Views & Reviews From the Frontline

Consultants’ contracts: could do better

BMJ 2013; 346 doi: (Published 12 June 2013) Cite this as: BMJ 2013;346:f3701
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

Doctors complain about the inconvenience when their children’s schools close for teacher training. The logic runs like this: why can’t this training be done during their generous holiday period, and, anyway, how much does teaching actually change year to year? And why don’t teachers run after school activities anymore?

I suppose these frustrations are down to teachers’ contracts. And now doctors also have new contracts. General practitioners gave up responsibility for out of hours care and got a pay rise. Today general practitioners are criticised by the public (and by hospital colleagues) for working part time, not doing weekends, and being overpaid. The quality component of the contract represents activity for activity’s sake, with doctors engaged in endless, meaningless filling out of forms. The appointment system is clogged with futile reviews, meaning normal patients can wait weeks to be seen. There’s little point in being defensive because these criticisms are legitimate, especially around access—the single greatest quality issue for patients. Things need to change.

So what of the new consultant contract? It has increased pay by as much as 28%,1 with a 50% increase in the number of consultants over a decade.2 The goal is a consultant led service and better access. But little has changed; weekends still see more deaths,3 with junior medical staff still delivering out of hours care. Outpatient waiting times are measured in months, clinics are often cancelled, and private practice still thrives on queue jumping. It remains difficult to contact consultant colleagues and nearly impossible for patients to do so. NHS hospitals are dysfunctional, with poor productivity, poor communication, and poor accountability. Little has improved but at great cost.

What I am going to say next will cause irritation, defensiveness, and anger. In a standard 40 hour week consultant contract, a quarter is reserved for non-clinical activity known as supporting professional activities (SPA) such as audit, appraisal, and education.4 In addition, consultants have two weeks’ paid study leave. This time out is deemed essential to deliver quality of care.4 But these terms seem excessively generous, inefficient, unnecessary, and frankly unjustifiable for the highest paid and the most essential decision makers in an organisation.

If SPA were converted to clinical time this would greatly improve access, productivity, continuity, and care throughout the NHS. This obvious fact is increasingly recognised by hospitals, and new consultants are employed on much less generous terms.5 This inequality between consultants is causing friction. All NHS doctors’ contracts need to be rewritten. Just ask a teacher.


Cite this as: BMJ 2013;346:f3701



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