New consultant contract will exclude “opt-out” for weekend working, says government

BMJ 2015; 351 doi: (Published 17 July 2015) Cite this as: BMJ 2015;351:h3883
  1. Zosia Kmietowicz
  1. 1The BMJ

The BMA has set itself up for a six week battle with the government over reforms to consultants’ contracts, after the health secretary said that a new contract would be imposed on the profession if negotiations over seven day working with the union were not fruitful.

Mark Porter, BMA council chair, called on Jeremy Hunt to “get real” over plans to introduce seven day services in the NHS. He said that, while doctors supported seven day hospital services, the government had repeatedly failed to respond to requests to outline how the plans would be staffed and funded.

In a report published on 16 July the Review Body on Doctors’ and Dentists’ Remuneration said that the “opt-out” clause in the 2003 consultant contract, which enables a consultant to choose whether or not to provide non-emergency care at weekends, should be removed.1

The report was published on the same day that Hunt delivered a speech at the King’s Fund on his vision for the NHS over the next 25 years.2 In his speech he said, “We will reform the consultant contract to remove the opt-out from weekend working for newly qualified hospital doctors. No doctors currently in service will be forced to move onto the new contracts, although we will end extortionate off contract payments for those who continue to exercise their weekend opt-out.”

Hunt said that, by the end of the current parliament, he expected most doctors to sign up to the new contract and that he would not “allow the BMA to be a roadblock to reforms that will save lives.” He said that a period of six weeks would now follow for negotiations with the BMA before a decision in September. “But be in no doubt: if we can’t negotiate, we are ready to impose a new contract,” he said.

Porter was highly critical of Hunt’s solution to the issue of weekend NHS services. “His simplistic approach ignores the fact that this is a much broader issue than just doctors’ contracts,” he said. “Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that, for two years, the government has failed to outline any concrete proposals for introducing more seven day hospital services.”

He added, “The health secretary has questions to answer. How does he plan to pay for it? How will he ensure there isn’t a reduction in mid-week services or fewer doctors on wards Monday to Friday? Yet again there are no answers.”

Hunt had not answered questions on what other additional staff, including nurses, diagnostic staff, porters, and administrative staff, would be needed deliver the same high standard of care that patients deserve seven days a week, said Porter.3 “This is a blatant attempt by the government to distract from its refusal to invest properly in emergency care. So, I say again to the health secretary, get real and show us what you mean,” he said.

However, other bodies have been more welcoming of Hunt’s plans. Clifford Mann, president of the Royal College of Emergency Medicine, said, “Full recruitment and retention into emergency medicine with the consequent savings on locum costs will only occur when employment contracts offer an equitable work-life balance for those who undertake to provide direct patient care irrespective of day of week or time of day.”

The Academy of Medical Royal Colleges, which campaigned for seven day consultant led care, also welcomed Hunt’s announcement but said that resource implications needed to be tackled.

Sue Bailey, chair of the academy, said, “It will be important to build on the inherent support among doctors for seven day services and retain the support and goodwill of doctors in the implementation, both nationally and locally. It will be a complex and sensitive task which will require mature and sensible discussions between employers and doctors.”

Clare Marx, president of the Royal College of Surgeons, said, “Many doctors and most surgeons already commit to working over seven days, and we support moves to help ensure this is standard practice in the NHS. However, we would like to see this apply to other key hospital services such as diagnostics, pharmacy, and radiology. This is an essential step for patient safety and should help to reduce variability in standards of care.”

Ann Macintyre, director of workforce at Guy’s and St Thomas’ NHS Foundation Trust and chair of the management side team that led the negotiations on consultant contract reform with the BMA, spoke of a “compelling case” to change consultants’ contracts “to ensure that this is better aligned with the needs of patients and the NHS.”

She added, “ As a next step we want to talk to the BMA to determine if there is scope to work together to finalise and implement the necessary contractual changes that will benefit patients, are fair to staff, and also ensure that we reward doctors who are undertaking the most onerous working patterns appropriately.”


Cite this as: BMJ 2015;351:h3883


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