Signal deep problems

The British government's 10 year plan for reforming the NHS set great store by reforming the way staff worked.1 The public, said the plan, wanted more and better paid staff, using new ways of working. Some of the biggest problems with the old NHS were “old fashioned demarcations between staff and barriers between services and a lack of clear incentives and levers to improve performance.” The plan promised in 2000 that for the first time there will be modern contracts for both general practitioners and hospital doctors. There will be a big extension of quality-based contracts for general practitioners. The number of consultants entitled to additional discretionary payments will rise from half to two thirds, but in return they will be expected to increase their productivity while working for the NHS. Three years on, reform of the consultant contract is stalled, the new general practitioner contract is hanging by a thread (p 1105), the government is frustrated, the BMA is deeply embarrassed, and reform of the NHS is threatened. What's gone wrong?

The story of the two contracts is nothing short of Homeric: for three years the adventurers trying to deliver the new contracts have been wandering the high seas, hoping to bring the contracts to a safe port, but neither yet is close. Indeed, the consultant contract seems to be wrecked.2 3 The contract for general practitioners suffered a serious setback last week when a special conference of representatives of local medical committees voted to send the negotiators—who had just survived a vote of no confidence—back for six months' further negotiation. But the very next day—at a meeting of the General Practitioners Committee—the impracticality of this position was understood: legislative windows would be missed, possibly delaying the contract for a year or more. The negotiators are still …