Take back your mink, take back your pearls

doi:10.1136/bmj.325.7372.1047

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Rejection of the consultant contract starts a new era

Richard Smith, editor

News p 1053 Reviews p 1120

”Take back your mink, take back your pearls

What made you think that I was one of those girls?”

From the musical Guys and Dolls

English and Welsh consultants last week rejected the new consultant contract by two to one.1 Specialist registrars, the consultants of the future, rejected it by more than five to one. But consultants from Scotland and Northern Ireland voted for the contract, hastening the pace of devolution. The contract had been negotiated over two years and endorsed by the BMA's central consultants and specialists committee. Peter Hawker, chairman of the committee, resigned when the vote was announced. The resounding rejection of the contract in England and Wales raises difficult questions for the NHS, the government, and the BMA and probably starts a new era of local negotiation and possibly of a junior consultant grade.

Why was the contract rejected?

In essence, the new contract offered more money in return for accepting greater managerial control and the potential to be obliged to work unsocial hours.2 Although those who negotiated the contract urged consultants to accept it, the junior doctors committee immediately rejected it.3 Feedback from consultants to the BMJ and other publications and websites was consistently negative, 4 5 and it was no surprise when the contract was rejected.

It wasn't rejected because of money. Consultants famously had their mouths “stuffed with gold” at the start of the NHS, but this time they've sent back the mink and the pearls. Nor was it rejected because of minor restrictions on private practice. It was rejected primarily because it gave more control to managers, people who in many hospitals are neither trusted nor respected. This might be seen as a simple power struggle, with consultants refusing to be told what …