they should accept it.

    Respondents complain of excessive management control. Consultants asked us to deliver a more time limited contract. If your hours are defined and limited, it is inevitable that trust managers will want to be sure that they are getting what they are paying for. It will be in the best interests of the vast majority of consultants to have a defined job plan because then trusts will have to start paying for all the extra work currently donated to the NHS by the consultant body and reducing our hours.

    The prime minister and the chancellor are making great play that further investment in the public services must be coupled with reform. For Health Secretary Alan Milburn that translates to greater control for trust managers over how they deploy consultants, but the new contract does not give them any powers they do not already have. Retaining the old contract is no proof against managerial zeal. A properly defined contract and job plan will be. We will provide support to consultants negotiating their job plans.

    There is complaint that consultants are not being paid at premium rates for working at nights and weekends. Currently most of us are not paid even at plain time rates. We are not paid at all. We have tried to build a contract that is fair to all specialties and allows people to change their working patterns without sacrificing extra payments and incentives. That means putting the maximum possible into the basic contract.

    It is claimed that the new contract is not family friendly. This poses a genuine difficulty as patients' illness is inherently unpredictable, we have long waiting lists, and it is unsatisfactory that so many patients mark time over the weekends because test results cannot be obtained or treatment regimens started.

    In principle an evening clinic is no more family unfriendly than an evening ward round or an emergency operating session. To meet genuine patient need and legitimate expectation, we must have sufficient consultants to share the unsocial work more equitably and achieve a reasonable balance between life and work.

    If an evening session is agreed well in advance and is not too frequent, it may well suit many consultants to have free time during the day for other commitments. The contract also gives scope for annualised hours, which will help those consultants who want to avoid working in school holidays.

    Currently many part time consultants are getting the worst of both worlds, reduced pay but the same level of on-call commitment and a huge amount of unpaid work. The new contract, by defining their commitments and recognising their emergency work, should make life much more manageable.

    There are some elements still to be resolved but the health departments have made it abundantlyclear that they have learnt lessons from the juniors' negotiations. Reopening the fundamentals of what has been negotiated so far is not possible. It does not need to be. It is a good contract.


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